I am grateful for the interest taken in my article on the place of psychotherapy in modern psychiatric practice. Although I agree with Dr Green that both sexual and fiduciary boundary violations and misdiagnoses are concerns in relation to psychotherapeutic practice and I have written about these elsewhere (Reference Subotsky, Bewley and CroweDenman 2010), I do not believe that these occurrences are rightly termed adverse effects of psychotherapy. When we discuss adverse effects in other areas of medicine, we refer to ill effects that arise from treatments that are correctly prescribed and correctly administered. This is not the case in situations where psychotherapy is given to patients with organic conditions or where, under the badge of ‘psychotherapy’ or otherwise, doctors take sexual or other advantage of their patients. The point is important because many people do not believe that there are intrinsic adverse effects of psychological treatments even when these are appropriately prescribed and administered.