While therapy has the potential to provide relief for mental health issues, it's critical to recognize it also carries risks of harm (iatrogenesis). Potential negative effects include:
- Convincing a patient they are sick and organizing their identity around a diagnosis
- Encouraging family estrangement and loss of key support systems
- Reducing resilience and self-efficacy
- Retraumatizing a patient
- Fostering excessive dependence on the therapist
Especially for children, the power imbalance between therapist and patient makes them vulnerable to harm. Parents should carefully weigh risks and only pursue therapy for kids if clearly needed.
Section: 1, Chapter: 1
Many parents, in an effort to alleviate their teens' distress, are quick to seek medication for the normal mood swings of adolescence. But psychologist Scott Monroe cautions there are serious drawbacks to this:
"If you give [adolescents] medication for anxiety - and I would say, you could extend it to depression - if you palliate those symptoms, you are messing with the natural adaptive resources of the human being that has evolved over centuries. I'm not a biologist - I don't know how badly it can impair brain development. But it seems like those are prime years. I'd want to find alternatives before implementing that."
Experiencing difficult emotions like heartbreak, disappointment, anxiety and sadness - and learning to cope with them - is part of how teens build resilience.
Section: 2, Chapter: 10
Melanie has accommodated her son Dylan's every sensitivity, avoiding activities and situations that make him uncomfortable. Finally one prescribed Lexapro, an antidepressant, despite no clear diagnosis. Now Melanie wonders if the medication is even helping as Dylan's anxiety continues to rule the family's life.
For kids like Dylan, a diagnosis often becomes the organizing principle of their identity. Minor setbacks feel catastrophic as they lose faith in their own natural resilience. Well-meaning parents, overly focused on "fixing" their kids with therapy and meds, end up pathologizing them instead.
Section: 2, Chapter: 10
Dr. Richard Byng runs a program helping ex-convicts, many of whom experienced severe childhood trauma, reintegrate into society. But he's found constantly probing their traumatic memories to be counterproductive. "Quite the opposite," he argues. For those with trauma, the healthiest approach is often to acknowledge it briefly, then pivot to focusing on the present.
Byng criticizes a culture of therapy that assumes everyone benefits from talking through their pain. The insistence on "processing" can make trauma loom larger. Some do best moving forward without dwelling on the past. Even for the traumatized, a level of healthy repression is often necessary to functioning.
Section: 1, Chapter: 3
The "adverse childhood experiences" or ACEs concept has become ubiquitous in education. It claims that kids exposed to various stressors (abuse, neglect, parental mental illness, etc.) are primed for a host of poor life outcomes from disease to delinquency.
But the original ACEs study was never intended as a screening tool for individuals. Misapplied, it massively overpredicts trauma prevalence and impact. Researchers conflate correlation and causation, retrospectively linking adult woes to childhood events. Genetics, temperament, and environment all influence whether difficulties derail or strengthen a child. Kids deserve high expectations and opportunities to prove their resilience, not preemptive pigeonholing as "damaged goods."
Section: 2, Chapter: 6
Therapy often teaches kids to see their feelings as a valid and important signal. But feelings can be unreliable and manipulable, according to Dr. Yulia Chentsova Dutton. She argues emotions don't necessarily reflect reality and can lead us astray if followed uncritically.
Asking kids repeatedly how they're feeling has downsides. Dr. Michael Linden argues it inherently elicits negative responses, as most of the time we feel "just okay" while ignoring minor discomforts. Chentsova Dutton says focusing on momentary emotional states promotes an unhelpful "state orientation" vs the "action orientation" needed for achievement. For emotional regulation and success, kids need to be taught to be sometimes skeptical and dismissive of passing feelings.
Section: 1, Chapter: 3
Many trauma-informed educators argue the primary way to help struggling students is by empathizing with their pain. But this is often counterproductive:
- Encouraging kids to see themselves as victims risks a self-fulfilling prophecy. Resilience, not fragility, should be the message.
- Focusing on validating kids' feelings of anger and hurt can inadvertently reinforce and prolong them. Pivoting to problem-solving builds more constructive habits.
