When Therapy Goes Wrong: What Clients Experience and How to Avoid It
While most people enter therapy with hope for positive change, not every therapeutic experience leads to improvement. In fact, research shows that a significant number of clients report negative or harmful experiences in therapy. Understanding what can go wrong—and how to recognize and prevent these issues—is crucial for anyone considering or currently in therapy.
The Quick Answer: Negative Therapy Experiences Are More Common Than You Think
A groundbreaking qualitative meta-analysis published in Psychotherapy Research found that adverse effects of therapy are surprisingly common. This review of 51 studies represents the most comprehensive summary of these experiences to date, revealing that negative therapy experiences can range from minor frustrations to serious psychological harm.
The key insight: understanding what can go wrong in therapy empowers you to recognize red flags early and advocate for better treatment.
What the Research Reveals About Negative Therapy Experiences
The Scope of the Problem
Up to 58% of patients experience adverse or unwanted effects of psychological treatments, according to recent research. These experiences aren't just minor inconveniences—they can significantly impact mental health outcomes and future willingness to seek help.
The research synthesis examined multiple qualitative studies to identify patterns in how clients describe their negative therapy experiences, providing unprecedented insight into what goes wrong from the client's perspective rather than the therapist's viewpoint.
Why This Research Matters
Traditional therapy research has focused primarily on positive outcomes and therapist perspectives. However, psychotherapy practitioners and researchers should be informed by the substantive body of qualitative evidence that has been gathered to represent clients' own experiences of therapy. This client-centered approach reveals important blind spots in how therapy is delivered and understood.
Categories of Negative Therapy Experiences
Based on the comprehensive meta-analysis and related research, negative therapy experiences fall into several key categories:
1. Therapist-Related Problems
Poor Therapeutic Alliance:
Feeling misunderstood or judged by the therapist
Lack of warmth, empathy, or genuine concern
Therapist seeming distracted, bored, or disengaged
Cultural insensitivity or lack of understanding of client's background
Poor communication or explanation of treatment approach
Boundary Violations:
Inappropriate personal disclosure by therapist
Physical boundary crossing (inappropriate touch)
Dual relationships (therapist as friend, business partner, etc.)
Sexual misconduct or inappropriate romantic interest
Breaking confidentiality inappropriately
Competence Issues:
Therapist appearing inexperienced or unsure
Using inappropriate techniques for the client's problems
Lack of knowledge about specific conditions or populations
Rigid adherence to one approach regardless of client needs
Failure to recognize when referral to specialist is needed
2. Treatment-Related Negative Effects
Inappropriate or Harmful Interventions:
Pushing techniques that feel wrong or harmful to the client
Forcing confrontation before adequate safety is established
Using outdated or discredited treatment methods
Applying techniques inappropriately for the client's condition
Ignoring client feedback about what isn't working
Mismatched Treatment Approach:
Using highly structured approaches with clients who need flexibility
Applying insight-oriented therapy when practical skills are needed
Focusing on past trauma when present-day coping is the priority
Using group therapy with clients who need individual attention
Mismatching therapy intensity with client's readiness for change
3. Process and Communication Problems
Poor Goal Setting:
Therapist imposing goals without client input
Unclear or unrealistic treatment expectations
Lack of progress monitoring or feedback
Working on therapist's agenda rather than client's needs
Failure to adjust goals as therapy progresses
Communication Breakdown:
Therapist not explaining their approach or rationale
Using jargon or concepts client doesn't understand
Not checking for client understanding or agreement
Dismissing client concerns or feedback
Power imbalances that prevent open communication
4. Systemic and Practical Issues
Administrative and Practical Problems:
Frequent cancellations or scheduling changes by therapist
Billing errors or unexpected charges
Inadequate crisis support between sessions
Poor coordination with other healthcare providers
Insurance or payment issues affecting treatment
Institutional Factors:
High therapist turnover in clinic settings
Pressure to use brief therapy models regardless of client needs
Limited session availability or long wait times
Inadequate supervision of inexperienced therapists
Organizational policies that prioritize efficiency over effectiveness
The Impact of Negative Therapy Experiences
Immediate Effects
Psychological Impact:
Increased distrust of mental health professionals
Worsening of original symptoms
Development of new symptoms (anxiety about therapy itself)
Feelings of shame, self-blame, or failure
Loss of hope about possibility of change
Behavioral Consequences:
Premature termination of therapy
Reluctance to try therapy again in the future
Withdrawal from other forms of help-seeking
Increased isolation or self-reliance
Negative recommendations to others about therapy
Long-term Consequences
Research shows that negative therapy experiences can have lasting effects:
Treatment Avoidance: Many clients who have poor therapy experiences become reluctant to seek professional help again, even when facing serious mental health crises.
