Negative Effects From Psychological Treatments A Perspective

Center for Anxiety and Related Disorders, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
American Psychologist (Impact Factor: 6.87). 01/2010; 65(1):13-20. DOI: 10.1037/a0015643
Source: PubMed


The author offers a 40-year perspective on the observation and study of negative effects from psychotherapy or psychological treatments. This perspective is placed in the context of the enormous progress in refining methodologies for psychotherapy research over that period of time, resulting in the clear demonstration of positive effects from psychological treatments for many disorders and problems. The study of negative effects--whether due to techniques, client variables, therapist variables, or some combination of these--has not been accorded the same degree of attention. Indeed, methodologies suitable for ascertaining positive effects often obscure negative effects in the absence of specific strategies for explicating these outcomes. Greater emphasis on more individual idiographic approaches to studying the effects of psychological interventions would seem necessary if psychologists are to avoid harming their patients and if they are to better understand the causes of negative or iatrogenic effects from their treatment efforts. This would be best carried out in the context of a strong collaboration among frontline clinicians and clinical scientists.

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    • "Moreover, there seem to be only minor significant differences of therapeutic effects in different psychotherapy schools (Castonguay and Beutler, 2006; Barber et al., 2013; Wampold and Imel, 2015). However, other findings indicate that there is still a considerable amount of patients who do not benefit from psychotherapy (Lambert, 2013), or even get worse and that the sustainability of therapy effects is limited in certain patient populations (Barlow, 2010). "
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    ABSTRACT: Language is one of the most important “tools” of psychotherapists. The working mechanisms of verbal therapeutic techniques, however, are still marginally understood. In part, this is due to the lack of a generally acknowledged typology as well as a gold standard for the assessment of verbal techniques, which limits the possibility of conducting studies focusing this topic. The present study reviews measures used in clinical research which assess directly observable dimensions of verbal interventions in a reliable manner. All measures were evaluated with respect to their theoretical foundation, research goals, assessment modes, and various psychometric properties. A systematic search in databases (PubMed, PsycInfo, PsycArticles, PSYNDEX, Web of Science, Embase) followed by an additional “snowballing” search covering the years 1940–2013 yielded n = 179 publications eligible for review. Within these publications, 34 measures were identified showing great heterogeneity regarding the aspects under study. Only two measures reached the highest psychometric standards and can be recommended for clinical use without any reservation. Central problems include deficiencies in the systematization of techniques as well as their partly ambiguous and inconsistent definitions. To promote this field of research, it will be important to achieve a consensus concerning the terminology, conceptions and measures of verbal interventions.
    Frontiers in Psychology 11/2015; 6:1705. DOI:10.3389/fpsyg.2015.01705 · 2.80 Impact Factor
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    • "A therapy style characterized by harsh confrontations may well have an adverse effect and could increase the risk of recidivism (Marshall et al, 2005). The awareness that therapy can cause damage has grown, although this is not a problem unique to forensic therapy (see Barlow, 2010). Nunes and Cortoni (2006) looked at offenders who dropped out and found that those who were excluded from therapy ended up with an increased risk of relapse. "
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    ABSTRACT: Motivation for change in offenders is a multi-layered concept and requires a specialized approach. This article first discusses some motivation concepts (together with their limitations) that are often used in forensic practice. Daniel Pink (2009) picked up on some insights from behavioral research and introduced a modern motivation approach in the business world. He calls his approach “motivation 3.0” and promotes commitment in individuals by stimulating three basic human drives: autonomy, mastery and purpose. This model is also useful for clinicians working with offenders. Various steps are illustrated by means of a case study of a sexual offender. ( accepted for publication by SEXUAL OFFENDER TREATMENT, the official journal of the International Association for the Treatment of Sexual Offenders, IATSO)
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    • "1.2. Side-effects of psychotherapy – terra incognita Despite early reports that psychotherapy can cause unwanted effects, too (Barlow, 2010), the systematic examination of adverse effects arising from psychotherapy is still in its infancy (for a review see Linden, 2013). Reasons for the apparent neglect of adverse events in psychotherapy research are multi-faceted. "
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    ABSTRACT: Objective: It is almost a matter of fact for both clinicians and patients that pharmacological agents exert wanted as well as unwanted effects. In contrast, unwanted events of psychotherapy have long been neglected. Method: The present study investigated the frequency and correlates of wanted and unwanted effects of psychotherapy in 85 participants with obsessive-compulsive disorder (OCD). The study was performed anonymously over the Internet in order to reduce response biases. Results: Most patients showed ambivalent appraisals: 95% named at least one wanted effect, whereas 93% named at least one adverse treatment reaction (i.e., side-effect) and 89% indicated at least one instance of (subjective) malpractice. Complaints about unethical behavior were named by 14% of the participants. Wanted and unwanted effects were negatively correlated. Prevalent side-effects included development of new symptoms in 29% of the participants, for example, in the course of exposure treatment. Conclusions: Our findings corroborate prior reports that adverse effects in psychotherapy are common, even if treatment is successful. Results refute a "no pain no gain" view: adverse events negatively impact outcome. Findings await confirmation in well-characterized in- and outpatient samples.
    Journal of Obsessive-Compulsive and Related Disorders 02/2015; 5. DOI:10.1016/j.jocrd.2015.02.002 · 1.18 Impact Factor
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