- Lowering academic expectations robs disadvantaged kids of a path out of difficulty. Belief in their potential and insistence they develop their abilities maximizes possibilities.
Kids' hardships merit compassion, but pity is less productive than challenging them to transcend circumstances.
Section: 2, Chapter: 6
Today's teens have less in-person interaction and laughter with friends than ever. Their time is heavily scheduled and surveilled by hovering adults. School has become a vortex of "trauma-informed" emotional labor, not academics.
Immersed in the therapeutic worldview, many are quick to pathologize setbacks as mental health crises. Inundated with morbid messages, death by suicide feels like a looming specter. Learned helplessness is endemic as teens marinate in their diagnosis of brokenness.
Anxious parents outsource the heavy lifting of mentorship and guidance to paid professionals. But while well-meaning, therapy is often a flimsy backstop against the ennui of a medicated, artificially prolonged adolescence. Atrophied by overaccommodation, young adults feel stranded between childhood and independence.
The path forward is the same as it's always been: embracing the bog-standard discomforts of the human condition and growing the hell up already.
Section: 3, Chapter: 12
Despite a 75-year surge in mental health treatment availability and sophistication, rates of anxiety and depression in young people have swelled. A "treatment-prevalence paradox" has emerged, where expanded access to therapy and medication has not reduced mental illness prevalence as expected.
Therapists argue this is because today's youth face unprecedented stressors compared to previous generations, such as smartphones, social media, the COVID-19 pandemic and lockdowns, and climate change fears. But the author contends that adolescent mental health has been slipping since the 1950s, long before these modern issues existed. She suggests that perhaps the mental health complex itself, in pathologizing normal stress, inhibiting coping skills, and creating dependence, is part of the problem rather than the solution.
Section: 1, Chapter: 12
"Ortiz absolutely believes in the ameliorative power of specific kinds of therapies, especially cognitive-behavioral and dialectical behavior therapies (known as CBT and DBT) for remediating specific ailments like tic disorders, affective disorders, and obsessive-compulsive disorder... But he has enough respect for the power of therapy to reject the idea that everyone should be in therapy, a notion Ortiz likens to a surgeon who ventures: Well, he looks healthy, but let's open him up and see what we find."
Section: 1, Chapter: 3
We all experience thought biases, especially when mood is low, that negatively color our perspective. Some common ones include mind reading (assuming you know what others think), overgeneralization (applying one negative event to everything), emotional reasoning (I feel it so it must be true), and all-or-nothing thinking.
Strategies to counter biased thoughts:
- Recognize thoughts are not facts but one possible interpretation
- Get in the habit of noticing and labeling biases when they occur
- Consider alternative perspectives by talking to others
- Practice mindfulness to step back and observe thoughts without judgement
Naming thought distortions helps you gain distance from them so they have less power over your emotions. You can't control what thoughts pop up, but you can change your relationship to them.
Section: 1, Chapter: 2
When the ground crumbles beneath you after loss, it takes intentional effort and support to gradually piece life back together. These eight pillars provide a scaffold for healing:
- Continuing bonds - Find ways to maintain a symbolic connection to your loved one, like visiting special places or rituals.
- Self-awareness - Tune into your own emotional needs and limits. Practice compassionate self-care.
- Expressing grief - Give sorrow a voice through talking, writing, art, music or movement. Let it flow through you.
- Time - Release arbitrary expectations for how long grief should last. The timeline is yours alone.
- Mind-body nourishment - Tend to the physical vessel that carries your grief. Prioritize sleep, nutrition and movement.
- Boundaries - Honor your needs by saying no when you need to. Protect your energy as you heal.
- Structure - Reestablish a daily rhythm. Routines provide a sense of normalcy and forward momentum.
- Meaning - Explore what this loss means to you. How does it change your worldview? What lessons could it impart?
Section: 4, Chapter: 17
Many people are familiar with the "five stages of grief" model - denial, anger, bargaining, depression and acceptance. While these experiences are common after loss, modern research suggests grief is not a linear progression with clearly defined phases. It's much messier than that.
- Emotions oscillate, sometimes rapidly. You might feel at peace one moment and in despair the next.