Relationship Impact: Negative experiences with therapists can generalize to difficulty trusting other helping professionals or authority figures.
Self-Concept Damage: Clients may internalize negative therapy experiences as evidence that they are "unfixable" or too difficult to help.
Red Flags: How to Recognize Problematic Therapy
Early Warning Signs (Sessions 1-3)
Therapist Behavior Red Flags:
Seems distracted, frequently checks time, or multitasks during session
Makes you feel judged, criticized, or misunderstood
Shares inappropriate personal information about themselves
Pressures you to commit to long-term treatment immediately
Doesn't explain their approach or answer your questions
Shows discomfort with your identity, background, or experiences
Talks significantly more than they listen
Treatment Red Flags:
Pushes specific techniques without explaining rationale
Insists their approach is the "only" effective method
Dismisses your goals in favor of their own agenda
Uses outdated or controversial treatment methods
Promises unrealistic outcomes or "cures"
Doesn't check whether interventions feel helpful to you
Ongoing Red Flags (After First Month)
Relationship Deterioration:
Feeling increasingly uncomfortable or unsafe in sessions
Sense that therapist doesn't remember or care about your concerns
Feeling more criticized than supported
Therapist becoming defensive when you raise concerns
Increasing secrecy about what happens in therapy
Feeling worse about yourself after most sessions
Treatment Stagnation:
No progress toward agreed-upon goals after reasonable time
Therapist unable to explain why certain approaches are being used
Feeling stuck in repetitive patterns without new insights or skills
Sense that therapy has become routine rather than purposeful
Therapist unwilling to adjust approach based on your feedback
How to Protect Yourself in Therapy
Before Starting Therapy
Research Your Therapist:
Check licensing and any disciplinary actions
Read reviews while recognizing their limitations
Verify their experience with your specific concerns
Understand their theoretical approach and methods
Confirm practical details (insurance, scheduling, policies)
Prepare Questions:
"What's your experience treating concerns like mine?"
"What approach do you typically use, and why?"
"How do you handle it if something isn't working?"
"What should I expect in terms of progress timeline?"
"How do you incorporate client feedback into treatment?"
During Therapy
Trust Your Instincts: Your gut feelings about the therapeutic relationship are important data. If something feels wrong, it probably is.
Advocate for Yourself:
Ask questions when you don't understand something
Share feedback about what is and isn't helpful
Request explanations for treatment recommendations
Express concerns about the therapeutic relationship
Don't hesitate to discuss wanting to change approaches
Monitor Your Progress:
Keep track of your symptoms and functioning
Notice whether you generally feel better or worse after sessions
Assess whether you're making progress toward your goals
Pay attention to your overall hope and motivation levels
Set Boundaries:
Clarify what you're comfortable discussing and when
Speak up if interventions don't feel right to you
Maintain your right to pause or stop techniques that feel harmful
Remember that you can end therapy at any time
When Things Go Wrong
Address Issues Directly: Many therapy problems can be resolved through open communication. Try discussing your concerns with your therapist first.
Seek Consultation: If direct communication doesn't resolve issues, consider:
Getting a second opinion from another therapist
Consulting with trusted friends, family, or other professionals
Contacting your insurance company if there are billing issues
Know When to Leave: Sometimes the best decision is to end the therapeutic relationship:
When you feel consistently worse rather than better
If boundary violations occur
When therapist is unwilling to address your concerns
If you've lost trust or feel unsafe
When progress has stalled despite good-faith efforts to address issues
Report Serious Violations: If therapist misconduct occurs, consider reporting to:
State licensing board
Professional ethics committees
Insurance companies
Law enforcement (in cases of criminal behavior)
Finding Better Therapy After a Negative Experience
Processing Your Previous Experience
Acknowledge the Impact: Negative therapy experiences are real and their effects are valid. Don't minimize what happened or blame yourself.
Identify Specific Problems: Understanding exactly what went wrong can help you avoid similar issues in the future.
Consider the Difference: Remember that one negative experience doesn't mean all therapy is problematic—it means that particular therapeutic relationship wasn't right.
Choosing Your Next Therapist
Prioritize Fit Over Credentials: While qualifications matter, the most important factor is finding someone with whom you can build a trusting, collaborative relationship.
Be Upfront About Your Previous Experience: A good therapist will welcome information about what didn't work before and use it to provide better treatment.
