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Therapy has been called a gift. For many, it's a path to greater fulfillment and meaning—even liberation. But therapy can also have a shadow side. Research has revealed that not everyone who engages in treatment is better off for it.

What are the most common negative experiences in therapy? This question was at the center of a meta-analytic study led by psychologist Zbyněk Vybíral of Masaryk University in the Czech Republic. More specifically, given the substantial concerns around harm in therapy, he and his team wanted to identify negative experiences in therapy from the perspective of clients.

To that end, the investigators searched the psychology databases for qualitative studies about negative therapy experiences. The studies were conducted around the world, including the United Kingdom, the United States, South Africa, Israel, and Chile. In total, Vybíral and his collaborators culled 936 statements from 51 studies for analysis.

The results were striking. The researchers identified four broad clusters, each containing “meta-categories." In total, the findings yielded 21 areas where clients report negative experiences in therapy.

Cluster I: Therapists’ Misbehavior

Therapist not listening: Some clients wondered whether their therapist cared or was sincerely interested in them. Some even harbored doubts about whether their therapists were listening. One client expressed: “My God, is she listening to me at all?”

Therapist not understanding: Clients shared that they felt misunderstood, even if their therapist was listening. One participant described “saying something and having the counselor summarize it differently than what I want.”

Therapist perceived as incompetent: Participants felt unease with clinicians they felt were incompetent or inexperienced, and questioned whether they could “handle” the work. This was true with respect to cultural competency as well. One client reported that their therapist seemed to draw from stereotypes: “She had made up her mind from the way we are usually shown on TV as Arab or Muslim men, as basically being........

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