Skip to main content
Log in

Negative Treatment Effects in Dyadic Psychotherapy: A Focus on Prevention and Intervention Strategies

  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

Therapy holds the potential to harm as well as help. This paper highlights approaches that may help prevent or decrease the incidence of negative effects in psychotherapy. These approaches include supervision, peer consultation, ongoing assessment of the therapeutic process, therapist-client matching, and referrals and transfers. We hope that this paper will serve as a stimulus for clinicians, psychotherapy researchers, and educators to put forth collabo-rative effort into identifying variables directly associated with adverse treat- ment outcomes and determining appropriate prevention and intervention strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ackerman, S. J., & Hilsenroth, M. J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy, 38, 171–185.

    Google Scholar 

  • Barlow, D. H. (1994). Effectiveness of behavior treatment for Panic Disorder with and without Agoraphobia. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of depression. New York: Guilford.

    Google Scholar 

  • Bein, E., Anderson, T., Strupp, H. H., Henry, W. P., Schacht, T. E., Binder, J. L., et al. (2000). The effects of training in time-limited dynamic psychotherapy: Changes in therapeutic outcome. Psychotherapy Research, 10, 119–132.

    Google Scholar 

  • Benshoff, J. M. (1993). Peer supervision in counselor training. The Clinical Supervisor, 11, 89–102.

    Google Scholar 

  • Bergin, A. E. (1963). The empirical emphasis in psychotherapy: A symposium. The effects of psychotherapy: Negative results revisited. Journal of Counseling Psychology, 10, 244–250.

    Google Scholar 

  • Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision. Boston: Allyn and Bacon.

    Google Scholar 

  • Beutler, L. E. (1997). The psychotherapist as a neglected variable in psychotherapy: An illustration by reference to the role of therapist experience and training. Clinical Psychology: Science and Practice, 4, 44–52.

    Google Scholar 

  • Beutler, L. E., & Clarkin, J. F. (1990). Systematic treatment selection: Toward targeted therapeutic interventions. New York: Brunner/Mazel.

    Google Scholar 

  • Beutler, L. E., Clarkin, J. F., & Bongar, B. (2000). Guidelines for the systematic treatment of the depressed patient. New York: Oxford University Press.

    Google Scholar 

  • Beutler, L. E., & Harwood, T. M. (1995). Prescriptive psychotherapies. Applied and Preventive Psychology, 4, 89–100.

    Google Scholar 

  • Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: A practical guide to systematic treatment selection. New York: Oxford University Press.

    Google Scholar 

  • Beutler, L. E., Machado, P. P. P., & Neufeldt, S. A. (1994). Therapist variables. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 229–269). New York: Wiley.

    Google Scholar 

  • Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 54, 965–978.

    Google Scholar 

  • Binder, J. L. (1993). Is it time to improve psychotherapy training? Clinical Psychology Review, 13, 301–318.

    Google Scholar 

  • Binder, J. L. (1999). Issues in teaching and learning time-limited psychodynamic psychotherapy. Clinical Psychology Review, 19, 705–719.

    Google Scholar 

  • Binder, J. L., & Strupp, H. H. (1997). Negative process: A recurrently discovered and underestimated facet of therapeutic process and outcome in the individual psychotherapy of adults. Clinical Psychology: Science and Practice, 4, 121–139.

    Google Scholar 

  • Buckley, P., Karasu, T. B., & Charles, E. (1981). Psychotherapists view their personal therapy. Psychotherapy: Theory, Research, and Practice, 18, 299–305.

    Google Scholar 

  • Calvert, S. J., Beutler, L. E., & Crago, M. (1988). Psychotherapy outcome as a function of therapist-patient matching on selected variables. Journal of Social and Clinical Psychology, 6, 104–117.

    Google Scholar 

  • Coleman, S. B. (1985). Failures in Family Therapy. New York: Guilford.

