Risk factors for negative experiences during psychotherapy

Abstract

Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of "unwanted effects," including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.

Psychiatric Interventions in Virtual Reality: Why We Need an Ethical Framework

“…In contrast to pharmacological or even invasive techniques, VR appears comparatively harmless at first glance and likely free of serious side effects-akin to evaluations of the safety of psychotherapy where the discussion of possible side effects only very recently began. 86 A closer look reveals that the inherent potential of VR to modify behavior in a desired way at the same time holds the danger of bringing about undesired mental states that might influence the behavior of a person not only in virtuo but also in vivo. Despite these risks, clinical use of VR offers unique therapeutic opportunities.…”

Exploring harm in psychotherapy: Perspectives of clinicians working with children and young people

“…Deterioration in clinical samples involving children and young people has been shown to be around 7.7% for anxiety and 3.7% for depression (Edbrooke-Childs, Wolpert, Zamperoni, Napoleone, & Bear, 2018). Not all clinicians identified this as a type of harm which fits with the notion that additional factors need to be taken into account when making these judgements (Hardy et al, 2019;Linden, 2013). One reason for this is some patients do get worse before they get better (Kramer & Stiles, 2015), and clinicians may view this as part of the therapeutic process.…”

“…Additionally, selecting the 'right' treatment, which was congruent with the patients' values and preferences, was also considered important. Previous research around negative experiences has highlighted that clinicians should understand patients' psychosocial context to get the right fit (Hardy et al, 2019). Yet, children The therapist being in a dominant position over the patient has been previously highlighted as leading to harm.…”

“…With time being a precious commodity and demand unlikely to fall, open and honest conversations at the start of therapy about length and what can be achieved may be a necessary compromise (Hayes et al, 2015), as well as an expedited route back for individuals who have previously failed to attend.The last contextual factor focused on how certain types of therapeutic approaches could lead to too much focus on the patient, creating a narrative that there was something wrong with them. Stigmatisation is one of the unwanted events outlined in the Linden (2013) model, and within empirical papers, patients cite feelings of failure as an outcome related to ineffective therapy(Hardy et al, 2019). To counteract this, clinicians may wish to explore the biopsychosocial approach with patients during assessment, as well as the precipitating, perpetuating, predisposing and present factors around their mental health difficulty.…”

A systematic review of qualitative studies of adults’ experiences of being assessed for psychological therapies

“…There is some evidence that psychological therapies can cause long‐term harm and that people who identify as LGBT and/or as black and minority ethnic are more likely to report harms . Hardy and colleagues found that a clear assessment, amongst other factors, fostered engagement and helped mitigate against potential long‐term harms …”