Treatments that work well for most don’t work well for all. And even effective treatments have side effects and complications. This is true of medication and surgery—and it is also true of psychotherapy.
Psychotherapy is a proven effective treatment and should be the first choice for mild to moderate psychiatric symptoms. Far too often people take unnecessary psychiatric medication for problems that would get better on their own or with psychotherapy.
But sometimes psychotherapy creates its own set of problems. Like any effective treatment, it must be implemented well and applied judiciously for proper indications.
Jorgen Flor is a student in psychology doing his master’s at the Norwegian University of Science and Technology, on the topic of negative outcomes in psychotherapy. Mr Flor writes:
First, do not harm. This is the famous Hippocratic oath well known in the world of medicine. In the world of psychotherapy, however, harms have not been subject to much interest.
Since Sigmund Freud and Joseph Breuer discovered that talking to people could cure bodily illness, researchers have asked questions about the effective components of psychotherapy. Is it the specific techniques? The healing powers of the therapist? The general effects of being understood, validated, and listened to? All-important questions, but they fail to acknowledge the full picture.
There is no doubt that psychotherapy works for most of the mental disorders. If the interventions we use are potent enough to create positive change, it should not come as a surprise that they are potent enough to damage people as well. It is estimated that as many as 15% of patients get worse following treatment.
Negative effects come in two major forms: 1) worsening of problems already present, such as hopelessness or depression; and 2) new problems might emerge, such as becoming dependent on the therapist, marriage issues, or reduced self-image.
Often the patient is blamed when therapy doesn’t work, labeled as “treatment-resistant” or “unable to profit from therapy.” This is sometimes true, but is the least fruitful approach for explaining negative outcome. Sometimes the therapy technique is dangerous. Recovered-memory techniques and dissociative identity disorder-oriented psychotherapy should come with a warning sign.
And most important is the therapist. Some therapists are empathic and intuitive, ask for feedback, evaluate the therapy, and share the goal and process continuously with the patients. Others fall short on one or all of these critical dimensions. It may not be the technique that is harmful, but rather the wrongful use of it.
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1. Hannan C, Lambert MJ, Harmon C, et al. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychology. 2005;61:155-163.