Negative effects of psychotherapy: estimating the prevalence in a random national sample

Abstract

Background Negative or adverse effects of psychological treatments are increasingly a focus of psychotherapy research. Yet, we still know little about the prevalence of these effects. Aims Starting from a representative national sample, the prevalence of negative effects and malpractice was determined in a subsample of individuals reporting psychotherapy currently or during the past 6 years. Method Out of an initial representative sample of 5562 individuals, 244 were determined to have had psychotherapy within the past 6 years. Besides answering questions related to treatment, its effects and the therapists, patients filled out the Negative Effects Questionnaire, items of the Inventory of Negative Effects of Psychotherapy reflecting malpractice and the Helping Alliance Questionnaire, and rated psychotherapeutic changes in different areas. Results Rates of positive changes related to therapy varied between 26.6% (relationship to parents) and 67.7% (improvement in depressed mood). Deteriorations were most commonly related to physical well-being (13.1%), ability to work (13.1%) and vitality (11.1%). Although patients generally reported a positive helping alliance, many of them reported high rates of negative effects (though not always linked to treatment). This was especially true of the experience of unpleasant memories (57.8%), unpleasant feelings (30.3%) and a lack of understanding of the treatment/therapist (19.3/18.4%). Indicators of malpractice were less common, with the exception that 16.8% felt violated by statements of their therapist. Conclusions This study helps to better estimate aspects of negative effects in psychotherapy ranging from deteriorations, specific effects and issues of malpractice that should be replicated and specified in future studies.

Crisis text‐line interventions: Evaluation of texters' perceptions of effectiveness

“…Our finding that nearly half of suicidal texters reported feeling less suicidal after the text conversation is comparable to the reduction in suicidal ideation among chatters at the end of Lifeline crisis chat interventions (Gould, Chowdhury et al, 2021). This level of improvement mirrors the range of improvements reported after psychotherapy (Strauss et al, 2021). In contrast to CTL's positive outcomes, yet consistent with Lifeline crisis chat outcomes (Gould, Chowdhury et al, 2021), a small minority of all texters did not feel their conversations were helpful (13.5%) or felt less hopeful (6.4%), more depressed (5.9%), more overwhelmed (6.3%) or more suicidal (5.1%) after their conversations.…”

“…In contrast to CTL's positive outcomes, yet consistent with Lifeline crisis chat outcomes (Gould, Chowdhury et al, 2021), a small minority of all texters did not feel their conversations were helpful (13.5%) or felt less hopeful (6.4%), more depressed (5.9%), more overwhelmed (6.3%) or more suicidal (5.1%) after their conversations. While it would be ideal to have all or nearly all texters experiencing an improvement at the end of conversations, this is an unrealistic expectation given this population's distress levels (Pisani et al, 2022) and similar findings of worsening symptoms for a small portion of patients following psychotherapy (Strauss et al, 2021).…”

Patients with diabetes mellitus in outpatient psychotherapeutic care

“…Unerwünschte Nebenwirkungen durch Psychotherapie waren bei knapp der Hälfte der Inanspruchnahmepatienten mit Diabetes mellitus anzutreffen. Dies ist mit Ergebnissen einer Bevölkerungsbefragung in Deutschland von Strauss et al (2021) vergleichbar, bei denen der Anteil 56,6 % beträgt. Psychotherapiepatienten mit Diabetes mellitus berichteten am häufigsten von Enttäuschung über den Therapieverlauf bzw.…”

To Use or Not to Use: Exploring Therapists’ Experiences with Pre-Treatment EMA-Based Personalized Feedback in the TheraNet Project

“…Psychotherapy is a generally effective treatment for several mental illnesses (Barkham et al, 2021). However, some patients still do not benefit from this kind of treatment (Hofmann et al, 2012), with some patients even experiencing a worsening in symptoms after therapy (Strauss et al, 2021). Psychotherapists are not always able to recognize and appropriately respond to these kinds of deteriorations (e.g., Hannan et al, 2005).…”