Psychotherapy can also have side effects

They are meticulously listed on every package insert and information sheet—the risks and side effects of drug or surgical therapy. This is because the desired outcome is often accompanied by undesirable effects, and ideally the patient and the therapy team jointly decide on the best individual treatment after carefully weighing the pros and cons. The basic ethical principle of »nil nocere«—do no harm—also applies to psychotherapy. Transparent information about the risks and benefits of therapy is essential: it promotes the trust and autonomy of those undergoing treatment, balances expectations of the therapy and reduces the drop-out rate and dissatisfaction with psychotherapy.

A prerequisite for this transparent information is scientifically verfied information on the risk profiles of psychotherapeutic treatments. While effectiveness research has a long tradition, risks and side effects have only recently been added to the psychotherapeutic research agenda. At the invitation of the renowned journal »Nature Reviews Psychology«, a team of authors from Jena University Hospital (JUH) with international participation has now summarized the current state of scientific knowledge on the subject.

Side effects occur with every tenth therapy

»At our institute, we have been investigating the causes and effects of adverse outcomes of psychotherapy for some time«, says Prof. Dr Bernhard Strauß, Director of the Institute of Psychosocial Medicine, Psychotherapy and Psychooncology at the JUH. »In addition to our own surveys and representative questionnaires, we have been evaluating counselling requests from the ›Ethics in Psychotherapy‹ association for years and have compiled a comprehensive literature analysis.« The result: side effects occur in more than one in ten therapies, and severe side effects are significantly less common.

But what adverse effects can psychotherapy have? The spectrum ranges from increasing or newly occurring symptoms to the deterioration of social relationships and negative consequences for professional life to acute mental crises or suicidal thoughts. »Two central aspects in clarifying the term are perspective and causality«, explains first author Prof. Dr Jenny Rosendahl. From the patient’s perspective, it may be distressing to be confronted with their fears, but this can be part of a properly conducted therapy. Does a patient’s relationship fail because the therapy has boosted their self-confidence, or because the relationship was doomed from the outset? The causes of undesirable effects also include therapeutic malpractice—such as ending therapy too early, continuing therapy even though the patient-therapist relationship is disrupted, or even gross therapeutic misconduct such as social and sexual assault.

Promoting awareness of possible negative effects of therapy

Although there is a wealth of research on the effectiveness of psychotherapy, side effects are rarely considered. The team of authors therefore recommends that negative effects be recorded and published in psychotherapy research in both qualitative and quantitative terms. »Sensitivity to possible negative effects in therapy and awareness of the role of the psychotherapist in generating negative effects should already be developed during psychotherapeutic training«, emphasizes Bernhard Strauß.

Reporting systems should also support quality assurance in clinical practice. Jenny Rosendahl adds: »For a therapeutic relationship based on trust, transparent information about negative effects—without being overly pessimistic—is just as important as the opportunity for patients to address problems and criticism during treatment.«