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Counseling Psychology and Psychotherapy
2025. Vol. 33, no. 2, 31–49
doi:10.17759/cpp.2025330202
ISSN: 2075-3470 / 2311-9446 (online)

Adverse Effects of Psychotherapy

 
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Abstract

Context and relevance. Not ignoring possible negative results of psychotherapy, Russian researchers mainly pay attention to clinical side effects. They only mention psychological side effects of psychotherapy. Therefore, negative psychological effects mentioned by overseas authors have been still waiting for their interpretation. Objective. The objective of this research is an analysis of psychotherapy side effects. Methods and materials. As a research method, we involved the analysis of research data from randomized controlled trials, systematic reviews, and reviews of meta–analyses. The search was made through Medline, PsycINFO, Embase, ProQuest Dissertations, Web of Science, Theses Global, and the Cochrane Library. We preferred PsycINFO and PubMed articles and publications from last 5 years. Results. There are psychotherapy side effects if contraindications to interventions have been ignored. Psychotherapy side effects depend upon factors of the therapist, patient, and therapist–patient relationship. The cultural context and experience of previous psychotherapy also matter. A negative result manifests itself with clinical symptoms and psychological consequences. Psychotherapy interpersonal effects include divorces and break–ups, narrower social circle, and proneness to conflict. Psychotherapy intrapersonal effects include affective loadedness caused by revived traumatic memories, higher stress, and anxiety. Conclusions. The patients’ focus on intense negative feelings in psychotherapy causes affective loadedness in them with the deficit of psychological resources and leads to the appearance of side psychological effects.

General Information

Keywords: psychotherapy, side clinical effects, psychological effects, contraindications to psychotherapy, frequency of side effects, sources of side effects

Journal rubric: Research Reviews

Article type: scientific article

DOI: https://doi.org/10.17759/cpp.2025330202

Received 04.07.2024

Accepted

Published

For citation: Solov’eva, S.L. (2025). Adverse Effects of Psychotherapy. Counseling Psychology and Psychotherapy, 33(2), 31–49. (In Russ.). https://doi.org/10.17759/cpp.2025330202

