08/19/2026
Can Therapy Actually Make Things Worse?
Short answer, YES. However, I believe deeply in therapy. I have spent much of my adult life working as a therapist and I have watched counseling help save marriages, restore relationships, heal old wounds, and help people make changes they once believed were impossible. I believe enough in therapy that I have invested a significant portion of my professional life into it.
But believing in therapy also requires me to acknowledge an uncomfortable reality: not all therapy is good therapy.
I see a lot, and I mean a lot of clients who come to our counseling practice, Olive Branch Family Therapy, after working with other therapists and describe their previous counseling experience in negative terms. Often clients believe they were actually worse off because of their previous therapy. That does not necessarily mean the therapist caused the problems, but they didn’t help either.
Psychotherapy research overwhelmingly demonstrates that therapy can be helpful. At the same time, researchers have documented negative outcomes, unwanted side effects, and poor therapeutic alliances. Some research has also criticized the profession for paying considerably more attention to measuring the benefits of psychotherapy than its possible harms.
When Therapy Affects the Entire Family
One anecdotal trend that particularly concerns me as a Marriage and Family Therapist (LMFT), is that I increasingly encounter families in which important relationships have been severed following counseling. A family member has been encouraged to go “no contact,” cut someone out of his or her life, end communication with a parent or adult child, or otherwise disengage from an important relationship.
To be clear, there are circumstances in which separation is appropriate and sometimes necessary: Abuse, violence, exploitation, coercion, persistent danger, and severely destructive relational patterns to name a few. Protecting someone from genuine harm should never be minimized for the sake of preserving the appearance of family harmony.
However, ending a significant relationship is an enormous intervention. The consequences rarely affect only the two people separating. Estrangement between a parent and an adult child can affect many others including spouses, siblings, grandchildren as well as other important times like holidays, inheritance, and other family events. Divorce will reorganize an entire family system. Sibling separation can divide extended families for decades. From a systems perspective, there is never such a thing as simply removing one relationship while leaving everything else untouched.
That is one reason I believe therapists should approach recommendations about permanent relational separation with considerable humility. There is an important difference between establishing a boundary and terminating a relationship. Sometimes the latter is necessary, but I do not believe it should become our profession's default solution to difficult relationships. In fact I believe we should default to reconciliation as the highest value, and then work out from there.
So, for all of you considering therapy to help you and your relationships, picking the right therapist matters. And if the therapist matters this much, what should you be looking for when choosing one?
1. Look for a Therapist Who Thinks Systemically
We humans do not live in isolation. We live in relationships and take on roles such as husbands and wives, parents and children, brothers and sisters, friends, coworkers, neighbors, and members of communities. Our emotions are shaped within relationships, and those relationships can contribute to psychological distress, maintain unhealthy patterns, intensify symptoms, or become powerful resources for healing.
Systems theory training is one of the fundamental differences in the perspective of Marriage and Family Therapists. Rather than looking exclusively at the individual and asking, “What is wrong with this person?” a person taught to think systemically asks questions like, “What is happening between these people?” Taking it even one step further, many MFT’s are trained to look even at the individual as a complex system (IFS) within their own mind.
That difference can profoundly affect therapy. This does not mean individuals are never responsible for their behavior. Quite the opposite. A healthy system’s perspective helps people identify what belongs to them and take responsibility for it. But it also recognizes that lasting change often requires understanding the cycles, feedback loops, and relationships surrounding the individual rather than treating that person as though he or she exists in a vacuum.
2. Understand the Values Your Therapist Brings Into the Room
I also recommend finding a therapist whose values are reasonably compatible with your own. This can make some therapists uncomfortable because our profession appropriately emphasizes respecting client autonomy and avoiding the imposition of our personal values. Those ethical commitments are extremely important. Therapists should be trained to recognize their biases and prevent their personal preferences from becoming prescriptions for their clients.
But that does not mean therapists are value-neutral. None of us are.
Every therapist enters the counseling room with assumptions about what constitutes health, what relationships should require of us, what boundaries should look like, what constitutes harm, what obligations people have toward one another, and what outcomes are desirable. Even deciding that individual autonomy should take priority over some competing relational obligation is itself a value judgment.
