There are three major causes of client harm in psychotherapy:
- Therapist unethical, unprofessional or outright abusive behavior;
- Therapist’s incompetence;
- Systemic flaws of the psychotherapy profession as a whole.
The cause of harm is usually a combination of all of the above factors. Let’s take a closer look at each one.
Therapist’s unethical, unprofessional, abusive or otherwise inappropriate behavior is often thought to be a major, if not THE major, issue that creates problems for those unfortunate clients, who happen to have come across such therapists.
In my post “When Therapy Harms” I explained why harm in therapy is not really a problem of the “bad apples” among the ethical, competent and decent majority. The problem of individual unethical professionals is intimately connected with the systemic failures of the entire profession and, as such, cannot be understood outside of the entire professional system. However, the moral shortcomings and the psychological incapacities of individual practitioners is a serious issue in and of itself and certainly deserves an elaborate discussion, firstly, because a significant number of people have been harmed by the therapists, who aren’t fit to practice, and, secondly, if the significant number of therapists isn’t well fit for the work they chose to do but still manage to stay in practice and maintain their professional membership, this is a reflection of the systemic failure of the psychotherapy profession to ensure that psychotherapy practice is reasonably safe in most cases for most people.
It’s important to note that the words “unethical”, “unprofessional” and “abusive” are not necessarily interchangeable. They may or may not be used interchangeably depending on the situation. Read more here.
Therapist’s incompetence is another cause of harm, the one that mistakenly is not believed to be common, but is recognized as a legitimate cause. In reality, the practitioner’s competence is often inseparable from his or her personal ethics (read more here), even though a pure lack of experience or knowledge certainly can exist with no connection to one’s personal morals or personal values. In other words, a practitioner, who is genuinely ethical and has good intentions, can be also genuinely ignorant or inexperienced in certain areas.
Because of the reality of therapy work, however, the competence of a particular professional is hard to judge, because the members of this profession are not equipped with the precise methods and procedures the same way the medical doctors are. Read more about it here.
Most importantly, the two causes of harm in therapy described above, being real and legitimate as they are in and of themselves, are tightly connected with the entire professional system of training and practicing that creates conditions for professional incompetence and professional misconduct to emerge and to spread. Read more here.