Understanding Harm in the Mental Illness Industry

A lot of people have been harmed in one-on-one therapy. Not just disappointed, but harmed. They have been gaslit, pathologized, controlled, dismissed, punitively misdiagnosed, and worse. That happens within a system built around hierarchy and authority rather than nervous system safety.

After what I’ve experienced and learned, I cannot pretend the therapy industry is “safe.” It isn’t. It wasn’t built primarily around human well-being, but around diagnosis, compliance, and profit. It doesn’t fail by accident. It manages people rather than supporting regulation and dignity.

The danger is unexamined power and providers who cannot tolerate another person’s reality. Harm occurs in relationships where survival adaptations are treated as pathology.

Some rare practitioners do reduce hierarchy and work in ways that support pacing, consent, and nervous system safety. They exist, but they are not the norm, and people deserve to be warned, not reassured. The truth is that most therapy is not trauma-safe.

But the answer isn’t “never be in relationship.” It is: never stay in relationships that reproduce domination, dismissal, or threat. This is a key reason I gave up on the mental illness industry altogether. We don’t need treatment as the starting point. We need conditions that support homeostasis, connection, agency, and the capacity to recover.

The Relational Foundation of Healing

Most people do not struggle because they lack insight or coping skills. Human beings develop within relationships and environments, and prolonged threat can shape how the nervous system responds, how we relate to other people, and what we are able to access in the moment.

You cannot talk a body out of survival mode, analyze your way into rest, or heal in relationships that repeat power, control, or emotional distance.

From an Interpersonal Neurobiology (IPNB) lens, the first question is not “What technique do you use?” It is: “Can this person help create a relationship in which my nervous system has enough safety and connection to support change?”

With that in mind, here are six questions to ask a potential therapist.

6 Questions to Ask a Potential Therapist

1. “How do you understand trauma?”

If their answer is mainly about distorted thoughts, behaviors, or “coping skills,” pay attention. Trauma is not simply a thinking problem. It can affect the whole person, including the body, relationships, attention, memory, emotions, and capacity to feel safe.

You want someone who understands that many symptoms can be adaptations to what a person has lived through rather than evidence that the person is fundamentally disordered.

2. “How do you work with the body and with relationship?”

If everything they do is verbal and cognitive, they are overlooking important parts of the experience. A trauma-informed therapist should understand how to slow things down, notice what is happening in the body, and work with connection, pacing, and consent right in the room.

You are allowed to ask exactly what that looks like in practice rather than accepting “I’m trauma-informed” as an answer.

3. “What do you do when someone feels overwhelmed or shuts down in session?”

If they don’t have a clear answer, pay attention.

People with complex trauma do not need to be pushed through overwhelm. A therapist needs to recognize when a person is moving outside their capacity and respond by slowing down, increasing safety, and supporting a return toward regulation rather than intensifying the experience.

4. “How do you understand power and hierarchy in the therapy relationship?”

If they see themselves as the expert and you as the patient who needs fixing, that deserves serious consideration.

A therapeutic relationship does not have to pretend that the therapist and client have identical roles. The therapist has specialized training and institutional authority, while the client is the expert on their own lived experience. A safer relationship makes that power visible rather than pretending it does not exist.

5. “How do you manage your own internal state when you are working with someone who is distressed?”

This is one of the questions I consider most important. A therapist is not outside the relationship. Their own history, unresolved experiences, beliefs, assumptions, fears, and reactions can enter the room and affect what happens between you.

Ask them how they recognize when their own unresolved material is being activated and how they determine whether it is beginning to interfere with your progress or with the therapeutic process.

A therapist who cannot recognize their own contribution to what is happening in the relationship has much less ability to repair problems when they arise.

You are looking for someone who can reflect on their own responses, recognize when something belongs to them rather than to you, and take responsibility when their own unresolved material affects the relationship.

6. “How do you think about safety?”

Not just physical safety, but relational and nervous system safety.

Ask how they create an environment where you have enough safety, choice, pacing, and connection for your nervous system to move out of threat and toward greater integration.

Don’t be distracted by the buzzwords. Tools like EMDR, somatic therapy, or parts work can be useful, but tools in the wrong hands can still cause harm. You’re not looking for a particular method. You’re looking for a person whose presence and way of relating support your capacity rather than repeatedly pushing you beyond it.

Finding What Your System Needs

The marker of a good therapist for trauma is not how smart they sound. It is what happens in the relationship over time. Do you experience more space, more breath, more clarity, and more dignity? Or do you repeatedly leave feeling smaller, more confused, more overwhelmed, or more alone?

Pay attention to patterns rather than judging a therapist by one particularly good or bad session. A therapeutic relationship will have moments of misunderstanding and rupture. What matters is whether the therapist can recognize what happened, listen to your experience, take responsibility for their part, and participate in repair.

If you have CPTSD, insomnia, depression, or anxiety, you are not the problem. These experiences can reflect a human nervous system that has had to function without enough safety, protection, and attuned support. You don’t need to be fixed. You need conditions that support your system’s capacity to move toward greater stability, integration, and connection. If the relationship repeatedly undermines those conditions, no technique can make the relationship safe.

And there is another problem rarely acknowledged: finding a therapist who can actually do this is hard. Finding one who is accessible is even harder. Many trauma survivors have little choice but to rely on insurance coverage, which can severely limit who they can see, what kind of care is available, how long they can receive it, and whether the practitioner they find has the depth of understanding they need. The people who most need appropriate support are often the least able to pay privately for it.

This is one reason IPNB has been so useful to me. It gives people a way to understand human development, relationships, nervous system responses, safety, connection, and the conditions that support integration without making access to a particular practitioner the only path forward. We evolved to support each other. Human development happens in relationship, and the knowledge of how relationships affect us should not belong exclusively to professionals behind an insurance system. Understanding those principles gives people more ability to recognize what supports them, what does not, and when a relationship is contributing to their capacity to heal or interfering with it.