    Google Scholar 

  • Cowan, M. L., Weiner, E. A., & Weiner, B. J. (1974). Therapist perceptions of clients and client self-report. Journal of Clinical Psychology, 30, 227–230.

    Google Scholar 

  • Crutchfield, L. B., & Borders, L. D. (1997). Impact of two clinical peer supervision models on practicing school counselors. Journal of Counseling and Development, 75, 219–229.

    Google Scholar 

  • Daldrup, R. J., Beutler, L. E., Engle, D., & Greenberg, L. S. (1988). Focused Expressive Therapy. New York: Guilford.

    Google Scholar 

  • Elliott, R., & Morrow-Bradley, C. (1994). Developing a working marriage between psychotherapists and psychotherapy researchers: Identifying shared purposes. In P. F. Talley, H. H. Strupp, & S. F. Butler (Eds.), Psychotherapy research and practice: Bridging the gap (pp. 124–142). New York: Basic Books.

    Google Scholar 

  • Fisher, D., Beutler, L. E., & Williams, O. B. (1999). Making assessment relevant to treatment planning: The STS Clinician Rating Form. Journal of Clinical Psychology, 55, 825–842.

    Google Scholar 

  • Goldfarb, N. (1978). Effects of supervisory style on counselor effectiveness and facilitative responding. Journal of Counseling Psychology, 25, 454–460.

    Google Scholar 

  • Greenburg, S. L., Lewis, G. J., & Johnson, M. (1985). Peer consultation groups for private practitioners. Professional Psychology: Research and Practice, 16, 437–447.

    Google Scholar 

  • Hadley, S. W., & Strupp, H. H. (1976). Contemporary views of negative effects in psychotherapy: An integrated account. Archives of General Psychiatry, 33, 1291–1302.

    Google Scholar 

  • Hart, R. R. (1978). Therapeutic effectiveness of setting and monitoring goals. Journal of Consulting and Clinical Psychology, 46, 1242–1245.

    Google Scholar 

  • Henry, W. P., Schacht, T. E., Strupp, H. H., Butler, S. F., & Binder, J. L. (1993). Effects of training in time-limited dynamic psychotherapy: Mediators of therapists’ responses to training. Journal of Consulting and Clinical Psychology, 61, 441–447.

    Google Scholar 

  • Henry, W. P., Strupp, H. H., Butler, S. F., Schacht, T. E., & Binder, J. L. (1993). Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior. Journal of Consulting and Clinical Psychology, 61, 434–440.

    Google Scholar 

  • Hill, C. E., Thompson, B. J., & Corbett, M. M. (1992). The impact of therapist ability to perceive displayed and hidden client reactions on immediate outcome in first sessions of brief therapy. Psychotherapy Research, 2, 143–155.

    Google Scholar 

  • Hill, C. E., & Williams, E. N. (2000). The process of individual therapy. In S. D. Brown & R. W. Lent (Eds.), Handbook of counseling psychology (pp. 670–710). New York: Wiley.

    Google Scholar 

  • 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.

    Google Scholar 

  • Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51, 1059–1064.

    Google Scholar 

  • Kivlighan, D. M., Angelone, E. O., & Swafford, K. G. (1991). Live supervision in individual psychotherapy: Effects on therapist’s intention use and client’s evaluation of session effect and working alliance. Professional Psychology: Research and Practice, 22, 489–495.

    Google Scholar 

  • Lafferty, P., Beutler, L. E., & Crago, M. (1989). Differences between more and less effective psychotherapists: A study of select therapist variables. Journal of Consulting and Clinical Psychology, 57, 76–80.

    Google Scholar 

  • Lambert, M. J., & Bergin, A. E. (1994). The effectiveness of psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 143–189). New York: Wiley.

    Google Scholar 

  • Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159–172.

    Google Scholar 

  • Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., et al. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services.

    Google Scholar 

  • Lane, R. C., Barber, S. S., & Gregson, K. J. (1998). Divergent views in psychodynamic supervision. Journal of Contemporary Psychotherapy, 28, 187–197.

