Service users' perspective of therapist-related unwanted events in psychotherapy-A systematic review

Despite the availability of evidence-based treatments and related studies for depression and anxiety, there is a research gap regarding therapist-related unwanted events in psychotherapy. Conducting a systematic review is essential to address such gap. This review aimed to address (a) How were therapist-related unwanted events described and measured in the literature? (b) What were the themes for therapist-related unwanted events from the perspective of service users as reported in the literature? A systematic search was conducted in Embase, MEDLINER, and APA PsycInfo databases. A total of 11,596 records were identified. Studies that provided information about therapist-related unwanted events reported by adult service users who received evidence-based treatment through face-to-face individual therapy delivered by health care professionals, therapists, or therapists in training were screened. Twenty-one quantitative studies and 26 qualitative studies were screened in for coding and analysis. Questionnaires and semistructured interviews were the most common methods capturing therapist-related unwanted events from service users' perspective. Three key themes were generated, namely, (1) therapists' skill and knowledge, (2) relationship with therapists, and (3) being hurt or harmed by therapists. This study contributes to the growing body of knowledge on therapist-related unwanted events in psychotherapy for depression and anxiety. The results of this study can be utilized to shape the creation of guidelines, training programs, and initiatives focused on improving the safety and effectiveness of psychotherapy for individuals with depression and anxiety. These findings have the potential to enhance the overall quality of care provided in psychotherapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).