Effects of talking about side effects versus not talking about side effects on the therapeutic alliance: A controlled clinical trial

Abstract

Introduction: Side effects of psychotherapy are common. Therapists and patients must recognize negative developments to take countermeasure. Therapists can be reluctant to talk about problems of their own treatment. The hypothesis could be that talking about side effects can impair the therapeutic relationship. Methods: We examined whether a systematic monitoring and discussion of side effects has a negative effect on therapeutic alliance. Intervention group (IG) therapists and patients filled in the UE-PT scale (unwanted events in the view of patient and therapists scale) and discussed their mutual ratings (IG, n = 20). As unwanted events can be independent of therapy, but also be treatment-related side effects, the UE-PT-scale first asks for UE and then for their relation to the ongoing treatment. In the control group (CG, n = 16) treatment was done without any special side effect monitoring. Both groups filled in the Scale for Therapeutic Alliance (STA-R).Results: IG-therapists reported various unwanted events in 100% and patients in 85% of cases: complexity of problems, burdensome or overdemanding therapy, problems with work, and symptom deterioration. Any side effect was reported in 90% by therapists and in 65% by patients. Most frequent side effects were demoralization and worsening of symptoms. IG therapists observed an improvement of global therapeutic alliance in STA-R (M = 3.08 to M = 3.31, p = 0.024, interaction effect in ANOVA with two groups and measurement repetition), and reduced patient fear (M = 1.21 to M = 0.91, p = 0.012). IG patients perceived improvement in bond (M = 3.45 to M = 3.70, p = 0.045). In the CG no comparable changes were seen (alliance M = 2.97 to M = 3.00; patient fear M = 1.20 to M = 1.36; patient-perceived bond M = 3.41 to M = 3.36). Conclusion:The initial hypothesis must be rejected. The results suggest that monitoring, and discussion of side effects can even improve the therapeutic

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

“…However, consistent with our findings, reporting more negative therapy experiences was linked to fewer positive therapy experiences at mid-and end of treatment and overall lower patient evaluation of therapy success. Monitoring negative experiences during therapy is important, as shown in a randomized controlled trial of Muschalla et al (2023). These authors demonstrated that systematically monitoring and discussing potential side effects during therapy sessions had a positive impact on the therapeutic alliance when compared to the control group.…”

“…Monitoring negative experiences during therapy is important, as shown in a randomized controlled trial of Muschalla et al. (2023). These authors demonstrated that systematically monitoring and discussing potential side effects during therapy sessions had a positive impact on the therapeutic alliance when compared to the control group.…”

“…More generally, we need research to test whether monitoring both beneficial and harmful effects of psychotherapy has a protective effect in itself (Muschalla et al. 2023; Paveltchuk et al. 2022).…”

“…Monitoring adverse events in psychotherapy may help overcome this blind spot for therapists and provide professionals with feedback on when to intervene, thereby reducing the risk of therapy failure. More generally, we need research to test whether monitoring both beneficial and harmful effects of psychotherapy has a protective effect in itself (Muschalla et al 2023;Paveltchuk et al 2022). In any case, such monitoring with, for example, the PNEP would increase the informational value of randomized control trials (Ellett and Chadwick 2021;Guidi et al 2018;Ioannidis et al 2004), which is essential for the development of clinical practice guidelines (e.g.…”

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“…It has been suggested that the desired, positive effects of psychotherapy should also be included in assessment tools in order to minimize negative priming. An instrument with only items about negative experiences could potentially contribute to a nocebo effect due to negative expectations about the occurrence of side effects (Herzog et al, 2019;Moritz et al, 2019; but see Muschalla et al, 2023). Taking into account these findings on negative priming and the lack of a golden standard instrument for measuring negative reactions to psychotherapy, Dandachi-Fitz Gerald et al (2024) developed a new instrument incorporating several points of improvement: the Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP).…”