    Google Scholar 

  • Lindsay, C. A., Crowe, M. B., & Smutz, W. D. (1983). The Continuing Professional Education Development Project for Clinical Psychology: A collaborative process for enhancing professionalization. State College, PA: Continuing Professional Education Development Project.

    Google Scholar 

  • Linehan, M. M. (1993). Cognitive-behavioral treatments of Borderline Personality Disorder. New York: Guilford.

    Google Scholar 

  • Linehan, M. M., Kanter, J. W., & Comtois, K. A. (1999). Dialectical Behavior Therapy for Borderline Personality Disorder: Efficacy, specificity, and cost effectiveness. In D. S. Janowsky (Ed.), Psychotherapy indications and outcomes (pp. 93–118). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Machado, P. P. P., Beutler, L. E., & Greenberg, L. S. (1999). Emotion recognition in psychotherapy: Impact of therapist level of experience and emotional awareness. Journal of Clinical Psychology, 55, 39–57.

    Google Scholar 

  • Mash, E. J., & Hunsley, J. (1993). Assessment considerations in the identification of failing psychotherapy: Bringing the negatives out of the darkroom. Psychological Assessment, 5, 292–301.

    Google Scholar 

  • Mohr, D. C. (1995). Negative outcome in psychotherapy: A critical review. Clinical Psychology: Science and Practice, 2, 1–27.

    Google Scholar 

  • Muran, J. C., Gorman, B. S., Safran, J. D., Twining, L., Samstag, L. W., & Winston, A. (1995). Linking in-session change to overall outcome in short-term cognitive therapy. Journal of Consulting and Clinical Psychology, 63, 651–657.

    Google Scholar 

  • Muran, J. C., Samstag, L. W., Wallner, L., & Jilton, R. (1997). Development of a suboutcome strategy to measure interpersonal process in psychotherapy from an observer perspective. Journal of Clinical Psychology, 53, 405–420.

    Google Scholar 

  • Norcross, J. C., & Beutler, L. E. (1997). Determining the therapeutic relationship of choice in brief therapy. In J. N. Butcher (Ed.), Personality assessment in managed health care: Using the MMPI-2 in treatment planning (pp. 42–60). New York: Oxford University Press.

    Google Scholar 

  • Office of Continuing Professional Education, Pennsylvania State University (1985). The Pennsylvania State University Continuing Education Development Project, project summary: Clinical psychology. State College, PA: Author.

    Google Scholar 

  • Pekarik, G., & Finney-Owen, K. (1987). Outpatient clinic therapist attitudes and beliefs relevant to client dropout. Community Mental Health Journal, 23, 120–130.

    Google Scholar 

  • Pekarik, G., & Wierzbicki, M. (1986). The relationship between clients’ expected and actual treatment duration. Psychotherapy, 23, 532–534.

    Google Scholar 

  • Phillips, L. E. (1987). Is mandatory continuing education working? Mobius, 7, 57–64.

    Google Scholar 

  • Quintana, S. M., Kilmartin, C., Yesenosky, J., & Macias, D. (1991). Factors affecting referral decisions in a university counseling center. Professional Psychology: Research and Practice, 22, 90–97.

    Google Scholar 

  • Roback, H. B. (2000). Adverse outcomes in group psychotherapy: Risk factors, prevention, and research direction. Journal of Psychotherapy Practice and Research, 9, 113–122.

    Google Scholar 

  • Rodrigues Lima, K. R., Eisenthal, S., & Lazare, A. (1980/1981). Perception of requests in psychotherapy: Patient and therapist. Journal of Social Service Research, 4, 51–68.

    Google Scholar 

  • Sachs, J. S. (1983). Negative factors in brief psychotherapy. Journal of Consulting and Clinical Psychology, 51, 557–564.

    Google Scholar 

  • Safran, J. D., Crocker, P., McMain, S., & Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154–165.

    Google Scholar 

  • Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford.