For Christians seeking counseling, this can be particularly important. At Olive Branch Family Therapy, we do not force Christian beliefs or practices upon clients. We serve people from many backgrounds, and explicitly Christian practices such as prayer or the use of Scripture can be incorporated according to the client's wishes and goals.
At the same time, our Christian worldview inevitably influences the way we understand human beings and relationships. We believe people possess tremendous God-given value. We believe truth matters, responsibility matters, relationships matter, forgiveness matters, and reconciliation is worth pursuing when it is healthy and possible. We do not believe psychological health can simply be reduced to whatever makes a person feel better in the immediate moment.
You do not need a therapist who agrees with you about everything. In fact, a therapist who agrees with you about everything probably will not be particularly helpful. But when you are inviting someone into some of the most intimate decisions of your life, it is reasonable to understand the worldview and assumptions that person brings into the room.
3. Find a Therapist Who Does Not Confuse Affirmation With Therapy
A good therapist should take your experience seriously. Clients need to know that their pain is heard and that their dignity is respected. Particularly for people who have experienced trauma, betrayal, abuse, or years of feeling unheard, appropriate validation can be an enormously important part of treatment.
But validation and agreement are not synonymous.
Your therapist should be on your side without automatically assuming that your side of the story is always right. Every one of us experiences relationships from a limited perspective. We interpret other people's motives, remember events selectively, defend ourselves, and we miss our own contribution to patterns while seeing the other person's contribution with remarkable clarity.
Good therapy should therefore create room for reflection. A therapist might ask whether another interpretation of an event is possible, how a spouse or family member might describe the same interaction, what happens immediately before a particular reaction, or what responsibility the client can take even when another person has behaved negatively. The purpose of those questions is not to invalidate someone's experience. It is to expand it.
A therapy process in which every session continually confirms that the client is right, everyone else is toxic, and responsibility always lies outside the room should concern you. Sometimes other people genuinely are behaving terribly. But a therapist who can only validate what the client already believes may inadvertently reinforce the very patterns that brought the person to counseling.
4. Look for a Therapist Who Is Willing to Challenge You
Closely related to affirmation is the therapist's willingness to challenge the client appropriately. Effective therapy should be compassionate, but compassion does not require avoiding difficult truths, it often requires it.
Sometimes growth requires considering that my interpretation is incomplete. Perhaps I am contributing to the relational cycle I desperately want to change. Perhaps the boundary I am contemplating is partly healthy and partly avoidance. Perhaps I have blamed my parents for something for which I now need to assume adult responsibility. Conversely, perhaps I have called something “forgiveness” when what I am actually doing is repeatedly allowing someone to mistreat me.
A competent therapist should not make those conclusions for the client. The therapist's role is to help clients examine their assumptions, recognize patterns, consider alternatives, and make thoughtful decisions.
The goal of therapy should therefore be larger than leaving each appointment feeling affirmed. The goal is growth. Sometimes growth feels encouraging, and sometimes growth is uncomfortable.
5. Be Cautious of Therapists Who Quickly Recommend Irreversible Relational Decisions
Divorce, estrangement, going no-contact, cutting off a parent, disowning a child, or ending another significant relationship may sometimes become necessary. But these are consequential decisions that can alter the structure of a family for generations.
A therapist should be extremely cautious about becoming the person who simply tells a client to make such a decision. There is a difference between helping clients examine their options and using the authority of the therapist's chair to prescribe a life-altering relational choice.
From a systems perspective, a better question is often whether a boundary can adequately protect the person while preserving as much healthy relationship as circumstances safely allow. Boundaries, safety, and individual agency are important, but so are relationships.
Whenever possible, I believe boundaries should contribute to healthier relationships rather than simply becoming therapeutic language for ending them. When a relationship genuinely cannot be maintained safely or healthily, separation may be appropriate. But such decisions deserve careful assessment, humility, and attention to their broader relational consequences.
6. Find a Therapist Who Wants You to Eventually Need Them Less
Therapy itself is a relationship, and that relationship can become incredibly important during a difficult season of someone's life. But the goal should not be indefinite dependence upon the therapist.
