Psychotherapy can be highly effective, but like any treatment, it has potential side effects. With limited research on the negative effects of psychotherapy and little discourse on the topic, these risks can be easy to overlook. As a healthcare professional, it is important to understand the possible outcomes of therapy assigned to your patients seeking mental health services.
In recent years, mental health and psychotherapy has become a major focus in healthcare, driven by growing awareness and the rising prevalence of depression and other mental illnesses. Globally, approximately 280 million people experience depression, affecting 3.8% of the population. Each year, more than 700,000 people die by suicide, making it the fourth leading cause of death among individuals aged 15 to 29.*
This growing recognition has led to increased campaigns and investments aimed at making psychotherapy more accessible. Online services have expanded rapidly, offering lower costs and digital sessions to reach a wider audience.
Psychotherapy, such as Cognitive-Behavioural Therapy (CBT), Psychodynamic Therapy, and Humanistic Therapy, is often considered the first line of treatment over pharmacological interventions, partly due to the perception that it carries fewer risks.
There is limited research on the potential side effects of psychotherapy. Unlike SSRIs, which undergo extensive trials due to pharmaceutical backing and regulatory requirements, psychotherapy lacks similar scrutiny.
The perception that mental health therapy is inherently safe, combined with challenges in assessing its side effects, has limited research. As a result, while SSRIs have been widely studied for adverse effects, psychotherapy’s potential side effects remain underexplored, leading to a lack of awareness among healthcare professionals and the general public.
Read on to learn more about the negative effects of psychotherapy and what healthcare professionals need to be aware of:
Challenges in Defining Side Effects of Psychotherapy
Defining side effects in psychotherapy presents unique challenges that distinguish it from pharmacological treatments. Unlike medications, where side effects are often physiological and more easily identifiable, mental health therapy involves complex psychological and interpersonal dynamics, making the delineation of adverse effects less straightforward.
One primary challenge is the subjective nature of psychological therapy outcomes. Patients may experience emotional distress during therapy sessions, which could be a necessary part of the therapeutic process rather than an adverse effect. Distinguishing between therapeutic discomfort and genuine harm requires careful consideration. For instance, a patient confronting traumatic memories may initially feel worse before achieving improvement.
Another complicating factor is the variability in individual responses to psychotherapy. What one patient perceives as a negative outcome, another might view as a positive transformation. For example, therapy might lead to significant life changes, such as ending a detrimental relationship or changing careers. While these changes can be beneficial, they might also result in temporary stress or loss, which some could interpret as adverse effects of psychotherapy.
The lack of standardised criteria for identifying and reporting psychotherapy side effects contributes to the difficulty in defining them. Unlike drug trials that have established protocols for monitoring adverse events, psychotherapy research often lacks consistent methodologies for assessing negative outcomes. This inconsistency hampers the ability to gather reliable data on the prevalence and nature of such effects.
Therapist-related factors, such as competence and adherence to ethical guidelines, play a significant role in patient outcomes. Negative effects can arise from malpractice or unethical conduct, further blurring the lines between inherent therapy risks and those introduced by practitioner behaviour.
These challenges highlight the need for research and standardised assessment tools to identify and measure psychotherapy side effects. Raising awareness among healthcare professionals is crucial for improving patient care and reducing potential harm.
6 Examples of Side Effects of Psychotherapy
Psychotherapy, while beneficial for many, can sometimes lead to unintended side effects. Research has identified several potential adverse outcomes:
- Worsening of Symptoms: Some individuals may experience an exacerbation of their existing symptoms during or after psychological therapy. Studies estimate that between 3% to 15% of patients might face such deteriorations, influenced by various patient and therapist characteristics.* Although more research is needed to confirm these numbers, this highlights the importance of understanding the side effects of psychotherapy and monitoring patient progress closely.
- Strained Relationships: Therapeutic interventions in psychotherapy might inadvertently cause tensions within a patient’s personal relationships. Research indicates up to 33.2% of individuals undergoing psychotherapy, including cognitive-behavioural therapy (CBT), report side effects of psychotherapy, such as strained family relations and symptom deterioration.*
- Patients Feeling Invalidated or Undermined by Therapists: A qualitative meta-analysis found 56% of patients reported feeling rejected, disrespected, or humiliated during psychotherapy. This includes experiences of being dismissed, judged, or treated with hostility, as well as therapists imposing their values or trivialising clients’ concerns. Such interactions, considered among the side effects of psychotherapy, can lead to feelings of insignificance, alienation, or even violation, ultimately harming the therapeutic relationship.
- Development of New Symptoms: In some cases, psychotherapy can lead to the emergence of new psychological issues, such as increased anxiety, distress, or other negative emotions.
- Therapy Dependence: Some patients may develop an overreliance on their therapist or the therapeutic process as a result of psychotherapy, hindering their ability to function independently.
- False Memory Syndrome: Certain therapeutic techniques in psychotherapy, especially those involving memory retrieval, can lead to the creation of inaccurate or false memories, potentially causing additional distress.
Awareness of psychotherapy side effects is crucial for healthcare professionals to monitor and address them promptly, ensuring the overall well-being of their patients.
Research and Assessment Challenges of Psychotherapy Side Effects
Despite the increasing recognition of psychotherapy’s benefits, its potential negative effects remain under-researched and poorly defined.
For example, distinguishing between side effects, unwanted events, adverse treatment reactions, treatment failure, malpractice effects, and side effect profiles is essential for accurate research and assessment. However, the absence of standardised instruments and protocols for monitoring psychological therapy side effects makes systematic evaluation challenging. Unlike pharmacotherapy, which follows strict clinical guidelines for tracking adverse effects, psychotherapy research lacks consistency, leaving many negative outcomes undocumented.
Another significant challenge is perception bias, as therapists tend to focus on positive treatment outcomes, often overlooking or underreporting adverse effects of psychotherapy. This can create a skewed understanding of psychotherapy’s impact, leading to limited awareness of potential risks.
Another complication arises from psychotherapy’s broad spectrum of effects. Unlike pharmacological treatments, which primarily target specific symptoms, psychotherapy influences emotional, cognitive, and social behaviours. As a result, negative effects may manifest in diverse ways, making them harder to track and quantify.
Adding to this complexity is the lack of consensus on what qualifies as a negative effect. Life changes, such as a divorce initiated during therapy, could be interpreted as either a necessary step toward personal growth or an unintended consequence of treatment. Without clear definitions, it is difficult to assess the true risks and side effects of psychotherapy.
Psychotherapy has transformed countless lives, offering vital support for mental well-being. Like any treatment, understanding the potential side effects of psychotherapy ensures safer, more effective care. Increased research and awareness will only strengthen its role, helping healthcare professionals refine practices while continuing to provide life-changing support to those in need.
Do you have experience with reported side effects of psychotherapy as a healthcare professional? Share your thoughts in the comments below.
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