Risk factors for negative experiences during psychotherapy. (4th May 2019)

• Record Type: Journal Article
• Authors: Hardy, Gillian E.; Bishop-Edwards, Lindsey; Chambers, Eleni; Connell, Janice; Dent-Brown, Kim; Kothari, Gemma; O'hara, Rachel; Parry, Glenys D.
• Is Part Of: Psychotherapy research. Volume 29:Number 3(2019)
• Page Start: 403
• Page End: 414
• Publication Date: 2019-05-04
• Subjects: risk factors -- negative therapy experiences; fattori di rischio -- esperienze negative in terapia; 危險因子 -- 負向治療經驗; fatores de risco -- experiências negativas de terapia; Psychotherapy -- Periodicals; Psychotherapy -- Research -- Periodicals; Psychotherapy -- Periodicals; Psychothérapie -- Périodiques; Psychothérapie -- Recherche -- Périodiques; 616.891405
• DOI: 10.1080/10503307.2017.1393575
• Languages: English
• ISSNs: 1050-3307

Abstract

ABSTRACT: Background : It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. Aims : The aim of this study was to investigate the factors associated with patients' negative therapy experiences. Method : The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. Results : There was a Lack of fit between Patient needs, Therapist skills, and Service structures . This could result in Fault Lines, a tension between Safety and containment and Power and control . This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. Conclusions : 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.