How Therapy Can Reduce Self-Awareness and Obstruct Healing

For a long time, I’ve been troubled by the lack of resources discussing the risks and limitations of psychotherapy. To be sure, there are some great ones including the book Against Therapy by Jeffrey Masson, the Therapy Abuse subreddit, and many of Daniel Mackler’s Youtube videos. There are probably more that I’m not aware of, so forgive me for the omission.  But in general, discussion of this issue is far too marginal considering, what I would argue, is the magnitude of the problem.

Instead of extensive, honest discussion of how therapy can cause harm and often isn’t of value, there seems to be nearly endless encouragement for people to go to therapy.  Indeed, therapy has become virtually synonymous with practicing self-awareness, exploring one’s emotions, and understanding their history.  To a very significant degree, we buy into the promises that the therapy profession makes and the fundamental premises of therapy. While I wouldn’t argue that therapy helps no one, there is another side to the story: That there are good reasons to question the basic model of therapy and that it has great potential to cause harm.

For disclosure, I personally have had some very positive experiences in therapy, for which I’m very grateful. I’ve also had some very negative ones and have had some in between. Thus, I’m by no means a complete detractor of therapy, nor would I ever discourage people from considering it as a possible resource.

This lack of awareness of the risks and limitations of therapy makes it challenging for people who have been harmed by therapists to heal in the aftermath.  It also facilitates many people entering into harmful therapy relationships that they might otherwise avoid.  These problems are all the more serious when children are forced into therapy, as I’ll discuss later on.

The main reason why therapy can reduce self-awareness and obstruct healing has to do with the enormous power imbalance in the therapy relationship combined with the nature of the field.  On one side of that power relationship is the psychology professional with degrees, training, continuing education credits, a license, backing by various professional bodies, the support of various coercive systems including carceral psychiatry, the presumption that they are an expert on how these things work (the mind, relationships, life, etc.). On the other side of that relationship is the client who has none of those sources of power and has all of whatever vulnerability is bringing them to therapy in the first place.

This power imbalance alone puts the client at a significant risk of getting hurt.  One way this can happen is that the therapist will offer interpretations to the client about what’s going on with them, which could be completely wrong.  The client will then be led astray, with potentially significant consequences. For example, let’s say that the client is experiencing interpersonal dynamics in their life that essentially amount to psychological abuse and are a major source of their suffering, the therapist might falsely characterize the people in the client’s life as normal/healthy and the client as the one with “issues”.  Bringing this kind of interpretation from an expert pedestal into the client’s life could obviously be extremely destructive.

Notice how this is a problem, in large part, because of the enormous power imbalance that is generated because of the pedestal the therapist is on (due to the institutional arrangement within which they’re embedded). If, by contrast, the therapist’s legitimacy came from the client believing they had something to offer, it would be much easier for the client to reject whatever they don’t like from the therapist - which is closer to how it works for life coaches and similar professionals. But it doesn’t. The therapist’s legitimacy comes from society as a whole - it comes because they’re backed by a variety of institutions. The consensus reality surrounding the therapist is that they are the expert on how the mind, psychological healing, relationships, and introspection work. They are seen as the authority, whether the client values their contribution or not. This whole situation makes it such that the client’s ability to reject the therapist’s interpretations is severely constrained.

The client also may not have the degree of self-trust to push back on the therapist, which could be part of why they’re in therapy in the first place. And if they do, the therapist may pathologize this and assume that the client is having a “reaction formation” or “isn’t ready for real deep work”. I’ve personally experienced this with multiple therapists.  And again, the therapist is presumed the expert here and they’re supposedly right. So therapy then becomes a space where the client loses themself, despite the therapist’s rhetoric to the contrary.

But it’s not just an issue of a huge power imbalance. It’s also related to the nature of the therapy/psychology field itself. Notice how this issue probably wouldn’t be such a big problem if psychology were an exact science, in which training could truly ensure that they were almost always right and competency could be clearly established. But it’s nothing of the sort.  That’s why it would seem that this technocratic model with so much expert authority is highly inappropriate for this subject matter area. It may be appropriate for fields like engineering, much of medicine, and accounting, but not for a field whose scientific foundations are so flimsy that we should question whether it should be part of the health sciences at all.

The corollary of this is that it’s difficult, if not impossible, to have a functioning system of accountability for psychotherapists. Sure, licensing boards can hold therapists accountable for very specific and clear violations like sexual abuse or fraud. But what if the therapist ruins the client’s life because of how they diagnose and interpret the client’s situation? What if they gaslight the client about the real sources of suffering in their life?  Again, it gets back to the issue of; it’s hard to clearly establish what competency looks like for an area that’s mostly just a matter of opinion.

