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Cited by 61Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchPsychiatric care and mental health services

Risk factors for negative experiences during psychotherapy

Open access
Hardy, Gillian E., Bishop-Edwards, Lindsey, Chambers, Eleni, Connell, Janice, Dent-Brown, Kim, Kothari, Gemma, O’hara, Rachel, Parry, Glenys D.·2019·Psychotherapy Research
DOI 10.1080/10503307.2017.1393575
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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.

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Authors
Hardy, G. E., Bishop-Edwards, L., Chambers, E., Connell, J., Dent-Brown, K., Kothari, G., O’hara, R., & Parry, G. D.
Affiliations
  • University of Sheffield (GB)
  • School of Health and Related Research, University of Sheffield, Sheffield, UK
  • Department of Psychology, University of Hull, Hull, UK
Corresponding author
Hardy, Gillian E.
ORCID
Venue
Psychotherapy Research
Publisher
Informa UK Limited
Published
2017-10-27
Volume
29
Issue
3
Pages
403-414
ISSN
  • 1050-3307 (ISSN-L)
  • 1468-4381
DOI
10.1080/10503307.2017.1393575
OpenAlex
W2766071456
Cited by
61
References
47
Citations by year
2026: 3 · 2025: 10 · 2024: 11 · 2023: 4 · 2022: 11 · 2021: 7 · 2020: 9 · 2019: 3 · 2018: 2 · 2017: 1
FWCI
5.09
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Psychotherapy Research (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
  • Repository@Hull (Worktribe) (University of Hull) (submittedVersion, other-oa)
Funders
  • National Institute for Health Research
  • Research for Patient Benefit (RfPB) Programme (PB-PG-0408-15144)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
risk factors, therapist skills, patient engagement, patient feedback, patient expectations
MeSH terms
Adult, Aged, Mental Disorders, Female, Humans, Male, Middle Aged, Professional-Patient Relations, Psychotherapy, Risk Factors, Patient Satisfaction, Process Assessment, Health Care, Young Adult

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