Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies
Open accessAbstract
Negative effects of psychotherapy include side effects, malpractice, and unethical behavior. Its' setting-specific frequencies and predictors are mostly unknown. The aim of the two presented studies is to investigate NEP and its predictors systematically across different treatment settings. In study 1, N=197 patients of a German outpatient center were recruited on average 3.76 years after termination of psychotherapy. In study 2, data from N=118 patients of two German inpatient clinics were collected at admission (t0), discharge (t1), and 9-months follow-up (t2). All participants evaluated negative effects of their previous out-or inpatient psychotherapy and a priori hypothesized predictors. Inpatients reported significantly more side effects (U = 14347, z = 4.70 p < .001, r = 0.26) and malpractice and unethical behavior (U = 14168, z = 5.21, p < .001, r = 0.29) than outpatients. At least one side effect was reported by 37.3% of inpatients (t2) and 15.2% of outpatients. Frequently reported side effects were "experiencing more downs since the end of my therapy" by inpatients (t2; 16.1%) and "having trouble finding insurance or being worried about applying for new insurance" by outpatients (4.6%). At least one case of malpractice and unethical behavior was reported by 28.8% of inpatients (t2) and 7.1% of outpatients. Frequently reported cases were "being hurt by what the therapist said to me" by inpatients (t2; 20.3%) and "feeling forced to do things I did not want to do (e.g. confrontations, role plays)" by outpatients (4.1%). Rates of severe malpractice in form of breaking confidentiality, physical and sexual abuse were less than 1% in both settings. Predictors of side effects were prior experience with psychotherapy and current interpersonal difficulties. Predictors of malpractice and unethical behavior were a poor therapeutic alliance and prior negative experience with malpractice and unethical behavior. Negative effects of psychotherapy are common in both, in-and outpatient settings. Inpatients are at higher risk for negative effects of psychotherapy than outpatients. In order to safeguard patients' wellbeing, the systematic assessment and distinction of side effects and malpractice and unethical behavior should gain more attention in research and clinical practice.
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Two studies using the INEP found side effects in 15-20% of mixed outpatient CBT samples in university clinics.
“Two studies using the INEP found side effects in 15-20% of mixed outpatient CBT samples in university clinics (Gerke et al., 2020;Nestoriuc & Rief, 2013).”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Gerke et al., 2020
The Results (Study 1) report that 15.2% of outpatients experienced at least one side effect; the Methods describe a cognitive-behavioral outpatient center accepting patients irrespective of diagnosis. This paper’s second study was inpatient, not another outpatient CBT sample, and our copy does not identify the outpatient center as a university clinic. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSide effects as measured with the INEP have been linked to poorer therapeutic alliance, more interpersonal difficulties, higher treatment expectations, and lower treatment satisfaction.
“Side effects as measured with the INEP have been linked to poorer therapeutic alliance (measured with the Helping Alliance Questionnaire), more interpersonal difficulties (measured with the Inventory of Interpersonal Problems, Gerke, Meyrose, Ladwig, Rief, & Nestoriuc, 2020), higher treatment expectations (Abeling, Müller, Stephan, Pollmann, & De Zwaan, 2018;Rheker, Beisel, Kräling, & Rief, 2017)”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Gerke, Meyrose, Ladwig, Rief, & Nestoriuc, 2020
The most frequent side effects in this study were (fear of) treatment stigma, insurance problems, low mood, the experience to depend on the therapist and conflicts with patients' partners.
“The most frequent side effects in this study were (fear of) treatment stigma, insurance problems, low mood, the experience to depend on the therapist and conflicts with patients' partners”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Gerke et al., 2020
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- Authors
- Gerke, L., Meyrose, A.-K., Ladwig, I., Rief, W., & Nestoriuc, Y.
- Affiliations
- Helmut Schmidt University (DE)
- Philipps University of Marburg (DE)
- Corresponding author
- Gerke, Leonie
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2020-08-25
- Volume
- 11
- Pages
- 2144-2144
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC7478145
- OpenAlex
- W3080174800
- Cited by
- 33
- References
- 46
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 8 · 2023: 5 · 2022: 4 · 2021: 5
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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
- malpractice, inpatient psychotherapy, outpatient psychotherapy, therapeutic relationship, interpersonal problems, patient-reported outcomes, breach of confidentiality
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