When therapy has side effects

It seems odd, doesn't it.  Medication has side effects--lots of them, in fact.  You can hear them rattled off in the same droning-yet-chipper voice in every pharmaceutical commercial on the air.  But therapy?  How can therapy have side effects?

Time Magazine had a follow-up to a story about a family in Michigan who used a controversial therapy to help treat their autistic children.  And that's when everything unraveled.  The story itself is sad and even frightening, but that's not the point of the blog.  What struck me was a paragraph at the very end:

We don't often consider the "side effects" of nondrug therapies. But the Free Press series shows just how harmful it can be to buy into a technique or therapy that offers nothing but hope. Many things that help can also harm, which is why we need sound science before any new technique is widely adopted — let alone used as evidence in custody or criminal cases.

It struck me that some ED therapies are the same way: they offer hope, perhaps, but no solid results to back up their efficacy.  And that any treatment can have side effects, even if it's not in pill form. 

Eating can be extremely anxiety-provoking for those with EDs, and that anxiety can be expressed in panic attacks, defiance, self-harm, temper tantrums, and more.  But eating can also be thought of as "therapy" for eating disorders, as a type of exposure and response prevention.  The anxiety is a side effect, and sufferers and families should be warned and prepared for this.

The autism story is also a case study in the fact that therapy can, in fact, actually be harmful to patients and families.  Recently, Becky Henry wrote about how parent-blaming in traditional eating disorder treatment tore her family apart. I know lots of examples of lives stunted or lost, of families wrecked because of ineffective and inappropriate treatment.  Going to therapy isn't something we can think, "Well, it can't hurt, can it?"

Actually, yes. It can. 

Therapists and families need to do their homework before just signing up for weekly psychotherapy to make sure that the therapy's benefits outweigh any potential side effects, and that there's good evidence to show that it will help rather than harm.


sarahlynn said...

Am trying not to read this as: Hah! Yes! Eating disorder therapy is Bad! Has negative side-effects! Is Dangerous! Is not worth it!



Probably not how you intended this to be taken.

But I do know what you mean. I've been in therapies and with therapists who I felt were hurting me and my family, more than helping. Besides the fact that because there are no proven treatments for EDs (which makes insurance coverage more difficult) - there are also very varied treatments: some which are good, some which may not be.

And the side effects to therapy? Anxiety, increased self-hate and risk of harm, anger, depression, suicide - these ARE risks of therapy. I kind of wish my family had been warned before I started therapy about some of its 'side effects.'

j.m.r. said...

It's funny that people (like me) don't really consider potential risks of therapy. Sometimes it's the therapy itself, and sometimes it's the therapist. Like drugs, some things work better in some cases and worse in others.

Somewhat related: I came across this 2-part piece - on the general rise in mental illness cases - that notes some interesting issues, particularly with drugs, though: http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/?pagination=false. (I don't know how to do the shortened link thingy...) Came across the piece (part books-review/part analysis of those books' implications) on Longform.org. It's a pretty great site featuring journalism that many people find too long to read (like traditional weblinks).

hm said...

I have some childhood trauma that I repressed. A few years back, some memories got triggered- I decided to seek out EMDR treatment- I thought it'd be a quick fix to make it go away FAST. I knew that it worked for working through post traumatic stress types of memories.

The EMDR put me into an almost hypnotic state, during I was flooded with MORE memories, leaving me in an emotionally/mentally discombobulated, frantic state. It was HORRIBLE.

Went home and researched some more... found out that EMDR is NOT recommended for people with repressed memories or tendencies to dissociate. Oops. Maybe should have told my therapist the whole story before telling her how to do her job...

I think it's really important not just to research appropriate therapies, but also to be COMPLETELY HONEST with your therapist about yourself. I purposely didn't bother telling my therapist that there was more to the story. I thought it wasn't any of her business, and I knew exactly what I wanted anyway, so I manipulated the facts to get the therapy I thought would work for me.

I learned my lesson- I retraumatized myself, and couldn't let my husband look at me or touch me for days. Therapists are trained in these things- if I had been honest, I'm thinking she would not have done the therapy that hurt me.

Katie said...

I had a bad reaction to mindfulness when I was first taught it. I was 17, and it was being used as part of a group for self harming teenagers. I gave it a go, but found that it made me feel very over-stimulated and anxious, which triggered me to harm myself - not quite the result my psychologist was looking for! It wasn't until I was 23 that I was taught mindfulness properly and helped to adapt it to find a form that was genuinely helpful to me.

I get annoyed with the state of ED treatment. Other than FBT, there's not much in the way of evidence based treatment at all, to the detriment of all service users and their families. More research, please :)

Alyssa said...

This is an interesting post, definitely thought-provoking. Especially interesting to me is the tidbit on parent-blaming in eating disorder therapy. It's something that I've struggled with in therapy for not just my eating disorder but other mental health issues as well. Therapists always seems to be probing for that traumatic childhood event or the lack of affirmation from parents to pin the beginnings of my disorders on. However, I grew up with tons of love from my family, in a very calm, supportive environment. As a result, I often experience great shame and guilt about my "issues", since nothing HAPPENED to me to cause them. Therefore, in my head, I'm thinking, "well, if it's not my parents, then something is just wrong with ME. I'm a bad seed."

Which in turn leads to needing more therapy. :-) Certainly I've benefitted from therapy in many ways, but I can definitely see some possible dangers of it. I believe it's just a matter of finding the right therapist for you- some one who you can be open with but also challenges you.


AJ said...

I know you probably didn't think of it this way, but these are my thoughts exactly on Maudsley (FBT). I am so glad for everyone who has benefitted from Maudsley/family-based treatment, and I definitely believe that for some people, it works wonders.

However, that was not the case for me. I was 12 when my parents were first encouraged to re-feed me with Maudsley (supposedly the perfect age for that, right?) but I was so ill and brain-starved that I didn't care about doing anything else other than losing weight, I didn't mind having privileges taken away, and it put me and my parents in such a power struggle that, 9 years later, there's still a lot of residual anger and distrust from the Maudsley days. It definitely ruined our relationship for a long time, and almost killed me in the process. Finally I was put in hospital and -literally- force-fed to 100% IBW, which ended up being unhealthily high for me, then told I could start therapy. By that time I'd become suicidal (post-re-feeding) though, so it actually took several relapses before somebody realized that for me, the best approach was to do cognitive and pharmaceutical therapy in tandem with weight restoration.

I guess my point is that all therapies have side effects, and that as tempting as it may be to argue the other way, no one therapy is any more or less potentially damaging across a wide demographic. Treatment for all illnesses, especially brain diseases, is very individually-based.

*Steps off soapbox*

Jasmine said...

I've been working on my recovery in inpatient treatment and my therapist team just recommended this app http://itunes.apple.com/us/app/recovery-record/id457360959?mt=8 … is anyone else using it?

Jennifer said...

I am finally trying to get better through therapy too. I have struggled for Bulimia for more than 10 years. For me mindfulness and meditation helps a lot. I may be a bit off topic, but I'd just like to comment on Jasmine. This is app has also helped me in my therapy. I am so happy I found it. I have only used it for the last 4 days but reminds me to write my meals, feelings and thoughts. I suggest you also try this app, rather than finding side-effects of the therapy, let's help ourselves and enjoy the phase. http://itunes.apple.com/us/app/recovery-record/id457360959?mt=8

Belinda said...

Aren't therapies supposed to help us and not the other way around? My nephew had to be on a series of therapies and we're thankful he did well at end but this was not until finding his 3rd therapist.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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