We hear a lot about the unwelcome side-effects of psychiatric drugs, but not so much about the fact that therapy can also leave people feeling worse than they did already. Data is thin on the ground, but best estimates suggest that between 5 to 10 per cent of therapy clients experience a worsening of their symptoms. Now a study in The British Journal of Psychiatry has provided further evidence, from the clients’ perspective, about the prevalence of harmful therapy outcomes, with around 1 in 20 of thousands of participants saying that they had experienced “lasting bad effects” from therapy.

Mike Crawford and his colleagues surveyed nearly 15,000 people who were currently receiving, or had recently ended, out-patient therapy for depression or anxiety via the National Health Service in England and Wales. Of the 14,270 people who answered the question about potential adverse effects of therapy, 763 said that they agreed strongly or slightly that their therapy had resulted in lasting bad effects, a proportion the researchers described as a “substantial minority”.

The most common form of therapy was CBT but other therapies the participants had received included psychodynamic therapy, counselling and solution-focused therapy. The survey suggested that no particular therapy approach was more often associated with bad outcomes. However, participants who said they were unsure what kind of therapy they’d received or who said they’d received an “other” form of therapy (not listed on the survey) were more likely to report bad effects, as were those who indicated they hadn’t been given sufficient information about therapy before it started.

Participants from ethnic and sexual minorities were also more likely to report lasting bad effects – the researchers don’t know why this might be but they said it may indicate a need for more emphasis on “cultural competence” in therapists’ training.

Therapeutic harm is a difficult issue to study – among other things, it’s possible that any symptom deterioration would have happened anyway (of course this problem of interpretation also works the other way in that any symptom improvement may actually have been quicker without therapy). But nearly all psychologists are in agreement that adverse effects from therapy are a real risk, and that we need to know more about how commonly they occur and how to reduce the likelihood of them happening. This study therefore provides some welcome data on an important topic.

Indeed, Crawford and his team point out that well over a million people in England have received psychological treatment for common mental disorders in recent years, which means (based on the new data) that “thousands of people could have experienced negative effects from treatment”. The researchers advised that “clinicians delivering psychological therapies should ensure that people feel that they have sufficient information about treatment before it starts and obtain informed consent to treatment by ensuring that people considering psychological treatment for their condition are aware that there is the potential for both positive and negative effects.”

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Crawford, M., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., Clarke, J., & Parry, G. (2016). Patient experience of negative effects of psychological treatment: results of a national survey The British Journal of Psychiatry, 208 (3), 260-265 DOI: 10.1192/bjp.bp.114.162628

—further reading—

When therapy causes harm

What do clients think of psychotherapy that doesn’t work?

The mistakes that lead therapists to infer psychotherapy was effective, when it wasn’t

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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