© Solov’eva S.L., 2025

License: CC BY-NC 4.0

References

  1. Аведисова, А.С., Бородин, В.И. (2004). К проблеме нежелательных явлений при психотерапии. Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева,  1(3), 16—19.
    Avedisova, A.S., Borodin, V.I. (2004). On the problem of adverse events in psychotherapy. Review of Psychiatry and Medical Psychology named after V.M. Bekhterev, 1(3), 16—19.  (In Russ.).
  2. Айзенк Г.Д. (1994). Сорок лет спустя: новый взгляд на проблемы эффективности в психотерапии. Психологический журнал, 15(4),  3—19.
    Eysenck G.D. (1994). Forty years later: a new look at the problems of effectiveness in psychotherapy. Psychological journal, 15(4), 3—19.  (In Russ.).
  3. Бородин, В.И., Миронова, Н.В., Новиков, Д.Д. (2024). Нежелательные явления в процессе психотерапии (обзор литературы). Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева, 1(3), 22—25. URL: https://www.elibrary.ru/item.asp?edn=cvwdqg&ysclid=mcmc0wiy8d534835955 (дата обращения: 01.02.2024).
    Borodin, V.I., Mironova, N.V., Novikov, D.D. (2024). Adverse events in the process of psychotherapy (literature review). Review of Psychiatry and Medical Psychology named after V.M. Bekhterev, 1(3), 22—25. URL: https://www.elibrary.ru/item.asp?edn=cvwdqg&ysclid=mcmc0wiy8d534835955 (accessed: 01.02.2024).  (In Russ.).
  4. Бородин В.И. Переносимость лечения у больных с депрессивными расстройствами (комплексный анализ): дисс…докт. мед. наук. М., 2009.
    Borodin V.I. Tolerability of treatment in patients with depressive disorders (complex analysis): diss…doctor. of medical sciences. M., 2009.  (In Russ.).
  5. Васильева А.В., Караваева Т.А., Радионов Д.С. (2023). Психотерапия посттравматического стрессового расстройства — интеграция опыта чрезвычайной ситуации. Консультативная психология и психотерапия, 31(3), 47—68. https://doi.org/10.17759/cpp.2023310303
    Vasileva, A.V., Karavaeva, T.A., Radionov, D.S. (2023). Post-Traumatic Stress Disorder Psychotherapy - Integrating the Experience of an Emergency. Counseling Psychology and Psychotherapy, 31(3), 47—68. (In Russ.). https://doi.org/10.17759/cpp.2023310303 
  6. Карвасарский, Б.Д. (Ред.). (2006). Психотерапевтическая энциклопедия (3-е изд., перераб.) СПб.: Питер.
    Karvasarsky, B.D. (Ed.). (2006). Psychotherapeutic Encyclopedia (3rd ed., revised) St. Petersburg: Piter.  (In Russ.).
  7. Гарретт М. Психотерапия при психозах: когнитивно-поведенческая и психодинамическая терапия: комплексный подход. М.: ИД Городец, 2021. Garrett M. Psychotherapy for psychosis: cognitive-behavioral and psychodynamic therapy: an integrated approach. Moscow: ID Gorodets, 2021. (In Russ.).
  8. Катков, А.Л. (2021). Негативные эффекты психотерапии: феноменология, систематика, классификация. Антология российской психотерапии и психологии, 9, 43—51. https://doi.org/10.54775/PPL.2021.86.31.006
    Katkov, A.L. Negative effects of psychotherapy: phenomenology, systematics, classification. Anthology of Russian psychotherapy and psychology, 9, 43—51.  (In Russ.).  https://doi.org/10.54775/PPL.2021.86.31.006
  9. Кисельникова, Н.В. и др. (2020). Феноменологический анализ динамики переживаний клиентов в процессе психотерапии: изучение отдельных случаев. Часть 2. Консультативная психология и психотерапия, 28(3), 8—24.
    Kiselnikova, N.V., Lavrova, E.V., Almukhametova, T.N., Kuminskaya, E.A., Rzaeva, F.R. (2020). Phenomenological Analysis of the Dynamics of Clients’ Experience in the Process of Psychotherapy: A Case-Study. Part 2. Counseling Psychology and Psychotherapy, 28(3), 8—24. (In Russ.). https://doi.org/10.17759/cpp.2020280302
  10. Крючков, К.С. (2021). Неоконченные споры об эффективности психотерапии: «общие факторы» и «золотой» стандарт. Новые психологические исследования, 2, 100—114. https://doi.org/10.51217/npsyresearch_2021_01_02_06
    Kryuchkov, K.S. (2021). Unfinished debate about the effectiveness of psychotherapy: "common factors" and the "gold" standard. New Psychological Research, 2, 100—114.  (In Russ.). https://doi.org/10.51217/npsyresearch_2021_01_02_06
  11. Миронова, Н.В. Нежелательные явления антидепрессивной фармакотерапии и клинической трансперсональной психотерапии у больных с непсихотическими депрессивными расстройствами: дисс. … канд. мед. наук. М., 2007.
