Therapy Is Not a Safe Space. Here Are 3 Things I Wish People Knew.

If you're new here, here are three things I wish more people knew about therapy. The first one surprises people: therapy is not a safe space.

I made a short about it, and I want to go a little deeper here. I'll also share some of the research behind it, because this is not just my opinion from the therapy room. Much of it lines up with what decades of psychotherapy research keeps finding.

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Therapy is not a safe space. For a lot of people it's the opposite.

William Ferrell, counsellor at Mindora Counselling

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Therapy is not a safe space

For a lot of people it's the opposite. A good therapist is not going to say the thing you want to hear. They're going to say the thing in your life that nobody else is saying to you.

Think about who is around you. Friends want to keep the friendship comfortable. Family has its own history with you and its own stake in how you see things. Colleagues have no reason to get involved. Almost everyone in your life has a reason, usually a kind one, to leave the hardest thing unsaid. A therapist is one of the few people whose job is to say it, carefully and on purpose.

They're going to point to the pattern you've been successfully avoiding for years. 10, 20, 30 years. And they're going to ask you to look at it directly.

It's not comfortable. It's not easy. It's not safe, and it's not going to feel safe. It's going to feel hard. It's going to feel difficult.

So try to learn to be comfortable being uncomfortable. I go further into why in People Don't Grow When They're Comfortable. They Grow From Pain.

What the research says about the relationship

When I say therapy isn't safe, I am not saying the relationship doesn't matter. It matters more than almost anything else. In a 2018 meta-analysis of 295 independent studies and more than 30,000 patients, Flückiger and colleagues found a reliable link between the strength of the therapeutic alliance and how well people did in treatment (r = .278). Alliance is one of the most studied ingredients in all of psychotherapy.

But the alliance is not the same as being comfortable. In the research, it is usually understood as three things: a bond between you and the therapist, agreement about what you are working on, and agreement about how you will work on it. Warmth is part of it. So is a therapist who is willing to say, "I think we keep circling the same thing." A relationship that never risks tension can feel lovely and still go nowhere.

There is also research on what happens when the relationship hits a rough patch. Therapists call these moments ruptures: a disagreement, a misunderstanding, a client feeling criticized or pushed. In an early meta-analysis of rupture and repair, Safran, Muran and Eubanks-Carter found that working through ruptures was associated with better outcomes (r = .24). That analysis was small, just three studies and 148 patients, so I would not lean on the exact number. The direction is the useful part. Tension that is noticed, named and worked through is not a sign therapy is failing. It can be part of how therapy works.

Comfort is what got you here

Most of us, most of the time, move away from what hurts. It makes sense. The trouble is that the habit of moving away can become the whole strategy. Psychologists call it experiential avoidance: the effort to escape or suppress uncomfortable thoughts, feelings and memories, even when escaping costs you the life you want.

In the paper that introduced the Acceptance and Action Questionnaire, Hayes and colleagues tested the idea across more than 2,400 participants in several samples. Higher experiential avoidance went along with more depression, more anxiety, more specific fears, more trauma history, and lower quality of life. That is a correlation, so it can't prove that avoidance causes those problems. It does fit what I see: the thing a person has been working hardest to not feel is often the thing that is running the show.

This is why a therapy room that only soothes you can quietly keep the pattern in place. If every session ends with you feeling calmer and nothing about the way you live has moved, comfort may be doing the work that avoidance used to do.

Understanding your problem is not solving it

The second thing is that understanding your problem is not the same thing as solving it. You can understand everything you want, and it doesn't mean anything is going to change.

You can have perfect insight into exactly why you're doing what you're doing, and what happened in your childhood, and still do it for the next 20 years.

To be fair to insight, it does matter. A systematic review and meta-analysis in the American Journal of Psychiatry pulled together 22 studies and found a moderate link between insight and treatment outcome (r = .31). People who gain insight in therapy tend to do better. I am not telling you to skip the self-understanding.

But look at what that number can and cannot tell you. A correlation of .31 means insight accounts for roughly a tenth of the differences in how people do. A lot of what separates people who change from people who stay stuck lies somewhere else, and in my experience a large share of it is what they do next. Understanding what happened and why you're doing it is, of course, a starting point. It's not the finish line.

What actually matters is taking action to change what you've been doing. And again, that's not comfortable either. Olivier Courret covers this well in why understanding a pattern isn't enough to change it, and Sonia Samtani explains why you can't think your way out of a limiting belief.

The problem you walk in with is probably a symptom

The third thing I wish people knew is that whatever you think the problem is when you step into my room, that's probably not the actual problem. That's probably a symptom of what's going on.

A lot of people come in talking about their job, their relationship, their addictions, their alcoholism. But they end up really talking about who they had to be in their family growing up to survive. They talk about their parents. They talk about their siblings. They talk about things that happened a long time ago, where these ideas came from.

The surface issue you come in with is real. The problem with the job, the lack of sleep, the too many drinks, it's real for sure. But that's usually sitting on top of something a bit older, something a bit more ingrained. That's the thing that's really worth looking at. That's what we need to unpack.

In the Adverse Childhood Experiences study by Felitti and colleagues, which surveyed more than 8,000 adults, the more kinds of childhood adversity a person reported, the more likely they were to report health and mental health problems later in life. Adults who reported four or more categories of adversity were about seven times more likely to report alcoholism than adults who reported none.

I want to be careful with that finding. It describes groups, not individuals. Most people who have hard childhoods do not develop a drinking problem, and plenty of people with a drinking problem had an ordinary childhood (like me). It does not mean your past explains everything or that you are damaged. It means the patterns we build to get through childhood tend to follow us, and they often show up as a symptom in the present. If you want to see how old ideas turn into who we think we are, read why beliefs become identity.

What "not safe" does not mean

One note on what I mean. I don't mean being disrespected or pushed past what you can handle. A good therapist works with you at a pace you can manage, and you can always tell them when it's too much. What I mean is that the work isn't supposed to feel cozy. The point isn't to be soothed for an hour. It's to look at something you've been avoiding.

There is a real difference between discomfort that comes from looking at something true and harm that comes from a bad therapist. Feeling judged, shamed, dismissed or controlled is not productive discomfort. Neither is a therapist who crosses boundaries, breaks confidentiality, or makes you feel you can't push back. You should be able to say, "that landed hard," or "I don't think that's right," and have it taken seriously. If you can't, that is a fit problem or an ethics problem, and you are allowed to change therapists.

So the picture I want you to hold is this. The room is safe in the ways that matter: respect, confidentiality, pacing and your right to say no. The work is not safe in the way a warm blanket is safe. Both are true at once.

If you've been managing fine

So if you've been managing fine, but something still feels a bit off, a bit tricky, that's not nothing. That's actually something we need to look at, something we need to unpack. And that's exactly what therapy is for.

If that sounds like you, book a free consultation and we'll start with what's really going on. Not sure what to expect? Here's what happens in your first therapy session.

Sources

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy.

Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy, 48(1), 80-87.

Hayes, S. C., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.

Jennissen, S., Huber, J., Ehrenthal, J. C., et al. (2018). Association between insight and outcome of psychotherapy: Systematic review and meta-analysis. American Journal of Psychiatry, 175, 961-969.

Felitti, V. J., Anda, R. F., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258. Summary of the ACE study.

This post is general information and is not a substitute for individual care. If you are in crisis, please contact local emergency services or a crisis line.