to wonder where the belief that counselling is helpful at best/harmlessly ineffective at worst comes from?

[MightyNice]

not just on MN, you see/hear it everywhere - and some people are genuinely shocked by the idea that talking therapies can be damaging, even though that Emory study found about 10% of patients get worse after starting therapy and even though it is now quite widely accepted that debriefing after traumatic events actually causes PTSD

Many people I know felt damaged by counselling because they were asked to "re-live" the issues that cause their problems and felt they got stuck there.

I've never had it so can't comment personally.

Watch this with interest. I must say I felt wretched during my therapy but that was group. I think it helped me ultimately but not for a good year or so after.

I did drag up some horrible memories :(

I've had a couple of damaging counselling experiences. Wasn't the fault of the counsellor, it's just that I wasn't up to it and couldn't handle it. I have had CBT recently, but it started several months after the antidepressants were commenced and I've been fine this time

I've been searching online and can't find the Emory study you talk about

I do find in my own practise that people often get worse before they get better, reliving traumatic events is hard work, therapy is hard work. Those that stick with it until they feel better have usually worked hard and overcome great obstacles to claim good mental well being.

Is this really an aibu? Really?

oh I think a chunk of my op is missing!

something about there not being very many studies, because it's difficult to decide what is actual harm I suppose - obviously it means lots of people are helped or at the very least are no worse off after talking therapies but it strikes me as odd (and I've had conversations on here about it) that there is such widespread faith in treatments that are not really very well, what do I mean? audited?

I think it was Emory, and it is only a couple of years old, hang on

there has been only one other I think

Of course counselling can be hugely damaging and IMO decent counsellors understand this. I think it comes from people who only view hurt as a physical thing and can't see that talking can be damaging.

Also some theories of counselling recognise that talking about traumatic evenst over and over can be hugely damaging and instead concentrate on giving people tools to cope with what has happened instead.

ok, they talk about it here

there's an article here about post trauma counselling and various other therapies that have poorer outcomes/damage

Over past ten years I seems to have become the stock response to tragedy, that 'counsellors' have been sent in etc. I thought the rate of harmful intervention had been found to be much higher, at about 30% ?

Personally I have had some shocking experiences of 'counselling' which with hindsight were more abusive than the event for which counselling was sought. I think that too many people go into counselling who just aren't equipped to help.

I think that, similarly to how MH problems affect different people in different ways and to different extents, therapy can help/hinder different people in different ways.
I had one on one counselling with a wonderful woman after a particularly tough period in my life and my family, but my sister used the same counsellor at the same time and found it almost like a step back due to having to relive everything.
For me, being able to talk it through and for someone to tell me it was alright to be sad and angry worked magic on me. It enabled me to get back on my feet and years later I feel like that was me wrapping those horrible times up in a box and putting them away, not letting them affect me now.

However, I would never recommend one way or the other to anyone else because it's such a deeply personal thing.

NICE is slowly auditing various forms of counselling/therapy btw for proven effectiveness. But this is a slow process so ones may be effective even though they have not yet been approved. Approved models include CBT and Interpersonal Therapy - latter for severe depression.

I've done solution based counselling which was sometimes helpful on the day as far as venting went, but didn't help beyond that. I personally found going over and over things just made them loom even more.

I've since done CBT which was brilliant and taught me not to let previous experiences colour what's happening now.

So, I think it depends what you mean by counselling, what branches of talking therapy did the study cover?

For me, CBT counselling works, but it's not for everyone and it makes me feel very drained mentally after a session.

For what it's worth, I think that sometimes people can be pushed into going for counselling when they're either not ready for it or don't want to do it, and that might be where the damage comes in. I was told several times to go to Cruise after my mum died but I wasn't ready to then and I'm still not ready now if the truth be told.

There are some fairly fundamental problems with measuring outcomes in therapy: for one thing double-blind controlled trials, as recommended for pharmaceutical trials, are impossible by definition (it's impossible for client and therapist to both be unaware of whether they're administering the treatment or the placebo). For another thing, what people consider a good outcome is pretty variable and subjective, and for another thing again counselling modalities vary enormously in their methods so getting comparable results across different modalities is very difficult.

It is fairly well established though that

• Some people get worse, not better
• Most people report some benefit
• The benefit seems to be dependent on qualities of the therapist, client and counselling relationship rather than the counselling modality.

Mick Cooper does a fairly good job of summing up the current state of research into counselling and psychotherapy (that's part 1, the others are on YouTube as well) for anyone that's interested.

As regards treating PTSD, that's a tricky one. It's worth pointing out that critical incident debriefing isn't really counselling as such, more a technique that's been taught in some places to help manage acute post-traumatic reactions and may be offered by all kinds of people other than/in addition to trained counsellors with expertise in working with trauma. There's a lot of very interesting contemporary work on neurophysiological responses to trauma and the importance of working carefully with both mind and body to help individuals overcome acute post-traumatic symptoms; all practitioners working the field emphasise creating safety and stability before embarking on any kind of re-experiencing work and critical incident debriefing may not follow this protocol.

I should declare an interest, in that I'm a practitioner, but just wanted to offer my 2p worth.

some of the ones they listed as harmful were: critical incident stress debriefing, facilitated communication, recovered-memory techniques, boot camps for conduct disorder, attachment therapy, dissociative identity disorder-oriented psychotherapy, grief counselling for normal bereavement and expressive-experiential psychotherapies.

some, like the attachment therapy stuff, just seems so obviously dangerous but I wouldn't have imagined that grief counselling could be particularly problematic - one of my maybe careers is pet bereavement counselling

Manatee - I know outcomes can in reality be very difficult to measure and compare and contrast. And that the skill of the counsellor and teh relationship is the crtitical feature, but there are some techniques and modes of counselling that do seem to be harmful or certainly less than helpful. There is also some evidence taht counselling can be harmful for children.

I had a counsellor who burst into tears whilst I was talking to her about the abusive childhood I had. She stopped the session as she found it too traumatic.
How did she ever mange to be a trained counsellor ? I was referred to her by my GP,so she wasn't someone I just found online.
I will never go into counselling again as she made me feel guilty for upsetting her at a time when I was reliving some awfull memories.

well I just wondered where the blind faith in it all came from really, most of us are alert to the potential for adverse effects from medication but still counselling is promoted as if it is entirely free from such risk, when of course it's not

Jaffa - Thats terribe!! My DP is a counsellor actually and has worked in a number of GP surgeries. She has at times talked about another counsellor she si aware that she doesn't think is up to the job. not that other counsellor is horrible, but that she is exactly the kind of person that could get upset herself for example.

Sadly its like any job. Some people will pass courses and get jobs when they really shouldn't and this can bedamaging for those individuals unfortunate enough to coem across them. i hope you fed this backj to your GP so they could do something about this?

jaffa and

I hope she got hauled over the coals for that, there's no excuse for it.

I definitely don't think counselling is the answer to all trauma. You have to actually want to talk and to be ready for it. That's why it annoys me when a person revealing they have been through some really tough stuff is immediately told "You need counselling." Often what the person really needs is just someone to listen for a minute rather than to fob them off and tell them to go somewhere else.

I had a very bad experience with an awful counsellor who said some very damaging things. Like all jobs, some people who are totally unsuitable end up doing it. Because a person going to counselling is vulnerable to begin with the damage a bad counsellor can do can be terrible.

I think people should be educated in what to expect from counsellors and therapists so they can recognise when it's not helping. The secrecy around the topics that people usually discuss in counselling (abuse, depression etc) contributes to the potential for bad counsellors to continue hurting people IMO.