When Therapists Do Harm

Disclaimer: [Trigger Warning: discussion of sexual abuse, sexual assault/rape]

Therapy can be transformative and healing but there are times that it can also do harm. Primarily when therapists are inexperienced or when treatment is not client centered. I would hope that it is primarily the first. I am hoping to shed light on this topic, so as professionals we focus on the highest level of care and fulfill our ethical duty to do no harm.

Trauma is a complicated issue. Not every type of trauma is the same. There are levels of trauma and also cases with complicated trauma. One form of complicated trauma is sexual trauma from sexual abuse and sexual assault/rape. This blog post will focus on sexual trauma. A recent experience with a client has caused me to want to speak up about this matter.

I wish I could say this was an isolated incident but in fact it is not. I am a therapist who specializes in trauma treatment and resolution. About 85% of the individuals who come to me for treatment have experienced sexual trauma. I have had quite a few brave individuals share that they have gone to see therapists who truly don’t know how to treat trauma. So if you are a professional and do not know or don’t feel comfortable treating this level of trauma please do not. You may be unintentionally doing more damage than helping. I’ve had clients who have gone to mental health professionals and report feeling re-traumatized and re-victimized when seeing professionals who really didn’t understand.

I am sharing a story with the permission and written consent of a client so that other professionals can truly gain insight to this matter. This client reported going to see a therapist she picked out of a directory. As a client, she did not know there was a difference in the type of therapist she sought out. As she sat in the chair, the therapist completed the typical psycho-social assessment on the first session. When the therapist asked the question, "Have you ever been the victim of sexual abuse?" She responded with a yes; however, the therapist inquired further and asked her to share her story. The client reported feeling uncomfortable but assumed that the mental health professional knew what she was doing. She was asked to share her whole story and then stories of other times she was further sexually violated. As the session neared an end the client reported being told that the time was up and an appointment for the next week was scheduled. She reported walking out of the professional’s office feeling completely raw and unsure of what to do with the overwhelming feelings she was walking around with. The client reported driving home and unsure of how she really got there. She reported getting into an argument with her boyfriend over something silly. He walked out needing time to cool down. This triggered her abandonment issues as she had struggled with relationships her entire adult life due to her past sexual abuse history. That night, she shared she drove to a bridge an hour away and fully intended on ending her life as she couldn't take the pain anymore. She described walking up the bridge and every step got heavier and heavier as she continued walking up the bridge making it harder and harder to walk. Her boyfriend called her in that moment to apologize and she returned home. She reports not having the courage to try counseling again until 3 year later when she ended up sitting on my couch. She reports struggling with not only the pain from her abuse but also the shame and guilt of what she almost did that night. I know that this is an extreme case and that is why I asked this client for permission to share.

As mental health professionals we have a duty to do no harm. Sadly, this type of thing happens all too so often. Maybe not intentional, however it is still being done. We cannot open the trauma before we know the client has been given resources and skills to be able to emotionally regulate and contain. As trauma therapists, we don’t dictate when a client is ready to process their trauma they do. We do help them see their strength, their true value, and honor where they are in the process. We do help them understand when they might be moving too fast or self-sabotaging. We basically join them in their journey to guide them from a place of feeling broken to a place where they can understand that they are valuable. We help them heal so they can have the life they always envisioned.

So, if you are a mental health professional and work with any form of sexual trauma and do not feel completely comfortable working with this, please consider my advice. If this is the population you want to work with, get additional training. Seek out knowledge so that you can truly help the individuals you have set out to help. Know your limitations, if you cannot help them now refer them to a more experienced clinician. You will be helping them so much more by doing this.