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Journal of Contemporary Psychotherapy

, Volume 43, Issue 2, pp 95–105 | Cite as

Patients’ Perceptions of Risky Developments During Psychotherapy

  • Anton LeitnerEmail author
  • Michael Märtens
  • Alexandra Koschier
  • Katharina Gerlich
  • Gregor Liegl
  • Heidemarie Hinterwallner
  • Ulrich Schnyder
Original Paper

Abstract

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.

Keywords

Psychotherapy research Psychotherapeutic damages Psychotherapy risks Conditions for negative development Online research Side effects 

References

  1. Barkham, M., Connell, J., Stiles, W., Miles, N., Margison, F., Evans, C., et al. (2006). Dose–effect relations and responsive regulation of treatment duration: The good enough level. Journal of Consulting and Clinical Psychology, 74(1), 160–167.PubMedCrossRefGoogle Scholar
  2. Barlow, D. H. (2010). Negative effects from psychological treatments: A perspective. The American Psychologist, 65, 13–20.PubMedCrossRefGoogle Scholar
  3. Bergin, A. E. (1963). The effects of psychotherapy: Negative results revisited. Journal of Counseling Psychology, 10, 244–250.CrossRefGoogle Scholar
  4. Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). New York: Wiley.Google Scholar
  5. Binder, P. E., Holgersen, H., & Nielsen, G. H. (2010). What is a “good outcome” in psychotherapy? A qualitative exploration of former patient’s point of view. Psychotherapy Research, 20(3), 285–294.PubMedCrossRefGoogle Scholar
  6. Birnbaum, M. H. (2004). Human research and data collection via the internet. Annual Review of Psychology, 55, 803–832.PubMedCrossRefGoogle Scholar
  7. Busch, I., & Lemme, R. (1992). Schulenspezifische Unterschiede hinsichtlich der Einstellung der Therapeuten zur Wirkung von Psychotherapie. Berlin: TU Berlin.Google Scholar
  8. Carey, T. A. (2010). Will you follow while they lead? Introducing a patient-led approach to low intensity CBT interventions. In J. Bennett-Levy (Ed.), Oxford guide to low intensity CBT interventions (pp. 331–338). Oxford: Oxford University Press.Google Scholar
  9. Carey, T. A., & Spratt, M. B. (2009). When is enough enough? Structuring the organisation of treatment to maximise patient choice and control. The Cognitive Behaviour Therapist, 2, 211–226.CrossRefGoogle Scholar
  10. Connolly, M. B., & Strupp, H. H. (1996). Cluster analysis of patient reported psychotherapy outcome. Psychological Research, 6, 30–42.Google Scholar
  11. BGB1.I. Datenschutzgesetz 2000. (Vol. 165/1999). http://www.ris.bka.gv.at/Dokumente/BgblPdf/1999_165_1/1999_165_1.pdf. Accessed 21 May 2012.
  12. Elliott, R. (1991). University of Toledo: Investigating significant therapy events. In L. E. Beutler & M. Crago (Eds.), Psychotherapy research—an international review of programmatic studies (pp. 317–321). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  13. Fäh, M. (2002). Wenn Analyse krank macht. Methodenspezifische Nebenwirkungen psychoanalytischer Therapien. In M. Maertens & H. G. Petzold (Eds.), Therapieschäden: Risiken und Nebenwirkungen von Psychotherapie. Mainz: Matthias-Grünewald-Verlag.Google Scholar
  14. Frank, M., & Fiegenbaum, W. (1994). Therapieerfolgsmessung in der psychotherapeutischen Praxis. Zeitschrift für Klinische Psychologie, 23(4), 268–275.Google Scholar
  15. Frohburg, I. (2001). Untersuchungen zum Schadensverständnis von Gesprächspsychotherapeut(inn)en. In M. Märtens & H. G. Petzold (Eds.), Therapieschäden: Risiken und Nebenwirkungen von Psychotherapie. Mainz: Matthias-Grünewald Verlag.Google Scholar
  16. Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web based studies? A comparative analysis of six preconceptions about Internet questionnaires. American Psychologist, 59(2), 93–104.PubMedCrossRefGoogle Scholar
  17. Grawe, K. (2005). (Wie) kann psychotherapie durch empirische Validierung wirksamer werden? Psychotherapeutenjournal, 1, 4–11.Google Scholar
  18. Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., et al. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. Journal of Clinical Psychology, 61, 155–163.PubMedCrossRefGoogle Scholar
  19. Hatfield, D. S., McCullough, L., Plucinski, A., & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapist’s ability to detect negative client change. Clinical Psychology and Psychotherapy, 17, 25–32.PubMedGoogle Scholar
  20. Heins, M. J., Knoop, H., & Bleijenberg, G. (2011). Reply to “harms of cognitive behavior therapy designed to increase activity levels in chronic fatigue syndrome”. Psychotherapy and Psychosomatics, 80, 112.CrossRefGoogle Scholar
  21. Heins, M. J., Knoop, H., Prins, J. B., Stulemeijer, M., van der Meer, J. W. M., & Bleijenberg, G. (2010). Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome. Psychotherapy and Psychosomatics, 79, 249–256. doi: 10.1159/000315130.PubMedCrossRefGoogle Scholar
  22. Hermer, M., & Röhrle, B. (2008). Therapeutische Beziehungen: Geschichte, Entwicklung und Befunde. In M. Hermer & B. Röhrle (Eds.), Handbuch der therapeutischen Beziehung (Vol. 1, pp. 15–108). Tübingen: DGVT.Google Scholar