    Google Scholar 

  • Safran, J. D., & Wallner, L. K. (1991). The relative predictive validity of two therapeutic alliance measures in cognitive therapy. Journal of Consulting and Clinical Psychology, 3, 188–195.

    Google Scholar 

  • Samstag, L. W., Batchelder, S. T., Muran, J. C., Safran, J. D., & Winston, A. (1998). Early identification of treatment failures in short-term psychotherapy: An assessment of therapeutic alliance and interpersonal behavior. Journal of Psychotherapy Practice and Research, 7, 126–143.

    Google Scholar 

  • Shapiro, D. A., & Shapiro, D. (1982). Meta-analysis of comparative therapy outcome studies: A replication and refinement. Psychological Bulletin, 92, 581–604.

    Google Scholar 

  • Shearin, E. N., & Linehan, M. M. (1994). Dialectical Behavior Therapy for Borderline Personality Disorder: Theoretical and empirical foundations. Acta Psychiatrica Scandinavica, 89, 61–68.

    Google Scholar 

  • Silverman, M. S., & Quinn, P. F. (1974). Co-counseling supervision in practicum. Counselor Education and Supervision, 13, 256–260.

    Google Scholar 

  • Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Steketee, G., & Chambless, D. L. (1992). Methodological issues in prediction of treatment outcome. Clinical Psychology Review, 12, 387–400.

    Google Scholar 

  • Stiles, W., Shapiro, D. A., & Firth-Cozens, J. A. (1980). Correlations of session evaluations with treatment outcome. British Journal of Clinical Psychology, 29, 13–20.

    Google Scholar 

  • Strupp, H. H. (1980a). Success and failure in time-limited psychotherapy: A systematic comparison of two cases: Comparison 1. Archives of General Psychiatry, 37, 595–603.

    Google Scholar 

  • Strupp, H. H. (1980b). Success and failure in time-limited psychotherapy: A systematic comparison of two cases: Comparison 2. Archives of General Psychiatry, 37, 703–716.

    Google Scholar 

  • Strupp, H. H. (1980c). Success and failure in time-limited psychotherapy: With special reference to the performance of a lay counselor. Archives of General Psychiatry, 37, 831–841.

    Google Scholar 

  • Strupp, H. H. (1980d). Success and failure in time-limited psychotherapy: Further evidence: Comparison 4. Archives of General Psychiatry, 37, 947–954.

    Google Scholar 

  • Tracy, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207–210.

    Google Scholar 

  • VandeCreek, L., Knapp, S., & Brace, K. (1990). Mandatory continuing education for licensed psychologists: Its rationale and current implementation. Professional Psychology: Research and Practice, 21, 135–140.

    Google Scholar 

  • Wampold, B. E. (2001). Therapist factors: An ignored but critical factor. In The great psychotherapy debate: Models, methods, and findings (pp. 184–202). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Weissmark, M. S., & Giacomo, D. A. (1998). Doing psychotherapy effectively. Chicago: University of Chicago Press.

    Google Scholar 

  • Wetchler, J. L., Piercy, F. P., & Sprenkle, D. H. (1989). Supervisors’ and supervisees’ perceptions of the effectiveness of family therapy supervisory techniques. American Journal of Family Therapy, 17, 35–47.

    Google Scholar 

  • Wilbur, M. P., Roberts-Wilbur, J., Morris, J. R., Betz, R. L., & Hart, G. M. (1991). Structured group supervision: Theory into practice. Journal for Specialists in Group Work, 16, 91–100.

    Google Scholar 

  • Young, L. J., & Willie, R. (1984). Effectiveness of continuing education for health professionals: A literature review. Journal of Allied Health, 13, 112–123.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susan A. Nolan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nolan, S.A., Strassle, C.G., Roback, H.B. et al. Negative Treatment Effects in Dyadic Psychotherapy: A Focus on Prevention and Intervention Strategies. J Contemp Psychother 34, 311–330 (2004). https://doi.org/10.1007/s10879-004-2526-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-004-2526-6

Navigation