    Mironova, N.V. Adverse events of antidepressant pharmacotherapy and clinical transpersonal psychotherapy in patients with non-psychotic depressive disorders: diss. … candidate of medical sciences. Moscow, 2007.  (In Russ.).
  12. Плугина, Е.С. Психотерапия. Образовательный портал «Справочник». URL: https://spravochnick.ru/psihologiya/psihoterapiya/ (дата обращения: 04.06.2024).
    Plugina, E.S. Psychotherapy. Educational portal "Reference". URL: https://spravochnick.ru/psihologiya/psihoterapiya/ (date of access: 04.06.2024). 
  13. Васильева А.В., Караваева Т.А., Незнанов Н.Г. (Ред.). (2022). Психотерапия. М.: ГЭОТАР-Медиа. https://doi.org/10.33029/9704-6485-4-VKN-2022-1-864
    Vasilyeva A.V., Karavaeva T.A., Neznanov N.G. (Ed.). (2022). Psychotherapy. M.: GEOTAR-Media.  (In Russ.).  https://doi.org/10.33029/9704-6485-4-VKN-2022-1-864
  14. Соколова, А.В. (2021). Условия эффективной психотерапии. Журнал практической психологии и психоанализа, 2, 16—24. URL: https://psyjournal.ru/articles/usloviya-effektivnoy-psihoterapii?ysclid=mcmbogoziu909826986 (дата обращения: 01.02.2024).
    Sokolova, A.V. (2021). Conditions for effective psychotherapy. Journal of Practical Psychology and Psychoanalysis, 2, 16—24. URL: https://psyjournal.ru/articles/usloviya-effektivnoy-psihoterapii?ysclid=mcmbogoziu909826986 (accessed: 01.02.2024).
  15. Сухоруков, С.Д., Голованова, И.В., Жукова, М.А. (2024). Качество сессии в психотерапии и консультировании: литературный обзор методов оценивания и основных характеристик. Современная зарубежная психология, 13(1), 21—32. https://doi.org/10.17759/jmfp.2024130102 Sukhorukov, S.D., Golovanova, I.V., Zhukova, M.A. (2024). Session quality in psychotherapy and counseling: a literature review of assessment methods and main characteristics. Modern Foreign Psychology, 13(1), 21—32.  (In Russ.).  https://doi.org/10.17759/jmfp.2024130102
  16. Франкл, В. (2022). Подсознательный бог. Психотерапия и религия. М.: Альпина нон-фикшн.
    Frankl, V. (2022). The Subconscious God. Psychotherapy and Religion. Moscow: Alpina non-fiction.  (In Russ.).
  17. Холмогорова, А.Б., Гаранян, Г.Г., Никитина, И.В. и др. (2010). Научные исследования процесса психотерапии и ее эффективности: современное состояние проблемы. Часть 2. Социальная и клиническая психиатрия, 20(1), 70—79.
    Kholmogorova, A.B., Garanyan, G.G., Nikitina, I.V. et al. (2010). Scientific research of the process of psychotherapy and its effectiveness: the current state of the problem. Part 2. Social and Clinical Psychiatry, 20(1), 70—79.  (In Russ.).
  18. Шарыпов, А.А. Бессознательное в современной философии. Образовательный портал «Справочник». URL: https://spravochnick.ru/filosofiya/sovremennaya_filosofiya/bessoznatelnoe_v_sovremennoy_filosofii/ (дата обращения: 02.06.2024).
    Sharypov, A.A. The Unconscious in Modern Philosophy. Educational portal «Reference Book». URL:  https://spravochnick.ru/filosofiya/sovremennaya_filosofiya/bessoznatelnoe_v_sovremennoy _filosofii/ (accessed: 02.06.2024).
  19. Ясперс, К. (2022).  Общая психопатология. М.: КоЛибри, Азбука-Аттикус.
    Jaspers, K. (2022). General psychopathology. Moscow: KoLibri, Azbuka-Atticus.  (In Russ.). 
  20. Aislinn, D., et al. (2023). The occurrence and categorization of adverse events in trials of digital mental health interventions: a descriptive review of studies in the International Standard Registry of Randomized Controlled Trials JMIR. Ment Health, 10, 42—50. https://doi.org/10.2196/42501
  21. Alann, S., et al. (2021). Predicting the improvement of working capacity in the modalities of short-term and long-term psychotherapy: the different effects of reflexive abilities and other aspects of the patient's fitness. J Clin Psychol, 77, 1905—1920. https://doi.org/10.1002/jclp.23128
  22. Avasthi, A., Grover, S., Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry, 64(1), 47—61. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21
  23. Balder, T., Rose, M. (2024). Side effects in psychodynamic and cognitive behavioral therapy. Journal of Modern Psychotherapy, 54,  28—31. https://doi.org/10.1007/ s10879-023-09615-5
  24. Batic, B.C., Dan, H. (2020). Exploring harm in psychotherapy: Perspectives of clinicians working with children and young people. Couns Psychother Res, 20, 647—656. https://doi.org/10.1002/capr.12347
  25. Benedetti, F. (2013). Placebo and the new physiology of the doctor-patient relationship. Physiological Reviews, 93(3), 1207—1246.
