FFrom influencer therapists on social media to psychotherapy platforms advertising on TV and radio, seeing a therapist is becoming increasingly mainstream – yet many people know little about who they see and what they get.
Experts said more information and awareness among the public about how therapy works was urgently needed to minimize the risks of their mental health worsening.
“The public needs more understanding that psychotherapy can do good, but it can also do harm, and that anything powerful enough to change your life for the better is powerful enough to do some damage if it gets into the wrong hands and is done wrongly or recklessly. says Glenys Parry, Emeritus Professor at the University of Sheffield and certified psychotherapist.
Parry said there was very little good research evidence to determine the extent of the harm caused by underqualified therapists. In most cases, the evidence suggests that therapy works well, with research showing that about 5-8% of people feel worse after therapy, she said. However, she added that it was particularly difficult to investigate “the wild west situations, such as the online areas”.
One red flag, she said, was when therapists said, “You have to feel worse before you feel better,” and another was when a therapist didn’t discuss expectations with the client. ‘The therapist has to assess the risks, and some don’t. They dive in without understanding someone’s vulnerabilities or history of psychotic attacks,” she said.
Part of being able to do this was understanding “the limits of their competence”, and knowing how to refer them to specialist services if necessary, for example a psychiatrist or a neurodiversity expert. She said NHS therapists tended to come under more scrutiny and were therefore a safer bet.
“One of the reasons why therapy goes wrong is transgressive therapists who are literally abusive or exploitative, and they are in the minority, but they do exist,” Parry said. “But it’s much more common for people to go into depth, for not understanding the limits of their competence – they do their best to be helpful, but they are unable to see that they are making things worse. ”
Parry added that there were so many different models of psychotherapy, from cognitive behavioral therapy (CBT) to psychodynamic therapy or counselling, that there was now “quite a lot of evidence that people don’t really understand what they’re getting”.
Regulation could ensure that all therapists have an agreed minimum level of training and experience, and they would be expected to keep up with new research and professional updates. For example, research from the University of Portsmouth shows that asking someone to talk about their parents during therapy can distort memories of childhood emotionsand that therapists need to communicate this to clients.
Dan Poulter, an NHS psychiatrist and former Health Secretary, said: “When you come across patients who tell you they have seen a private therapist or psychotherapist I often groan to myself and wonder if that has done more harm than good . for the patients I see. There can sometimes be professional overload by some psychologists who are not trained to diagnose mental health problems the way a psychiatrist does.”
Part of this is due to the ‘self-stigma’ that sometimes attaches to the idea of seeing a psychiatrist. “That’s why sometimes the first thing they do is talk about therapy instead of going to a GP,” he said. “It is not always in the psychotherapist’s interest to challenge the person’s self-perceptions or to refer him or her to someone else who may be better suited to help him or her. The current model does not always encourage responsible professional practice in that area.”
after newsletter promotion
For example, someone who has psychosis due to an illness such as bipolar disorder or schizophrenia will need to be prescribed medication. “If you don’t have the skills to diagnose that, or you have a financial interest in keeping a patient on your books, and there’s no recourse about poor practice… then there’s a real patient safety problem. It doesn’t help mental health in general. We want patients to receive the right help as quickly as possible.’
