Negative Effects of Therapy
Theoretical and Empirical Bases for Negative Effects

Smith and Glass (S&G) found that about 12% and S&S about 11% of all therapy patients get worse. The problem with just quoting stats is that there is more to negative effects than this. Studying negative effects requires a definition of negative effects, and possibly of primary and secondary negative effects as well. Both the definition of negative effects and the implied definition of positive effects stem from one's definition of mental health. This depends on who is defining mental health - society, the individual, or the therapist. Thus, deviations from societal norms could be considered a negative effect by society, but might not by a therapist. A patient leaving therapy after "learning a better defense" but not "improving" by dealing with some "underlying issue" might be a negative effect to the therapist but a positive effect to the patient. If this occurred in under 6 sessions, this might be a positive effect to the insurance company too. In a couple that seeks marital counseling and ends up getting divorced, the wife may believe this to be a positive effect of therapy, the husband a negative effect. A patient that leaves therapy having "found" themselves but without any altruistic sense of responsibility to the community would be a negative effect to other societies.

Strupp and Hadley surveyed the "biggies" in psychotherapy and give several examples of negative effects

1)an exacerbation of symptoms,
2)increased acting out behavior, depression, and paranoia
3)increased intellectualization and rationalization,
4)patient overidentification with the therapist to the point of doing things because the therapist wants them to,
5)disillusionment with therapy and the therapeutic relationship.

Others would add
6)premature terminations and
7)second order effects like decreased income due to expense of therapy, greater family stress as a result of changing family and work schedules and lower income…

S&H believe that negative effects may stem from things like

1)inaccurate or deficient assessment of strengths and abilities
2)therapist personality characteristics like poor clinical judgement, issues with excessive control, "OC"ness, narcissism, coldness, seductiveness, neglect
3)patient qualities such as low ego strength, low motivation, or "self-defeating personality disorder"
4)deficiencies or misapplication of technique such as
a)setting too abstract goals, not focusing on the underlying issue,
b)breaking down defenses without building new skills as well,
c)technical rigidity,
d)too much interpretation esp with a low verbal client or before the client is ready for the interpretation,
e)fostering dependency
5)problems with the therapeutic relationship, such as too little or too much rapport, counter-transference issues, communications problems, or control issues .

Since premature termination might be considered a negative effect, the literature on premature termination and increasing attendance might be important as well, but is another question in itself.