- There is no timeline for grief. Pressuring yourself or others to "move on" by a certain point can compound suffering.
- Grief is individual. Your relationship to the loss is unique, so don't compare your process to others.
- Cultural beliefs shape grief. Rituals and norms around expressing grief vary across societies.
- Grief is a natural response to loss, not a disorder to be cured. Feeling waves of sadness doesn't mean you're broken.
Instead of conforming to a rigid model, be open to your own unfolding experience. Find small ways to honor the loss while continuing to engage with life. With time and self-compassion, grief softens its edges and becomes integrated into a fuller story.
Section: 4, Chapter: 15
The more precise your language is to describe your inner world, the better equipped you are to handle it skillfully. But many of us have a limited emotional vocabulary, defaulting to vague labels like "good" or "bad." Expanding your feeling word repertoire can actually help regulate emotions and cope with stress.
- Get specific - Go beyond "happy" or "sad". What subtle flavors or layers are present?
- Use metaphor - If your feeling was a color, texture, or weather pattern, what would it be?
- Consult a feelings wheel - Psychologists have mapped out the spectrum of emotions to help you pinpoint your experience.
When you can precisely articulate what you feel, you open up more possibilities for how to address it. Naming tames - it's the first step to gaining mastery over your emotions vs. being controlled by them.
Section: 3, Chapter: 12
When gripped by emotional pain, the natural instinct is to try to make it go away as quickly as possible. This avoidance often backfires, prolonging suffering or causing it to resurface more intensely later. A more effective approach:
- Recognize emotions aren't facts, but sensations that come and go when you allow them to run their natural course
- Turn toward pain with curiosity, openness and self-compassion rather than criticism or resistance
- Get to know your patterns - what situations trigger you and how do you typically react?
- Have a toolbox of healthy self-soothing strategies to ride out intense feelings safely
Painful emotions are an inevitable part of life - you can't control what arises, but you can build resilience in how you respond.
Section: 3, Chapter: 10
Anxiety is often misunderstood as a sign that something's wrong with your brain. But anxiety is your brain's alert system for danger. It's meant to mobilize you into action - think fight, flight or freeze. The problem arises when your threat detector is oversensitive, perceiving catastrophe where there is none. To recalibrate your anxiety:
- Recognize false alarms. Your brain is wired to prioritize safety, but not all fears are facts. Examine the odds your worst case will occur.
- Externalize it. Give your anxiety a name or visualize it as an overprotective friend. Creating distance helps you think critically about the message.
- Use it as a messenger. What is your anxiety trying to tell you? Maybe there's a problem to be solved or a boundary to be enforced.
- Aim for the middle path. A life well-lived includes some risk. You're looking for the sweet spot between recklessness and complete avoidance.
Your anxiety, at its core, thinks it's keeping you safe. Befriend it, don't banish it.
Section: 6, Chapter: 22
Just as the body needs good nutrition, the mind needs consistent nourishment too. Make a habit of tending to these 5 "defense players" to fortify your mental health:
- Exercise - Boosts mood, energy and cognitive function. Find something you enjoy and can stick with.
- Sleep - Poor sleep makes everything harder. Optimize your wind-down routine and sleep environment.
- Nutrition - Food feeds the brain. Traditional diets like Mediterranean show mental health benefits. Make small improvements where you can.
- Routine - Having a daily rhythm balances your nervous system. Notice when you get off track and course correct.
- Connection - Social support is vital for wellbeing. Prioritize time with others even when you don't feel like it.
Section: 1, Chapter: 5
"Emotions are neither your enemy nor your friend. They do not occur because your brain has a few cogs misaligned or because you are a sensitive soul, as you were told in the past. Emotions are your brain's attempt to explain and attach meaning to what is going on in your world and your body. Your brain receives information from your physical senses about the outside world and from your bodily functions, like your heart rate, lungs, hormones and immune function. It then uses memory of these sensations that occurred in the past to make some sense of them now."
Section: 3, Chapter: 10
The fear of death is a universal human experience. For some, it's a distant abstraction easily compartmentalized. For others, death anxiety colors every facet of life, leading to a range of psychological issues. Mortality fears may masquerade as health anxiety, phobias, panic, OCD and more.
