Therapy is meant to heal – but sometimes, it hurts. Harm in therapy isn’t always obvious, and many clients struggle to name what’s gone wrong.
Therapist and trainer Erin Stevens (she/they) recently spoke to me about how harm can happen in therapy – even when intentions are good – and what therapists can do to make their practice safer, more accountable, and more attuned.
Erin shares their own story of harm in therapy, the role of power and boundaries, how cultural misattunement increases risk, and why shame keeps us from learning.
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What Does Harm in Therapy Really Mean?
Harm in therapy isn’t just about clear ethical breaches. According to Erin, harm is defined by the client’s experience – not just whether the therapist did something “wrong” by professional standards.
It might be:
- Emotional harm from boundary violations.
- Retraumatisation from a missed cue.
- The therapist shutting down a conversation that felt essential to the client.
If it leaves the client confused, distressed, or silenced – it’s worth paying attention to.
Why Harm Is So Hard to Name
Many clients don’t realise something harmful has happened until much later. Often, they leave therapy feeling like they’ve “done it wrong” or they weren’t “ready for the work.”
As Erin explained, harm often builds slowly.
It may start with inconsistent time boundaries, inappropriate self-disclosure, or subtle power plays. The client may feel something is off but be unsure how to bring it up – especially if they’re still attached to the therapist.
It’s this ambiguity that makes harm in therapy so difficult to recognise, talk about, or repair.
The Role of Power and Boundaries
Power is always present in the therapy room. Erin’s experience shows how quickly that power can become misused – not always intentionally, but often unconsciously.
For example, therapists may extend sessions beyond the agreed time, thinking it’s helpful. But if that later stops abruptly, the client can feel punished or rejected. Without clarity and consistency, boundaries can feel like they’re at the therapist’s whim.
Erin points out that when boundaries are inconsistent, clients lose a sense of agency. Boundaries, when thoughtfully held, actually empower clients.
Cultural Misattunement as a Source of Harm
Clients with marginalised identities are at significantly greater risk of harm in therapy. Erin regularly hears from clients who’ve experienced racism, dismissal of being neurodivergent, or other forms of cultural misattunement in therapeutic settings.
It’s not just overt discrimination – it’s also being pathologised, misunderstood, or treated as a problem to be fixed.
Therapists may not intend to harm, but if they haven’t reflected on their own position in society, their power, and assumptions, they can unintentionally repeat harmful dynamics their clients already experience in wider society.
What Therapists Can Do to Reduce Harm
Erin offers a practical way forward: know your boundaries, talk about them clearly, and be open to feedback.
Therapists should:
- Anticipate likely boundary requests (e.g., hugs, emails) and be ready with a thought-through response.
- Check in regularly about how therapy feels for the client – not just about “progress,” but about the relationship.
- Use supervision to explore moments of discomfort, confusion, or potential rupture without shame or defensiveness.
Harm is less likely to spiral when therapists stay grounded in curiosity and collaboration.
Supervision Needs to Be Safe, Too
Harm doesn’t just happen in therapy – it can happen in supervision too. Erin has heard from many therapists, particularly those from marginalised backgrounds, who’ve felt silenced or shamed in supervision.
If supervision becomes a space where shame is reinforced, rather than explored, it makes it much harder to prevent harm or repair it when it happens.
Creating safety in supervision means allowing space for uncertainty, mistakes, and real relational reflection.
What If You Think You’ve Caused Harm?
It’s a scary feeling. But Erin’s message is clear: you don’t have to go through it alone.
Find a safe space – supervision, peer support, or consultation – where you can talk it through. Stay curious about what’s happening. Ask yourself if you’ve started treating this client differently, or if the therapy feels out of control. These are signs to pause and reflect.
Acknowledging the possibility of harm doesn’t make you a bad therapist. It makes you a responsible one.
What If You’re a Client Who’s Been Harmed?
First of all: it’s not your fault. Erin’s advice is to take your time, trust your instincts, and know that you’re allowed to walk away if something feels wrong.
If you’re unsure whether what happened was harm, you’re not alone. Erin offers short-term consultations for clients in this exact position – a space to talk it through without pressure to continue therapy or make a complaint.
You can find out more at erinstevens.co.uk.
FAQ: Harm in Therapy
What counts as harm in therapy?
Harm is defined by the client’s experience. It can include boundary violations, emotional neglect, cultural misattunement, or retraumatisation. It doesn’t always involve a complaint.
Can a therapist harm someone without meaning to?
Yes. Most harm in therapy isn’t caused by bad intentions, but by a lack of awareness, poor boundaries, or unacknowledged power dynamics.
Is it OK to leave therapy if it feels wrong?
Clients are not obliged to stay in harmful or confusing dynamics – even if they’re told “this is where the work is.”
How can therapists identify harm in therapy?
Ask: am I treating this client differently than others? Do I feel overwhelmed or overly attached? Do I avoid talking about certain issues? These can be early signs of a dynamic that needs attention.
Where can I get support if I think I’ve caused harm?
You can talk to your supervisor, but you may also want to seek external consultation. Erin Stevens offers therapist consultations specifically around harm in therapy.
What if I’ve experienced harm but don’t want to make a complaint?
You don’t have to. Specialist therapists such as Erin Stevens and others offer consultation spaces to talk things through, with no pressure to act unless you want to.