“,”prompt”:Share your experience”, “displayOnSensitive”:false,”elementId”:a49ce69d-f7fa-4da8-8101-5c6ed62b8cf1″, title” “isNonCollapsible”:false,”formFields” :({“_type ‘model .dotcomrendering.pageElements.CalloutFormFieldBase’, ‘name’, name, ‘id’,175300770, ‘hideLabel’:false, ‘label’, Name, ‘hidden’ :false,”type”:text”, “required”:true },{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”, “name” where_you_live, “id”:175300771″, hideLabel”:false,”label”Where do you live?”,”hidden”:false,”type “text”required”:true},{“_type”:model.dotcomrendering.pageElements. CalloutFormFieldBase”,”name ‘tell_us_a_bit_about_yourself_eg_age_and_what_you_do_for_living’,id ‘175300772’, ‘hideLabel’:false,”label ‘Tell us something about yourself (e.g. your age and what you do for a living)’, hidden”:false,”type”text”required”:false},{“_type”model.dotcomrendering.pageElements.CalloutFormFieldBase”,”name”why_you_went_to_a_psychotherapist_or_counselor_for_how_long_how_did_you_find_did_you_check_their_qualifications_and_accreditation_and_if_ so_what_wer e_they”,”description : “Please provide as much detail as possible”,”id ‘175300773’, ‘hideLabel’:false,’label ‘Why did you turn to a psychotherapist or counselor, and for how long? How did you find them? Have you checked their qualifications and accreditation, and if so what were they?”,”hidden”:false,”type”:textarea”,”required”:true},{“_type”:model.dotcomrendering.pageElements. CalloutFormFieldBase”,”name ‘did_therapy_make_you_feel_better_or_worse_and_why’, description ‘Provide as much detail as possible’, id ‘175300797’,hideLabel’:false, label ‘Did the therapy make you feel better? or worse, and why?”,”hidden”:false,”type”textarea”,”required”:true},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”name”name” which_behavior_of_your_therapist_concerned_you_what_happened_that_made_you_feel_you_received_bad_therapy “description” : provide as much detail as possible, “id”:175300798, “hideLabel”:false,”label”: What behavior from your therapist concerned you? What happened that made you feel like you were getting bad therapy? “,”hidden”:false,”type”textarea”,”required”:true},{“_type”model.dotcomrendering.pageElements.CalloutFormFieldBase”,” name ‘if_you_are_happy_to_you_can_upload_a_photo_of_yourself_here’, ‘id ‘175300776 ‘, ‘hideLabel’: false, ‘label ‘If you like, you can upload a photo of yourself here’, ‘hidden’:false, ‘vacancies type: “required”:false},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase “,”name” phone number” description”” Your contact details are useful so that we can contact you for further information. They are only seen by The Guardian.”,”id”:175300778″, “hideLabel”:false,”label” “Phone number”, “hidden”:false,”type”:text”, required “:false},{ “_type ‘model.dotcomrendering.pageElements.CalloutFormFieldBase’,name ’email_address_’,description ‘Your contact details are useful so that we can contact you for further information. They will only be seen by The Guardian.”,”id”:175300779 “,”hideLabel”:false,”label”Email Address”, “hidden”:false,”type”text”,required “:true},{“_type ‘model.dotcomrendering.pageElements.CalloutFormFieldBase’,name ‘you_can_add_more_information_here ‘,’description ‘If you include other people’s names, ask them first.’,’id’: “175300780”, “hideLabel”:false,”label “You can add more information here”, “hidden”:false ,”type”:textarea”,”required”:false},{“_type” model.dotcomrendering.pageElements.CalloutFormFieldRadio”,”name”would_you_be_interested_in_speaking_with_our_audio_and_video_teams”,options”:({“label”audio only”,value”audio only “},{“label”video only “,”value”Video only”},{“label”Audio and video”, “value””Audio and video”},{“label””No, not interested”,” value”: “No, not interested”}),”id ‘175300781’, ‘hideLabel’:false,’label ‘Would you be interested in speaking to our audio and/or video teams?’, ‘hidden’:false ,”type”radio”, “required”:true}),”_type”model.dotcomrendering.pageElements.CalloutBlockElementV2″, “tagName”: “uk-callout-bad-therapy”, “activeFrom”:1729209600000 ,”id” ad84b-8b8a-4d0c-9858-8d5ee198fb24″, “calloutsUrl”:https://callouts.guardianapis.com/formstack-campaign/submit”, “formId”:5976707},”pageId”: “society/2024/oct/ 19/when-therapy-goes-wrong-the-problem-of-underqualified-psychotherapists”}”>
Professor Dame Til Wykes, head of mental health and psychological sciences at King’s College London, said many people are turning to the proliferation of online mental health apps, despite the fact that “not many people have seen a randomized controlled trial or even have had an observational study. ”. The way such apps were marketed, she said, was like companies selling “snake oil.”
Without the supervision of a trained therapist, she also warned that “some things can make the individual worse for some people.”
Lisa Morrison Coulthard, director of professional standards at the British Association for Counseling and Psychotherapy, said one of the concerns raised by members was the rise of influencer therapists, who they had seen sharing “unhelpful or harmful online support”.
On platforms that connect therapists and clients, she said, “there’s just no guarantee what you’re going to get,” especially on platforms that operate from different countries.
“Given the mental health crisis, which is developing into a mental health emergency, given the increasing number of young people, as well as adults, seeking therapeutic support, there is a real need to ensure they have access to a choice of a range of appropriate therapies, delivered by suitably qualified individuals,” she said.