Why is death anxiety so mentally destabilizing? Existential psychologists argue it's the ultimate unknown. We can't control the fact of our eventual demise nor the circumstances around it. Death renders everything we've worked for seemingly meaningless. It threatens our fundamental need for permanence and self-preservation.
Section: 6, Chapter: 26
"Reframing does not mean that you deny the inherent risks in a given situation. There was still a risk of failing my exam. But if I chose to focus exclusively on that risk then my stress response might have been much higher and I probably would have found it much more difficult to perform.
Reframing is when you allow yourself to consider reinterpreting the situation in a way that is going to help you move through it. Reframing an experience as a challenge can help us to shift from the flight urge to a somewhat more controlled fight urge. We can move towards something with intention."
Section: 6, Chapter: 25
Communal rhythmic activities and theater can serve as powerful tools for trauma recovery. Moving together to a shared beat fosters a sense of attunement, connection, and empowerment - experiences often shattered by trauma. Theater allows survivors to safely express and transform their stories through embodied role-play and collective creation. By physically experimenting with new possibilities, they can reclaim a sense of agency and spontaneity. These expressive arts tap into the emotional brain and invite the whole self into a space of witnessed authenticity. They remind trauma survivors of their capacity to create beauty and meaning from the fragments of pain.
Section: 5, Chapter: 20
Understanding how trauma affects the brain can guide therapists in choosing effective interventions. Since trauma disrupts left-brain functions like language and sequential processing, therapeutic methods that rely solely on talking things through are likely to fall short.
Therapies must also target physiological hyperarousal, using techniques like breath work, mindfulness, or yoga to help patients feel safe and grounded in their bodies.
Integrating traumatic memories requires activating both right-brain sensory experience and left-brain narrative processing. Treatments like EMDR that bilaterally stimulate both sides of the brain may help with this integration process.
Section: 1, Chapter: 3
"The greatest sources of our suffering are the lies we tell ourselves" - Elvin Semrad
Van der Kolk's teacher Elvin Semrad taught that the biggest obstacles to healing are the denial, lies and self-deceptions trauma survivors tell themselves to avoid the painful truth of their past. Being honest with oneself about one's experience and feelings is an essential first step in recovery.
Section: 1, Chapter: 1
Van der Kolk presents the Internal Family Systems (IFS) model as a paradigm for restoring inner harmony after trauma. In IFS, the psyche is viewed as a system of interacting "parts" with different roles and agendas. Trauma disrupts this inner ecology, causing parts to become polarized and disconnected from the core Self.
The goal of IFS therapy is to reestablish the Self's innate leadership and compassion. The Self is the seat of clarity, confidence and curiosity - it is not identified with any one part but can create space for all. From this empowered center, the individual can open a dialogue with the protective parts that carry trauma burdens.
Exiles are the wounded parts that become frozen in time, bearing the pain, terror and shame of trauma. Managers are the preemptively controlling parts that try to safeguard against further wounding. Firefighters are the impulsive, self-destructive parts that try to extinguish overwhelming emotions.
IFS teaches people to embrace all their parts with understanding and empathy. As the Self grows more robust, it can help exiles to heal, managers to relax, and firefighters to discover new roles. By honoring each part's positive intention and releasing it from extremes, the system moves toward balance and wholeness.
Section: 5, Chapter: 17
Books about Therapy
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Psychology
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Bad Therapy Book Summary
Abigail Shrier
In "Bad Therapy," journalist Abigail Shrier argues that today's pervasive "therapeutic" culture and overzealous mental health interventions are harming young people by promoting learned helplessness, pathologizing normal emotions, and inhibiting the development of resilience.
Psychology
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Why Has Nobody Told Me This Before Book Summary
Julie Smith
In "Why Has Nobody Told Me This Before?", Dr. Julie Smith shares practical insights and tools from therapy to help you navigate life's challenges, build resilience, and create a meaningful life aligned with your values.
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The Body Keeps the Score Book Summary
Bessel van der Kolk
The Body Keeps the Score revolutionizes our understanding of trauma's impact and offers a science-backed roadmap to healing the mind, brain and body.
