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How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users'
Joe Curran1, Glenys D Parry2, Gillian E Hardy3
1Sheffield Health and Social Care NHS Foundation Trust, Sheffield, United Kingdom.
Frontiers in Psychology
|April 2, 2019
Summary
Clients report psychotherapy can be harmful due to contextual issues and unhelpful therapist behaviors. Understanding these negative therapeutic processes is key to improving patient safety and therapy outcomes.
Area of Science:
- Psychology
- Psychotherapy Research
Background:
- Limited quantitative research exists on therapy-induced harm.
- Qualitative evidence highlights clients' negative psychotherapy experiences.
Approach:
- Systematic narrative synthesis of qualitative research and client testimony.
- Adapted Greenberg (2007) task analysis for data synthesis.
- Developed and validated a rational-empirical model of adverse therapeutic processes.
Key Points:
- Contextual factors (cultural validity, unmet expectations) and therapist behaviors (rigidity, lack of knowledge) contribute to negative therapeutic processes.
- Clients reported feeling disempowered, silenced, or devalued.
- Power dynamics and blame were identified as contributing factors.
Conclusions:
- Task analysis effectively synthesizes qualitative data on negative therapy experiences.
- Harmful factors exist at all stages of therapy, necessitating practice improvements.
- Client perspectives are crucial for identifying and mitigating risks in psychotherapy.