A Synopsis of the Side Effects of Psychotherapy – What Should Clinicians Know?
Psychological interventions are evidence based first line treatments for many psychiatric disorders with evidence that therapy can alleviate mental distress and enhance wellbeing. In conditions such as depression and anxiety, the beneficial effects of psychotherapy are often comparable with evidence-based pharmacotherapy options in terms of symptom reduction and protection against relapse.
At first pass it might appear bizarre to question whether psychotherapy could be harmful or have substantive side effects, with Nutt & Sharpe observing that there is an assumption……that as psychotherapy is only talking……no possible harm could ensue.  (Berk & Parker)
While discussion about side effects, risks and benefits are an important part of psychotropic medication prescribing, the same cannot be said for psychological treatments. All pharmacological medications come with relevant or absolute contraindications, and yet the common assumption is that talking therapies are risk-free or come with little risk at all.
Most psychotherapy clinical trials concentrate on observing clinical efficacy based on that study’s predetermined diagnostic criteria. It is important to recognise that psychotherapy is not free from side effects with a range of potentially negative patient outcomes in the context of treatment .
The study of negative effects in psychotherapy research is under-represented, and this is due to several reasons:
- There is an inherent difficulty in differentiating between side effects and unavoidable negative effects.
- A therapist has a legal responsibility and may face malpractice if the reported side effects were caused by incorrect therapist behavior rather than perhaps just aberrant patient behaviour.
- Lack of consensus on the terminology of side effects.
Crawford M et al., Patient experience of negative effects of psychological treatment: results of a national survey. British Journal of Psychiatry. 2016
Scheeringa M et al., Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. Journal of Child Psychology and Psychiatry. 2011
Piacentini J et al., Behavior therapy for children with Tourette Disorder: A randomized controlled trial. JAMA. 2010