  26. Christensen, B., et al. (2023). Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: a mixed-method study and analysis plan for the TECTO study. Reports on Modern Clinical Trials, 34, Article 101173. https://doi.org/10.1016/j.conctc.2023.101173
  27. Cohen, Z.D., et al. (2020). Demonstration of a multimethod approach to the selection of variables for treatment selection: recommendation of cognitive behavioral therapy as opposed to psychodynamic therapy for mild and moderate depression in adults. Psychotherapeutic Research, 30, 137—150. https://doi.org/10.1080/10503307.2018.1563312
  28. Crawford, M.J., et al. (2016). The experience of patients with negative consequences of psychological treatment: results of a national survey. British Journal of Psychiatry, 208(3),  260—265. https://doi.org/10.1192/bjp.bp.114.162628
  29. Crown, S. (1983). Contraindications and dangers of psychotherapy. British Journal of Psychiatry, 143(5), 436—441. https://doi.org/10.1192/bjp.143.5.436
  30. Curran, J., et al. How does therapy harm? A model of adverse process using task analysis in the meta-synthesis of service users' experience. Frontiers in Psychology, 2019, no. 10, p. 347. https://doi.org/10.3389/fpsyg.2019.00347
  31. Dimijian, S., Hollon, S.D. (2010). How would we know if psychotherapy is harmful? American Psychologist, 65(1), 21—33. https://doi.org/10.1037/a0017299
  32. Farquharson, L. (2020). Adverse effects of psychological therapies. In The Handbook of Professional Ethical and Research Practice for Psychologists, Counsellors, Psychotherapists and Psychiatrists (pp. 129—140). London: Routledge. https://doi.org/10.4324/9780429428838-11
  33. Flemming, E., et al. (2022). Attachment predicts changes in the level of personality functioning after psychotherapeutic inpatient treatment. Psychosom Med Psychother,  68(1), 6—23. https://doi.org/10.13109/zptm.2022.68.1.6
  34. Foulkes, P.  (2010). Therapist as a vital factor in the side effects of psychotherapy. Australian and New Zealand Journal of Psychiatry, 44(2), Article 189.
  35. Genova, F., et al.  (2021). The experience of crying patients in psychotherapy and working alliance relationships, therapeutic changes and attachment styles. Psychotherapy, 58, 160—171. https://doi.org/10.1037/pst0000339
  36. Gerke, L., et al.  (2020). Frequencies and predictors of negative effects in routine inpatient and outpatient psychotherapy: Two observational studies. Front Psychol, 11, 51—64. https://doi.org/10.3389/fpsyg.2020.02144
  37. Hardy, G.E., et al.  (2019). Risk factors for negative experiences during psychotherapy. Psychotherapy Research, 29(3), 403—414. https://doi.org/10.1080/10503307.2017.1393575
  38. Heinonen, E., Knecht, P., Lindfors, O.  (2022). What suits whom: psychological resources and vulnerability of patients as general and specific predictors of a working alliance in various psychotherapies. Frontiers in Psychiatry, 13, Article 848408. https://doi.org/10.3389/fpsyt.2022.848408
  39. Jonsson, U., et al.  (2014). Reports of harm in randomized controlled trials of psychological interventions for mental and behavioural disorders: an overview of current practice. Modern Clinical Trials, 38(1), 1—8. https://doi.org/10.1016/j.cct.2014.02.005
  40. Klatte, R.  (2022). Identification and evaluation of side effects and harmful effects in psychotherapeutic research protocols: a systematic review. Psychotherapy,  60(1), Article 13. https://doi.org/10.1037/pst0000359
  41. Klatte, R., et al.  ( 2018).  Side effects of psychotherapy: a protocol for systematic review and meta-analysis. Syst Rev,7, Article 135. https://doi.org/10.1186/s13643-018-0802-x
  42. Klatte, R., et al.  (2023). Adverse events in psychotherapy randomized controlled trials: A systematic review. Psychotherapy Research, 35(1), 84—99. https://doi.org/10.1080/10503307.2023.2286992
  43. Ladwig, I., Rief, W., Nestoriuc, Y.  (2014). Was sind die Risiken und Nebenwirkungen der Psychotherapie? - entwicklung einer Liste zur Bewertung der negativen Auswirkungen der Psychotherapie (INEP). Verhaltenstherapie, 24, 252—263.
  44. Lambert, M.J., Ogles, B.M.  (2004). The effectiveness and efficacy of psychotherapy. In Lambert M.J. (ed.) Bergin and Garfield's Handbook of Psychotherapy and Behaviour Change (pp. 139—193). New York: Wiley and Sons.
