Can psychotherapy be bad for you? What makes it bad? Is there a way to know if harm is coming from therapy? Bystedt and colleagues (2014) help shed light on clinician’s perspectives of these and other questions regarding potentially negative effects of psychotherapy. Although psychologists, like other health professionals, adhere to the Hippocratic oath to “do no harm, ” it is known that not all patients benefit from psychotherapy and some even experience worsening of symptoms. Symptom deterioration can occur even in “evidence based” therapies and may sometime be caused by therapy, rather than just occurring as a product of the passage of time. Bystedt and colleagues (2014) explored the views of 74 CBT therapists from various Swedish CBT associations on their thoughts about potential negative effects of psychotherapy. Beyond the possibility of therapy having no effect on patients or patients experiencing deterioration, therapists identified several other potentially negative effects. For example, many of the participants described how short-term discomfort, such as that which comes from exposure and response prevention or the discussion of trauma, is sometimes a necessary element of therapy. A few therapists also described how patients may become dependent on the therapist or therapy. As to what factors contribute to negative effects, therapists identified incompetence on the part of the therapist, the use of potentially harmful treatments (e.g, grief counseling for normal bereavement), and having a low therapeutic alliance as contributing to bad outcomes. Clinicians, however, struggled to identify methods for preventing and identifying deterioration in therapy. In the interest of improving patient outcomes, the study authors end with recommendations to raise awareness about available methods for identifying patients who will experience negative effects in therapy.
Society for Psychotherapy Research (SPR)
Marna S. Barrett, Ph.D.
Mood & Anxiety Disorders Treatment Research Unit
University of Pennsylvania Perelman School of Medicine
3535 Market St., Suite 670
Philadelphia, PA 19104