Good therapy should increasingly equip clients to function outside the therapy room. People should become better able to recognize their patterns, regulate emotions, communicate clearly, tolerate appropriate discomfort, repair relationships, establish healthy boundaries, make thoughtful decisions, and accept responsibility for the portions of life they can control.
Ideally, the therapist becomes less necessary as those capacities grow.
The therapist should not replace a spouse, family, community, church, or trusted friendships. The therapeutic relationship should help clients become healthier participants in the meaningful relationships and communities that make up their actual lives.
Choosing a Therapist Carefully
Research consistently finds that the therapeutic alliance—the quality of the collaborative relationship between client and therapist—is associated with psychotherapy outcomes. In couple and family therapy, that alliance becomes even more complicated because the therapist is simultaneously developing relationships with multiple members of a system. Researchers studying couple and family therapy have therefore paid particular attention to “split alliances,” in which one person's relationship with the therapist may differ significantly from another's.
That research reinforces something therapists should already know: the relationship between therapist and client matters enormously.
Interview your therapist. Ask about training. Ask how he or she approaches marriage and family relationships. Ask what the therapist believes the purpose of counseling is. Ask how values are handled. Ask how progress is measured. If family relationships are involved, ask whether the therapist has actual training in couples and family systems. (THIS IS HUGE!)
Then pay attention to what happens in the room. Do you feel heard without simply being agreed with? Are you being helped to recognize your own responsibility as well as the behavior of others? Does the therapist seem curious about important relationships or eager to categorize people as healthy or toxic? Is therapy moving toward greater relational and emotional functioning, or simply producing increasingly sophisticated explanations for why everyone else is the problem?
At Olive Branch Family Therapy, we believe therapy can be extraordinarily powerful. That is precisely why we believe it should be practiced carefully.
Our goal is not simply to determine who is to blame. It is not to affirm every feeling as fact, nor is it to preserve every relationship regardless of how destructive it becomes. Instead, our family systems orientation encourages us to understand people within the relationships that shape their lives. We want clients to recognize unhealthy patterns, take responsibility for what belongs to them, develop appropriate boundaries, repair relationships when possible, and pursue greater emotional, relational, and spiritual health.
Our Christian worldview adds another dimension to that work. We believe people are more than diagnoses, relationships are more than vehicles for personal fulfillment, and healing involves more than simply eliminating uncomfortable feelings. Grace and truth belong together. So do compassion and responsibility. Forgiveness and boundaries are not necessarily opposites. Neither are loving another person and confronting what needs to change.
There is excellent therapy being practiced every day by compassionate and highly skilled clinicians from many different disciplines and perspectives. This article is not an argument against therapy or against psychology. It is an argument for taking therapy seriously enough to recognize that the therapist's training, worldview, clinical judgment, and understanding of relationships matter.
Choose your therapist carefully.
Good therapy should not merely help you feel better about your story. It should help you live a healthier one.
References
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. This meta-analysis examined 295 independent studies involving more than 30,000 patients and found a robust positive association between therapeutic alliance and treatment outcome.
Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2016). Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events. PLOS ONE, 11(6), e0157503. Research examining unwanted and adverse experiences associated with psychological treatment.
Rozental, A., Castonguay, L., Dimidjian, S., Lambert, M., Shafran, R., Andersson, G., & Carlbring, P. (2018). Negative effects in psychotherapy: Commentary and recommendations for future research and clinical practice. BJPsych Open, 4(4), 307–312. Discusses the importance of identifying, monitoring, and studying negative effects associated with psychotherapy.
Friedlander, M. L., Escudero, V., Welmers-van de Poll, M. J., & Heatherington, L. (2018). Meta-analysis of the alliance-outcome relation in couple and family therapy. Psychotherapy, 55(4), 356–371. Examines the relationship between therapeutic alliance and outcomes specifically within couple and family therapy.
Crawford, M. J., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., Clarke, J., & Parry, G. D. (2016). Patient experience of negative effects of psychological treatment: Results of a national survey. British Journal of Psychiatry, 208(3), 260–265. Examines patients' reports of lasting negative effects associated with psychological treatment.
