A qualitative study of service user reports of negative experiences regarding therapist practices

Negative experiences with therapists are not uncommon but the literature lacks in-depth investigation on this issue. Therapists have been found to be ineffective in recognizing and even leading to negative experiences. It is crucial to gain a better understanding of these negative experiences from service users' perspective to prevent harm, especially among Asians who are underrepresented. The present study aimed to identify and analyze themes of negative experiences regarding therapists' practice based on subjective narratives of service users in Hong Kong. Twenty participants who received psychotherapy were recruited in Hong Kong for an individual semistructured interview. Interview questions included details of negative experiences with therapists, the impact of these events, and reasons for nondisclosure of negative experiences to their therapists. Reflexive thematic analysis was adopted. Four themes were generated: (1) therapists' technical skills, which included lacking basic skills, lacking appropriate responsiveness, and omission and passivity; (2) therapists' relational skills, which included lacking empathy, lacking genuineness, and not approachable; (3) therapists' hurtful and harmful practice, which included judgments and inaccurate assumptions, abandonment, and retraumatization; and (4) users' response to therapist-related negative experiences. This qualitative study provided valuable insights into the subjective experiences of service users on negative experiences with therapists during psychotherapy. It also revealed the impact and nondisclosure of these experiences. Future studies could consider utilizing this framework and clinicians are recommended to take active precaution and be prepared to address potential negative experiences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).