  45. Lijun, Y., et al.  (2022). Therapists and psychotherapy side effects in China: A machine learning-based study. Heliyon,  8(11), e11821. https://doi.org/10.1016/j.heliyon.2022.e11821
  46. Linden, M. (2013). How to identify, find and classify side effects in psychotherapy: from adverse events to adverse reactions to treatment. Clinical Psychology & Psychotherapy, 20(4), 286—296.
  47. Linden, M., Shermuli-Haupt M.L. (2014). Definition, assessment and frequency of side effects of psychotherapy. World Psychiatry, 3(3), 306—309.  https://doi.org/10.1002/wps.20153
  48. Lodewick, K., et al. (2023). Monitoring and reporting of adverse events in research on child psychosocial interventions: a systematic review. Child and Adolescent Mental Health, 28(3), 425—437. https://doi.org/10.1111/camh.12661
  49. Lorenz, T.K. (2021). Predictors and effects of side effects of psychotherapy in young people. Counselling and Psychotherapy Research,  21, 237—243. https://doi.org/10.1002/capr.12356
  50. Mohr, D.K. (1995). The negative result of psychotherapy is a critical review. Clinical Psychology,  2(1), pp. 1—27.
  51. Motta, R.W. (2023). Secondary Trauma. Silent Suffering and Its Treatment. New York: Springer Nature.
  52. Nikendei, C., et al. (2020). Persönlichkeitsstruktur und Bindungstil als Prädiktoren für die erfolgreiche Aufnahme einer ambulanten psychotherapeutischen Behandlung. Psychosom Med Psychother, 66(2), 178—192. https://doi.org/10.13109/zptm.2020.66.2.178
  53. O'Keeffe, S., Martin, P., Midgley, N. (2020). When adolescents stop psychological therapy: Rupture–repair in the therapeutic alliance and association with therapy ending. Psychotherapy, 57(4), 471–490. https://doi.org/10.1037/pst0000279
  54. Papaioannou, D. et al.(2021). Adverse event recording failed to reflect potential harms: a review of trial protocols of behavioural, lifestyle and psychological therapy interventions. Journal of Clinical Psychology, 136, 64—76. https://doi.org/10.1016/j.jclinepi.2021.03.002
  55. Parry, G.D., Crawford, M.J., Duggan, S. (2016). Iatrogenic harm from psychological therapy - it's time to move on. Br J Psychiatry, 208, 210—216. https://doi.org/10.1192/bjp.bp.115.163618
  56. Schmoll D. (2012). Side effects of psychodynamic therapy. Psychotherapeut,  57, 395—401. https://doi.org/10.1007/s00278-012-0933-9
  57. Scott, J., Yang, A.H. (2016). Psychotherapy should be evaluated both in terms of benefits and harm. Br J Psychiatry, 208(3), 208—209.
  58. Scott, J., et al. (2022). Whether cognitive behavioural therapy is applicable to people diagnosed with bipolar depression or suboptimal treatment for mood stabilization: a secondary analysis of a large study of pragmatic effectiveness. Int J Bipolar Disord, 10, Article 13. https://doi.org/10.1186/s40345-022-00259-3
  59. Simon, E.B., Thomas, H. (2021). Cognitive behaviour therapy at the crossroads. International Journal of Cognitive Therapy, 14(1), 1—22. https://doi.org/10.1007/s41811-021-00104-г
  60. Strauss, B., et al. (2021). Negative effects of psychotherapy: estimating the prevalence in a random national sample. BJPsych Open, 7(6), e186. https://doi.org/10.1192/bjo.2021.1025
  61. Swift, J.K., Greenberg, R.P. (2024). Premature termination of adult psychotherapy: a meta-analysis. Journal of Counselling and Clinical Psychology, 80(4), 547—559. https://doi.org/10.1037/a0028226
  62. Swift, J.K., Greenberg, R.P. (2014). Meta-analysis of the rejection of psychotherapy using the method of treatment of disorders. J Psychotherapeutic Integration, 24(3), 193—207.
  63. Swift, J.K., Greenberg, R.P., Tompkins, K.A., et al. (2017). Refusal of treatment and premature termination in psychotherapy, pharmacotherapy and their combination: a meta-analysis of face-to-face comparisons. Psychotherapy (Chic), 54(1), 47—57. https://doi.org/10.1037/pst0000104
  64. Yao, L., et al. (2020). Influencing factors and machine learning-based prediction of side effects in psychotherapy. Front Psychiatr,  11, e37442. https://doi.org/10.1016/j.heliyon.2022.e11821

Information About the Authors

Svetlana L. Solov’eva, Doctor of Psychology, Professor, Professor of the Chair of Psychotherapy, Medical Psychology and Sexology, Faculty of Psychology, North-Western State Medical University named after I.I. Mechnikov, St.Petersburg, Russian Federation, ORCID: https://orcid.org/0000-0001-6129-9825, e-mail: svetlana.soloveva@szgmu.ru

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