On Side Effects, Destructive Processes, and Negative Outcomes in Psychoanalytic Therapies: Why Is It Difficult for Psychoanalysts to Acknowledge and Address Treatment Failures?

Risk factors for negative experiences during psychotherapy

“…Despite this there is a dearth of empirical research on incidence, mechanisms and prevention (Parry, Crawford, & Duggan, 2016). In addition, often therapists and patients have differing views on outcomes of therapy (Mohr, 1995;Timulak, 2010), therapists have difficulty seeing or acknowledging treatment failures (Kächele & Schachter, 2014;Lambert, 2011), and patients often do not tell their therapist or services about negative experiences (Regan & Hill, 1992).…”

The Lara case: A group analysis of initial psychoanalytic interviews using systematic clinical observation and empirical tools

“…It is known that people with borderline personality form more intense and unstable relation-ships compared to other diagnostic groups. Kächele and Schachter (2014) report on this, citing the work of the following authors: Skodol, Buckley, and Charles (1983) report a 67% dropout rate among borderline patients after three months of psychotherapy. Waldinger and Gunderson (1987) found a 46% dropout rate at six months; only one third of their sample completed their treatment.…”

“…In the Lara case, our work has helped promote an in-depth discussion. Reviewing Stein's (1972, cited in Kächele andSchachter 2014) list, which includes the considerations in Bergin's (1963) article about the factors that can negatively affect the outcomes of psy-chotherapy, allowed these factors to be considered as contributions for the patient. The first was to clarify the diagnostic criterion for the patient.…”

“…Recent research on the differential effects of interpret-ations when based on transference follows this same line (Höglend and Gabbard 2012). This debate is ongoing, however, as other perspectives such as that of Kächele and Schachter (2014) warn about the negative contribution of certain techniques that chal-lenge habitual defences, especially for patients with borderline disorders. Different studies with borderline patients (Horwitz 1974;Weber, Bachrach, and Solomon 1985;Fonagy et al 1996, cited in Kächele and Schachter 2014) report that there is sometimes a worsening of patients' conditions and that therapeutic techniques are probably respon-sible for this decline, which does not minimise the fact that the patients' characteristics also come into play, as does the ever-present singularity.…”

“It was like having half of the patient in therapy”: Therapists of nonimproved patients looking back on their work

“…As concluded by Baldwin and Imel (2013, p. 292), "we need to attend and to learn more about within-therapist differences. " We also know that therapists are seldom able to correctly identify deterioration in their patients (Gold & Stricker, 2011;Whipple & Lambert, 2011), to see their own treatment failures (Kächele & Schachter, 2014), and are unfamiliar with methods and criteria for identifying and preventing negative outcomes (Bystedt et al, 2014). Still, the therapist's awareness of unsuccessful treatment may significantly improve clinical outcomes (Hatfield, Frantz, McCullough, & Krieger, 2010).…”