Risk factors for negative experiences during psychotherapy.

Area of Science:

• Psychology
• Psychotherapy Research
• Clinical Psychology

Background:

• An estimated 3% to 15% of patients report negative psychotherapy experiences, a phenomenon poorly understood.
• Few empirical studies have investigated the contributing factors to these adverse therapeutic outcomes.

Purpose of the Study:

• To investigate the specific factors associated with patients' negative experiences during psychotherapy.
• To identify risk factors for negative therapy effects and provide a model for clinicians.

Main Methods:

• The study utilized a mixed-methods approach, collecting data from 185 patient and 304 therapist questionnaires, alongside 20 patient and 20 therapist interviews.
• Thematic analysis was employed to analyze transcribed data from patients reporting unhelpful or harmful therapy experiences and therapists' perspectives on similar cases.

Main Results:

• A significant finding was the lack of fit between patient needs, therapist skills, and service structures, leading to 'Fault Lines'.
• These 'Fault Lines' created tension between safety, containment, power, and control, resulting in 'Strain' and 'Poor Engagement', ultimately leading to negative consequences.

Conclusions:

• Patients benefit from clear information, choice, shared decision-making, explicit contracting, and transparency regarding sessions and progress.
• Therapists and services should actively seek patient feedback and remain vigilant for signs of deterioration, implementing solutions promptly.
• Establishing a supportive service structure is crucial for mitigating negative therapy experiences and enhancing patient satisfaction.