Why I Write About Therapy Harm and Therapy Abuse
By Sam Brandsen
This is a (relatively!) shorter and less polished post. I’ve recently started writing more about therapeutic boundaries and harm, and thought it might be worth providing a bit of context for my perspective and background on this topic.
A Quick Disclaimer
I should probably start by noting that I’m not a clinician. My Ph.D. was in physics, with a focus on quantum information theory– so not only am I not a mental health professional, but my academic training was almost entirely focused on numbers and theorems and not at all focused on human emotions! In more recent years, I’ve had the wonderful opportunity to focus on autism research and, through this process, have been involved in some research and advocacy related to healthcare for neurodivergent individuals. But I still consider myself much more of an “eager learner” than an “expert.”
What Drew Me to This Topic
As far as how I became drawn to writing about therapeutic boundaries, harm, mediation, etc. in particular– I had a very stressful and unusual situation in therapy awhile ago, and was surprised to learn from firsthand experience how significant the impact of blurred boundaries in therapy could be.
While I won’t share in great depth about my personal experience, I find a lot of meaning in writing about topics like maintaining flexible but safe boundaries, restorative justice approaches/healing after harm, and autism-inclusive clinical care. My hope is that this can be a way of turning my painful experience into something that is of some small help to others who may be going through something similar.
More specifically, one thing that continues to stand out to me is that the therapist in question was (and, I’m sure, still is) an extremely kind person. In short, the experience taught me something about how people in general are fallible. Even people who are generally very kind and conscientious and set out with good intentions can cause significant harm if there aren’t enough guardrails in place. And I believe that any of us– with enough external pressure, in the wrong circumstances, without adequate time to self-reflect – can unintentionally behave in a more dismissive, defensive, or otherwise harmful way than we typically would.
Thoughts on Existing Resources
When I first searched for terms like “therapy harm” or “therapy abuse,” I quickly realized that:
There aren’t a lot of resources out there (though a few excellent ones do exist).
The resources I did find tended to fall into two extremes.
Many resources were dedicated to relatively isolated ruptures in an otherwise healthy therapy relationship (e.g. a therapist says something insensitive in a session.) While each situation is unique, on average these cases often had an easier pathway to repair as the patient may still trust their therapist enough overall to be able to resolve concerns with them directly. And on the other hand, I found some cases that described very severe or egregious abuse in therapy (e.g. sexual abuse, financial abuse) which I am not qualified to discuss. Unfortunately, patients in these situations are often left without any kind of closure or restoration and may even experience pressure from their therapist not to disclose their situation with others.
I felt that my situation occupied a sort of “in between” space. This in turn led to a fascination with how a reparative process might work in therapy that has become quite complicated or painful. More generally, it led to a fascination with mediation and restorative justice and all of the nuances of what broader concepts like “closure”, “accountability”, etc. mean.
Where I Might Be Most (and Least) Helpful
I’m certain there are many “unknown unknowns” in my thinking, or areas I don’t yet know I don’t know! One personal pitfall that I’m already aware of is a tendency to be a bit too generous towards the intentions of clinicians who have caused harm. As a result, I think my writing may be most relevant to therapists who:
Are generally deeply reflective or conscientious
To some extent, are open to acknowledging concerns about their actions or therapy approach (even if the acknowledgement is incomplete or paired with defensiveness)
May be wrestling with guilt or defensiveness due to shame rather than apathy
However, I also realise that unfortunately there are cases involving more deliberate manipulation or abuse. While I’d like to believe that restorative justice could extend to these circumstances as well, I feel less qualified to discuss them and the models I have worked on (e.g. “stages of accountability”) may not be fully general.
My Ongoing Learning
Over the past several months, I’ve spoken informally with others (clients, therapists, and people with experience in both roles) about therapy harm and repair. In a way, this is a sort of informal, personal research project and I hope to continue learning indefinitely.
I do welcome feedback, and please don’t hesitate to reach out if you have feedback that you would like to share.
Ultimately, I hope that this writing can make a small contribution toward helping people. Ideally, I’d love to see a world where a restorative justice approach is readily available, where services like mediation are normalised (rather than used as a “last resort” or seen as a sign that a clinician “failed”), and where there is a robust set of research and resources to support both clinicians and patients/clients in navigating difficulties in therapy.
