In Saar Roelofs' 1997 book Do not disturb the status quo of outpatient mental health institutions at that time is described based on professional literature, file research, and her own observations (as a department head, researcher, and behavioral therapist in mental healthcare).

In Do not disturb, the author provides (potential) clients with tools, among other things, to determine whether or not they are in good hands with a particular care provider. Clients should be informed in such a way that they are able to help shape the therapeutic relationship, so that the relationship becomes a collaborative one that is not defined unilaterally by the therapist. 

Perhaps this information can encourage people who are in or about to start therapy not to rely solely on the therapist's perspective, but also to trust their own insights into what is useful and meaningful to them. 

The following is a passage from Do not Disturb about the ways in which a client can become entangled in the therapeutic relation.

The passage has general validity. It is therefore still relevant.

Entangled in the therapeutic relationship

Position of dependency. For most clients, receiving mental health care is an unusual situation. People who turn to mental health services are often in a position of dependency at that moment. They are in urgent need of help and have thought long and hard about whether to seek it from a professional. The situation between client and therapist is therefore unequal. The client wants something, and the therapist can give it to him or her. The therapist has a head start in knowledge. Clients usually do not know what to expect from the care. They are dependent on the therapists willingness to inform them about the treatment and possible alternatives, so that they can participate in decision-making regarding that treatment. 

There are clients who drop out disappointed after a shorter or longer period. What happens to disappointed clients who remain in therapy?

Not every disappointed client knows how to find their way to client organizations. Not every client is equally articulate or self-confident. A client often fails to grasp what is wrong: while disappointed with the treatment, they cling to the idea that the therapist is doing everything for their own good. After all, that is the therapists duty.

Latent unease . What can happen to such latent unease if the client does not sufficiently confront it? If the unease continues to gnaw internally? In that case, there is a chance that the client's psychological problems will worsen. In medicine, there is a special expression for such a phenomenon: iatrogenic complaints. 'Iatros' is Greek for 'doctor'. 'Iatrogenic complaints' are complaints caused by the actions of a doctor. By analogy with this medical concept, I introduce the term therapygenic complaints to designate those complaints caused by the Riagg. Below, I describe a number of possible therapygenic complaints.

The benefit of the doubt. Suppose a client gives the therapist the benefit of the doubt. He or she assumes that their dissatisfaction is unjustified. However, clients run into difficulties when the disappointment with the care continues to gnaw at them nonetheless: on the one hand, they appreciate the therapists efforts, who goes to great lengths to assist them to the best of their knowledge; on the other hand, they feel unease and resentment. Yet, without being able to put their finger on the sore spot. Something is wrong, but the client does not know what. Out of ignorance and loyalty towards their therapist, many clients are inclined to take responsibility for a failed care. 'The help isn't making my symptoms any better, but the therapist means well, it must be my fault.' 'I find the therapist so strict and cold, but I must be the one bringing that upon myself.' This situation resembles one that many people experienced in their childhood: to preserve the illusion of a loving parent, children, when treated badly by that parent, prefer to blame themselves rather than the parent for that bad treatment. Consequently, in many cases, the situation in which the client takes responsibility for the failed care is rubbing salt in the wounds.

Boomerang. Another possibility is to discuss the matters causing dissatisfaction with the therapist. This can backfire: the therapist is often unwilling to take the complaints seriously and throws them back at the client. He or she defines the dissatisfaction as a necessary byproduct of the therapy or as a symptom of the client.

Stalemate. In the best-case scenario, the client resists what he or she perceives as unreasonable. This can lead to a pointless discussion or even a conflict. As a rule, therapists have little interest in the motives of dissatisfied clients. A stalemate can then arise in which all the client's energy is consumed. To a large extent, this is wasted energy.

Hate and love. In the worst-case scenario, the client allows themselves to be pressured and thrown off balance by the therapist. They then adopt the care provider's point of view: 'The therapist hurts me, but he says that is part of therapy.' Or: 'I don't feel comfortable with that therapist, but she explained to me that I see my mother in her, and she should know.' This is a variation of the situation described above, in which the client blames themselves for the failing care. In this murky situation, it is impossible for the client to consult further about an alternative approach. Because the ctherapetic relationship can also be satisfying at times, a love-hate bond develops with the therapist. The more time and energy the client invests in the therapy, the more difficult it becomes for thim or her to break free from it.