Abstract
Negative effects of psychotherapy (NEP) include side effects, malpractice, and unethical behavior. Its setting-specific frequencies and predictors are mostly unknown. The two presented studies aim 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 the 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-month follow-up (t2). All participants evaluated the negative effects of their previous out- or inpatient psychotherapy with the Inventory for the Balanced Assessment of Negative Effects in Psychotherapy and a priori hypothesized predictors. At least one side effect was reported by 37.3% of inpatients (t2) and 15.2% of outpatients. At least one case of malpractice and unethical behavior was reported by 28.8% of inpatients (t2) and 7.1% of outpatients. Inpatients reported significantly more side effects (U = 14347, z = 4.70, p < 0.001, r = 0.26) and malpractice and unethical behavior (U = 14168, z = 5.21, p < 0.001, r = 0.29) than outpatients. Rates of severe malpractice in the form of breaking confidentiality and physical and sexual abuse were less than 1% in both settings. Predictors of side effects were prior experience with psychotherapy and current interpersonal difficulties in the outpatient setting and higher motivation for psychotherapy (t0) in the inpatient setting. Predictors of malpractice and unethical behavior were younger age in the outpatient setting and poor therapeutic alliance, prior negative experience with malpractice and unethical behavior, and higher outcome expectations in the inpatient setting. NEP are common in both, in- and outpatient settings. Inpatients are at higher risk for the NEP than outpatients. 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.
Highlights
Psychotherapy is evidence-based for a wide spectrum of psychological disorders
The present study aimed to investigate side effects (SE) and malpractice and unethical behavior (MUB) from patients’ perspective in a natural out- and inpatient settings
At least one adverse event with an external cause during psychotherapy was reported by 50% of outpatients and by 73% of inpatients
Summary
Psychotherapy is evidence-based for a wide spectrum of psychological disorders. Yet, increasing evidence for negative effects of psychotherapy (NEP) was provided over the last decade (Crawford et al, 2016; Cuijpers et al, 2018; Gawlytta et al, 2019; Moritz et al, 2019). The research group on Risks and Side Effects of Psychotherapy recently introduced common criteria for the identification and systematic classification of NEP (Linden et al, 2018) By their definition, adverse events summarize all negative changes that are caused by either psychotherapy or external factors like critical life events. Based on the presented findings, we hypothesize that a poor therapeutic alliance, low outcome expectations, low psychotherapy motivation, and more interpersonal difficulties predict more NEP. Besides these variables addressing therapeutic alliance and patient characteristics, context factors like prior experiences with psychotherapy and the treatment setting might be relevant for NEP (Linden et al, 2015). The aim of the present investigation was to (a) quantify the frequencies of SE and MUB in a natural out- and inpatient setting, (b) identify its cross-sectional and longitudinal predictors, and (c) compare the frequency and predictors of SE and MUB between the out- and inpatient settings
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
