We speak of iatrogenic risk when we contemplate the possibility for psychotherapy to bring about adverse effects. Research puts forth a range of hypotheses on the origin of adverse effects: i.e. therapist’s incompetence; intrinsic risks inherent to certain models; non-specific results of a form of treatment; or the relational dynamics and mechanisms in a therapist-patient relationship. The author argues that iatrogenic effects are not due to technical incompetence, but stem from relational incompetence, i.e. the incapacity of the therapist to read the interactive process flow, or the therapist’s lack of awareness to do so. The author hypothesizes that iatrogenic harm appears when the therapist, faced with a deteriorating situation, instead of observing the process of co-construction of meanings, becomes inflexible and implements rigidly the technical model. Finally, the author suggests that iatrogenic risks in psychotherapy stem from the adoption of models that disregard the intertwining intrapersonal, interpersonal and social dynamics.
Keywords: Iatrogenic risk, relational competence, therapeutic alliance, sociocultural dimension.