  23. Hill, C. L., & Lambert, M. J. (2004). Methodological issues in studying psychotherapy processes and outcomes. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 84–136). New York: Wiley.Google Scholar
  24. Hoffmann, S. O. (2002). Unerwünschte und schädliche Wirkungen von Psychotherapie. In D. Mattke, Hertel, G., Büsing, S., Schreiber-Willnow, K. (Ed.), Störungsspezifische Konzepte und Behandlung in der Psychosomatik (vol. 15–32.). Frankfurt a.M: VAS.Google Scholar
  25. Hoffmann, S. O., Rudolf, G., & Strauß, B. (2008). Unerwünschte und schädliche Wirkungen von Psychotherapie. Eine Übersicht mit dem Entwurf eines eigenen Modells. Psychotherapeut, 53, 4–16.CrossRefGoogle Scholar
  26. Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139–149.CrossRefGoogle Scholar
  27. Jacobi, F. (2002). Risiken und Nebenwirkungen verhaltenstherapeutischer Behandlung. In M. Märtens & H. G. Petzold (Eds.), Therapieschäden. Risiken und Nebenwirkungen von Psychotherapie (pp. 89–109). Mainz: Matthias-Grünewald-Verlag.Google Scholar
  28. Kim, D. M., Wampold, B. E., & Bolt, D. M. (2006). Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data. Psychotherapy Research, 16(2), 161–171.CrossRefGoogle Scholar
  29. Kindlon, T. (2011). Harms of cognitive behavior therapy designed to increase activity levels in chronic fatigue syndrome: Questions remain. Psychotherapy and Psychosomatics, 80, 110–111.PubMedCrossRefGoogle Scholar
  30. Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S. S., & Hayes, J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapie Research, 21(3), 267–276.CrossRefGoogle Scholar
  31. Lambert, M. J. (2004). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley.Google Scholar
  32. Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  33. Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy. In J. C. Norcross (Ed.), Psychotherapy and relationships at work (pp. 17–32). New York: Oxford University Press.Google Scholar
  34. Levitt, H. M., Butler, M., & Hill, C. (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment-to moment change. Journal of Counseling Psychology, 53(4), 314–324.CrossRefGoogle Scholar
  35. Mayring, P. (2000). Qualitative Inhaltsanalyse: Grundlagen und Techniken. Weinheim: Deutscher Studien Verlag.Google Scholar
  36. Nadelson, C. C., Notman, M. T., & McCarthy, M. K. (2005). Gender issues in psychotherapy. In Oxford textbook of psychotherapy (pp. 411–420). Oxford: Oxford University Press.Google Scholar
  37. Neises, M., & Barolin, G. S. (2009). Gender-spezifische Aspekte in der Psychotherapie. Wiener Medizinische Wochenschrift, 159(11–12), 281–287. doi: 10.1007/s10354-009-0680-x.CrossRefGoogle Scholar
  38. Nolan, S. A., Strassle, C. G., Roback, H. B., & Binder, J. L. (2004). Negative treatment effects in dyadic psychotherapy: A focus on prevention and intervention strategies. Journal of Contemporary Psychotherapy, 34(4), 311–330.CrossRefGoogle Scholar
  39. Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 307–389). New York: Wiley.Google Scholar
  40. Rennie, D. L. (2000). Aspects of client’s conscious control of the therapeutic process. Journal of Psychotherapy Integration, 10(2), 151–167.CrossRefGoogle Scholar
  41. Sonnenmoser, M. (2002). Geschlechtsspezifische Unterschiede: Vernachlässigte Gender-Perspektive. Deutsches Ärzteblatt PP, 7, 317.Google Scholar
  42. Stiles, W. B., Barkham, M. B., Connell, J., & Mellor-Clark, J. (2008). Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: Replication in a larger sample. Journal of Consulting and Clinical Psychology, 76, 298–305.PubMedCrossRefGoogle Scholar
  43. Strauss, A. L. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  44. Strauß, B., & Wittmann, W. W. (2005). Psychotherapieforschung: Grundlagen und Ergebnisse. In W. Senf, & M. Broda (Eds.), Praxis der Psychotherapie. Ein integratives Lehrbuch (pp. 760–781). Stuttgart: Thieme.Google Scholar
  45. Strupp, H. H., Fox, R. E., & Lessler, K. (1969). Patients view their psychotherapy. Baltimore: John Hopkins Press.Google Scholar
  46. Strupp, H. H., Hadley, S. W., & Gomes-Schwartz, B. (1977). Psychotherapy for better or worse: An analysis of the problem of negative effects. Montvale: Jason Aronson.Google Scholar
  47. Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73(5), 914–923.PubMedCrossRefGoogle Scholar
  48. Welker, M., Werner, A., & Scholz, J. (2005). Online-Research. Markt- und Sozialforschung mit dem Internet. Heidelberg: dpunkt.verlag GmbH.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Anton Leitner
    • 1
    Email author
  • Michael Märtens
    • 2
  • Alexandra Koschier
    • 1
  • Katharina Gerlich
    • 1
  • Gregor Liegl
    • 1
  • Heidemarie Hinterwallner
    • 1
  • Ulrich Schnyder
    • 3
  1. 1.Department for Psychotherapy and Biopsychosocial HealthDanube University KremsKremsAustria
  2. 2.University of Applied Sciences FrankfurtFrankfurt am MainGermany
  3. 3.Department of Psychiatry and PsychotherapyUniversity Hospital ZurichZurichSwitzerland

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