Abuse vs. Harm in Therapy

During my work on this website, I started receiving questions from people who were confused about what was going on in their therapy. They had mixed feelings about certain things their therapists did or said and didn’t know how to make sense of them. They weren’t sure if their therapists were conducting themselves professionally or if they were competent or even emotionally healthy. Something felt wrong, but they couldn’t quite put a finger on it.

Some of them, as it often happens in therapy, had warm and loving feelings and feelings of sexual attraction toward their therapists or, in professional terms, they were experiencing erotic transference, which made it even more difficult for them to evaluate the therapists’ behavior objectively.

All I have learned from my own experience in therapy and have heard others say lead me to develop my own theory of what constitutes harm and/or  abuse in therapy.

First off, let’s clarify the definitions of harm and abuse. The words “harm” and “abuse” are not interchangeable. They don’t have the same meaning, even though they are intimately related. Here is my understanding of how they are different:

Abuse is exploiting/taking advantage of the other person’s vulnerable/less powerful position for the abuser’s emotional, physical, sexual or all of the above gratification. 

Harm is psychological and/or physical damage one caused the other person through their actions. 

Not every abuse causes harm. 

There might be instances when people get abused, but it doesn’t harm them. For example, when someone verbally abuses you, you might initially get angry and hurt but then let it go shortly afterwards. In this case, the abuse did take place, but you weren’t harmed because you didn’t internalize it. Somebody else may react to the same incident differently. The abuse may re-open their old wounds and trigger their traumas from previous abuses thus re-traumatizing them. Therefore, the same incident of verbal abuse can harm some people and not harm others, but whether this behavior harms its recipient or not, it is still abusive.

Not every harm is caused by abuse.

If you get hit by a car, you may suffer massive physical and mental damage, but the damage has not been caused by abuse. The driver, most certainly, didn’t do it intentionally. He was either daydreaming or wasn’t focusing on the road for other reasons. In any case, he harmed you and is responsible for your physical and mental injuries, but he didn’t abuse you.

Likewise,  you can be harmed in therapy without being abused and abused without being harmed.

Here is the example of a therapist’s abusive behavior that doesn’t harm a client:

You just started seeing a therapist and pretty soon he tells you a sexual joke or makes a sexual remark about your appearance or even touches you inappropriately. You are rightfully infuriated. You tell this therapist exactly what you think of him, walk out of the room and never come back. In this case, the therapist clearly attempted to abuse his position of power, but you didn’t let him do it by walking away as soon as the abusive behavior started and so you weren’t harmed.

And here is the example of a client getting harmed while not being abused:

Your  beloved dog who lived with you for 18 years just died. Your therapist tells you to concentrate on the positive side of life instead of “dwelling” on “negative events.” You feel that your pain is completely dismissed and invalidated and it hurts. What just happened is called an “empathy failure” in therapy. If this empathy failure happens consistently due to the therapist’s ignorance, you may end up getting traumatized because things that hold significance for you will get continuously dismissed. The therapist in this case is not abusive and doesn’t have any intention to hurt you, but he does hurt you unintentionally through his ignorance. So, in this case, you are harmed, but not abused.

Many times harm and abuse go hand in hand, as often harm is caused by abuse. Once we clarify the definitions of harm and abuse, it’s easier to understand when we get abused, but not harmed, when we get harmed, but not abused and when we get harmed as a result of abuse.

You may ask why bother trying to define things and differentiate them from one another? Isn’t it enough to know that someone caused us pain? Does it matter how to call it, “harm,” “abuse” or something else? If we got hurt, it’s just bad, and isn’t that all we need to know?

The answer is that yes, we do need to distinguish between these definitions as we want to be as conscious as possible about things that happen to us or around us. If we don’t do it, we might end up throwing words like “abuser” and “perpetrator” left and right, whether it’s applicable or not, or even dump our undifferentiated anger on virtually anyone, who unknowingly pushes our buttons. Most importantly, if we don’t attempt to understand every nuance of every specific situation, we will fail to see the big picture and by failing to see the big picture we will fail to see and to appreciate life in its fullness and complexity. We will be forever stuck in the primitive place where we will see bad things only as someone’s fault (usually not ours), never as manifestations of life itself. In that place we will remain perpetual victims. Some people choose to stay in that place for the rest of their lives, others don’t. The choice is yours.





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