Start Slowly: Consider beginning with shorter commitments or more frequent check-ins about how things are going.
Trust the Process—But Verify: Be open to therapy while maintaining appropriate skepticism and self-advocacy.
What Good Therapy Looks Like (Learning From the Negative)
Understanding negative experiences helps highlight what positive therapy should include:
Healthy Therapeutic Relationship
Mutual Respect: Both you and your therapist treat each other with dignity and consideration.
Collaborative Approach: You work together to set goals, choose methods, and monitor progress.
Cultural Sensitivity: Your therapist understands and respects your background, identity, and experiences.
Appropriate Boundaries: Professional boundaries are maintained while warmth and genuine concern are evident.
Regular Check-ins: Your therapist regularly asks how things are going and adjusts based on your feedback.
Effective Treatment Process
Clear Communication: Your therapist explains their approach, answers questions, and uses language you understand.
Evidence-Based Methods: Treatment approaches have research support and are appropriate for your concerns.
Progress Monitoring: Both you and your therapist track progress toward agreed-upon goals.
Flexibility: Treatment adapts based on what works and doesn't work for you specifically.
Empowerment: You feel more capable and confident as therapy progresses, not more dependent.
The Role of Supervision and Professional Development
What Therapists Should Be Doing
Ongoing Education: Good therapists continue learning throughout their careers, staying current with research and best practices.
Regular Supervision: Even experienced therapists benefit from consultation about difficult cases and challenging situations.
Self-Awareness: Effective therapists understand their own limitations, biases, and blind spots.
Client Feedback: The best therapists actively seek and respond to client feedback about the therapeutic process.
Supporting Better Training
Qualitative evidence representing clients' own experiences of therapy should inform how therapists are trained and supervised. This includes:
Training programs that include extensive client perspective material
Supervision that focuses on relationship quality, not just technique
Continuing education requirements that address common client concerns
Professional development that emphasizes cultural competence and self-awareness
The Bottom Line: You Deserve Good Therapy
The research on negative therapy experiences isn't meant to discourage you from seeking help—it's meant to empower you to be an informed consumer of mental health services. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date, giving us unprecedented insight into what can go wrong and how to prevent it.
Key takeaways for protecting yourself in therapy:
Trust your instincts about the therapeutic relationship
Communicate openly about your needs and concerns
Advocate for yourself when something doesn't feel right
Remember that you have choices about your treatment
Don't let one bad experience prevent you from getting the help you need
The American Psychological Association maintains strict ethical guidelines for therapists, and the vast majority of mental health professionals are committed to providing helpful, ethical treatment. However, being an informed and empowered client increases your chances of having a positive therapeutic experience.
Remember: therapy should generally make you feel better, more capable, and more hopeful over time. If you're consistently feeling worse, more confused, or less confident in your ability to handle life's challenges, it may be time to reassess your therapeutic situation.
You deserve a therapist who respects you, understands you, and works collaboratively with you toward your goals. Don't settle for less, and don't let negative experiences prevent you from getting the support you need and deserve. Good therapy is possible, and being an informed client helps ensure you get it.
It's your time, money, and health on the line. Take charge today.
Research Sources
Probst, T., Humer, E., Jesser, A., & Pieh, C. (2022). "Attitudes of psychotherapists towards their own performance and the role of the social comparison group: The self-assessment bias in psychodynamic, humanistic, systemic, and behavioral therapists." Frontiers in Psychology
Mandangu, C., Ramos, A. M., Sengupta, M., et al. (2025). "Implicit bias in referrals to relational psychological therapies: review and recommendations for mental health services." Frontiers in Public Health
Wilson, G. T., et al. (2011). "Allegiance Bias and Therapist Effects: Results of a Prospective Study." Journal of Clinical Psychology
Van Hoy, A., et al. (2022). "Burnout and psychological wellbeing among practicing psychotherapists: A cross-sectional study." Frontiers in Psychology
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). "An Investigation of Self-Assessment Bias in Mental Health Providers." Psychological Reports, 110(2), 639–644
Abargil, M., et al. (2025). "Therapists’ emotional responses and their relation to patients’ perceived responsiveness." Psychotherapy / Psychotherapy Research
Deisenhofer, A. K., et al. (2024). "Love yourself as a therapist, doubt yourself as a clinician: Therapist self-compassion, self-criticism, and professional outcomes." Psychotherapy / Psychotherapy Research
Strauss, B., et al. (2021). “Negative effects of psychotherapy: estimating the prevalence in a random national sample.” British Journal of Psychology, 7(6):e186.