All therapeutic relationships can harm as well as heal. In orthodox medicine, the bulk of the responsibility is placed on the doctor, because healing is attributed to specific effects brought about through the doctor's diagnostic and technical expertise. In CAM relationships, where users are expected to exercise self-responsibility, it may be inappropriate to focus solely on the shortcomings of the therapist (even though the law is unlikely to recognise mutual responsibilities when therapy goes wrong). That said, it is the therapist's responsibility to create the necessary conditions and boundaries for healing to occur. Despite CAM's user-centred rhetoric, holism can be as disempowering for users as reductionism. Dominant ideas link healing with the removal of physical symptoms. Conversely, harmful treatments tend to be associated with direct physical harm. However, harm can take several forms and be emotional as well as physical. While total failures of the therapeutic relationship are comparatively rare, therapeutic relationships can fail to achieve their potential in several ways. Despite the high levels of satisfaction in CAM, the absence of complaints is no cause for complacency; it may indicate that existing regulatory frameworks are ill suited to respond to the holistic relationship. It remains to be seen how shifts towards more integrated patterns of delivery, and scientific advances in understanding the link between mind and body, will affect the therapeutic relationship in the future.
CAM practitioners are not equally successful in forming healing therapeutic relationships. This can be because of personality and temperament but also through lack of training.
Despite a professed commitment to holism, practitioners may impose their own world views on patients. Being holistic is not synonymous with being user-centred, and practising holistically does not guarantee that practitioners will consider users' views of their bodies and illnesses.
CAM theories may offer new ways of understanding the body, which may or may not be helpful to users.
Therapeutic relationships that heal can also harm. The ways in which therapeutic relationships fail include: failing to deliver a desired outcome; failing to achieve the conditions in which healing can occur; and abusing trust.
Debates about placebo will continue to divide the supporters and detractors of CAM. Advances in psychoneuroimmunology will increasingly shed light on the ways in which the mind can directly influence the body.