For these reasons, it seems to me that the very premise of therapy is at least somewhat problematic. Specifically, the idea that a professional can get sufficient training and, voila, they understand how the mind works and assume this expert role with all the power and authority that comes with it.  Now, I don’t think this means that therapists shouldn’t do what they do. But I think it does mean that they shouldn’t be given this towering expert authority by society so that the client can have more power in the situation.

In general, it’s helpful to distinguish between process and substance. That is, there’s a much broader substantive area here which you could call self-awareness, introspection, or whatever you prefer. And there are many different resources that are relevant to that substantive area that may or may not be helpful to the individual. They would include therapy, meditation, journaling, spirituality, self-help, etc. When we blur that line, and we make therapy and self-awareness one and the same, we do a disservice to the public interest.

Now, when people push back on these criticisms of therapy, they typically say that this is an issue of training. That such harm happens because the therapist supposedly doesn’t have proper training.

This argument doesn’t square for a number of reasons. First of all, it appears to be circular: How do you know a therapist is properly trained? Answer: Because these things don’t happen. Why do these things happen? Because the therapist doesn’t have proper training. So it’s not helpful for the client. There’s nothing they can look for to know if the therapist is “properly trained”. They’ll only know once it’s too late.

More importantly, is it actually possible to eliminate harmful therapy with so-called proper training? If harm arises from the fact that the therapist has all of this power and authority in a field that isn’t well suited to a technocratic approach with expert roles, how exactly would training address that?  In fact it’s possible more training would just exacerbate the problem. It seems to me that the only thing that would mitigate the problem would be to take the therapist off of their pedestal and dismantle the system that creates it.

Harmful therapy is a problem that arises because you have this towering expert authority in a domain where such a thing is extremely problematic. I'd be inclined to say that you can’t have enough training and knowledge about psychology in order to justify that kind of expert authority and power imbalance. Psychotherapy is seen as part of the health sciences. But in cardiac surgery or oncology, they actually understand the mechanisms in their area of study pretty well. In psychology, it’s mostly just the psychologists’ opinion and the ideas they get from their training. There’s no guarantee that this will be relevant to the person who is paying them.  Which, again, wouldn’t be such a problem if they didn’t have the level of power and authority that they do.

It’s common to assume that safety for consumers always comes from greater regulation, professionalization, training, occupational closure, etc. I have no reason to believe that this isn’t true in many, many areas. But I think we should be skeptical about this idea when it comes to mental health treatment. More required training and regulation doesn’t make the therapist’s areas of focus any less subjective. It just increases their power and expert authority which makes the client less safe. Granted, it may reduce really fundamental abuses like sexual harassment, but it doesn’t address the ways in which psychotherapy can inadvertently become tantamount to manipulation and psychological abuse.

This unholy combination of towering expert authority and enormous subjectivity becomes really scary when children are involved. Much, if not most, of youth mental health treatment involves kids, who for whatever reason are deemed a problem for the systems they are trapped in, being adjusted so that they are more convenient. This gets obscured because the mental health professionals provide a facade of helping the kid.  And so from the adults’ perspective, the kid has problems and the mental health professional treats them, which is a nice thing to do for the kid.

But what’s really happening, at least much of the time, is the kid is suffering in their environment, and they’re being forced to bury their real feelings and perspective, in order to get them to adjust. Maybe there are toxic dynamics in the family system with intergenerational trauma or maybe they feel the school system is killing their soul.  If the kid is forced to see a therapist, the therapist is likely to interpret the situation from the adult’s perspective and then shape the kid so that they fit into their environment better - because that’s what they’re being hired to do.  So what happens is the child’s real self and perspective get crushed, and they get brainwashed, because of what this authority has just brought to their situation. It’s hard to overstate just how destructive this can be.

For example, let’s say the kid is upset about being mistreated in their family system, the therapist might imply that they are being “immature” and that they are the problem.  They have the ability and the incentive to do this.  And in general, when kids express dissatisfaction with their environment with any kind of assertiveness, adults tend to have very little tolerance for this and respond by threatening the child. Why should we expect therapists to not just channel the same biases as everyone else?

You also see this dynamic a lot with school psychologists, where the kid is being rebellious and the school psychologist is essentially tasked with threatening them into obedience.  They’re not likely to validate the kid’s perspective and tell them that modern schooling is backward and destructive in many important ways, and that this could have something to do with why they feel the need to rebel.  Because, despite what they say, the school psychologist likely isn’t actually there to get to the bottom of the kid’s problems and support them, they’re there to get them to be more convenient for that system.

I’ve heard people say that if a therapist is colluding against the kid in this way, then it’s simply an abuse of the therapist’s role. Maybe, but it’s still within the therapist’s power to do this.  And it’s hard to imagine eliminating that ability while maintaining the current system.