When Therapy Causes Harm: Unpacking the Risks

Psychotherapy is widely regarded as an effective treatment for mental and psychosomatic conditions, but like any medical intervention it can have unintended negative consequences. Prof. Bernhard Strauß of Jena University Hospital and Prof. Michael Linden of Charité Berlin, both longstanding researchers in this area, caution that many patients are never fully informed about the risks.

The very nature of therapy — confronting painful memories, fears and ingrained patterns — makes emotional turmoil likely. Tears, anger or temporary worsening of symptoms are common and, according to Strauß, often necessary to pave the way for lasting change. He says: “There can be no psychotherapy without side effects.”

But not all side effects are therapeutic. Linden describes a wide spectrum of unwanted effects: new symptoms can emerge; social relationships can deteriorate suddenly when a casual remark about a parent leads a patient to cut off contact; or well‑intended career advice can be misconstrued, resulting in job loss. In some cases the harm stems from therapeutic errors — such as prematurely ending therapy, continuing a damaged therapeutic relationship, or gross misconduct including boundary violations.

Estimates suggest serious, lasting negative developments occur in about 10 % of cases, though that figure excludes malpractice or criminal behaviour such as sexual abuse. Experts stress that the therapeutic method itself is rarely the decisive factor; any form of psychotherapy can produce adverse effects. The key, they say, lies in recognising problems early and addressing them openly with the therapist.

Why Side Effects Are Part of the Process — and When They're Not

The Fine Line Between Therapeutic Discomfort and Harm

Not all distress is a sign of treatment failure. When a patient experiences intense emotions during or after a session — anxiety, sadness, rage — it often signals that the therapy is touching core issues. Strauß emphasises that such reactions are “necessary to get the problem under control”. The challenge for both patient and clinician is to distinguish between this temporary, productive pain and side effects that worsen the person’s condition without therapeutic gain.

Why All Forms of Therapy Carry Risk

The problem is not confined to any single school of therapy. Even a well‑established approach like cognitive‑behavioural exposure for anxiety can backfire if a patient is confronted with a feared situation too abruptly or without adequate preparation, risking re‑traumatisation. The common denominator is that any deep‑change process can unsettle a person’s emotional and social equilibrium.

The Prevalence Debate: How Common Are Serious Side Effects?

The 10 % figure cited by Linden is a cautious expert estimate, not a hard epidemiological finding. Research into psychotherapy side effects is still relatively sparse compared with pharmacological studies, and many negative outcomes go unreported or are misattributed to the underlying illness. This lack of robust data makes informed consent difficult and argues for far more systematic adverse‑event tracking in mental health care.

What to Do If Psychotherapy Makes Things Worse

If you are in therapy and notice unwanted changes, these steps are supported by the experts quoted:

  • If therapy itself is causing new symptoms — for example, panic that was not present before — or is making existing problems worse, mention this directly to your therapist. Linden insists that such changes must be “spoken about openly”.
  • When a therapist’s suggestion has led to a sharp deterioration in a relationship or your professional life (as in the examples of a mother‑conflict escalation or job loss), do not assume you misunderstood. Review the advice with the therapist and ask how it was intended.
  • If the distress feels unmanageable outside sessions, ask to jointly work on coping strategies — for instance, techniques to handle inner restlessness or anger between appointments.
  • Should the therapist dismiss your concerns or fail to adjust the approach, seek a second opinion. Linden notes this can be “useful” when the original therapy is not helping.
  • If you consistently leave sessions feeling more burdened than unburdened, consider switching therapists. The experts agree that a change can be the right choice when treatment becomes a source of ongoing harm.