* Spontaneous remissions frequently happen to clients whose lives improve because of fortunate events, such as an improved position at work, successful marriages and personal relationships, and periods during which pressing problems become fewer and life more stable. Given these facts, spontaneous remission critics argued that, since many troubled individuals will get better anyway, _without psychotherapy_, we cannot know that psychotherapy caused any beneficial effects. Again, poor logic. It is like saying that since certain bone fractures will eventually heal themselves in correct alignment, without being set in a cast, we cannot know for these cases that a cast had any beneficial effects. Well, for many people, a suitable psychotherapy serves much the same function as a cast does for a broken bone: it supports, lessens vulnerability, reduces pain, and makes life a little more comfortable until natural healing can take place. Again, whom do we ask to determine whether this is the case? We must ask the person with the fractured arm whether the cast made him or her more comfortable. {274} HOW PSYCHOTHERAPY CAN BE INJURIOUS TO YOUR HEALTH /#] Is there substantial evidence that psychotherapists sometimes harm, as well as benefit, their clients? I think that there definitely is and that this has been fairly well demonstrated.[13] [13] Albert Ellis, "Must Most Psychotherapists Remain as Incompetent as They Now Are?," in J. Hariman, ed., _Does Psychotherapy Really Help People?_, p. 240. Even love can harm, and psychotherapy is no exception. Ellis identifies some of the main ways psychotherapists can make clients worse:[14] [14] _Ibid._, pp. 24-36. * Therapists may encourage clients to be dependent on them. Directly or indirectly a therapist can convey to a client, "You cannot get along without me," "You will probably need to spend at least two more years in therapy," etc. * Therapists may overemphasize the significance of the client's past experience to the point that they persuade the client to feel unjustifiably weighed down and controlled by past events and circumstances. * Therapists may become so hooked on the importance of modeling positive personal qualities (warmth, positive regard, congruence, empathy) for a client that they will not provide any active-directive leadership during a time when the client is floundering and needs strong recommendations. * Therapists may place too much importance on the role of insight. The search for insight can be never-ending. It is useful only to some clients; for others, insight is irrelevant to helping them change. * Many therapists feel that therapy gives clients a chance to vent their feelings. But catharsis by itself is not enough to replace destructive patterns of behavior and thinking with constructive ones.