Possible Negative Effects of Psychotherapies

Year 2012, Volume: 4 Issue: 4, 506 - 519, 01.12.2012

İ. Volkan Gülüm

https://doi.org/10.5455/cap.20120430

Abstract

Any treatment that has the potential to be useful could also have harmful effects on patients. All psychotherapy approaches should take this issue into consideration. Although there is no direct intervention to the physical integrity of the patient, this does not mean that the psychotherapy techniques, psychotherapists or psychotherapy itself, do not have enough power to be harmful to the patient. Because of that, psychotherapists should be aware of "do not harm" principle. There are many studies reporting the efficiency and effectiveness of psychotherapy in the literature. But not many study focused on possible negative effects of psychotherapy. On the other hand, there are increasing numbers of theoretical and practical studies about this issue. In this review, efficiency and effectiveness studies on psychotherapy, the possible definition of negative effects of psychotherapy, sources of these negative effects and intervention to this process have been discussed.

Keywords

Psychotherapy, adverse effect, side effect

Psikoterapilerin Olası Olumsuz Etkileri

Abstract

Yararlı olabilme potansiyeline sahip herhangi bir tedavinin aynı zamanda zararlı olabilme ihtimali de vardır. Psikoterapi uygulamaları da bu şekilde değerlendirilmelidir. Hastaların fiziksel bütünlüklerine doğrudan bir müdahale olmaması psikoterapinin kendisinin, psikoterapide uygulanan tekniklerin ya da psikoterapistin hastaya zarar verme gücüne sahip olmadığı anlamına gelmez. Bu nedenle de psikoterapistlerin öncelikle hastalarına zarar vermemeleri gerektiği ilkesini sürekli akıllarında tutması gerekmektedir. Literatürde psikoterapi etkinlik ve etkililik çalışmalarının sayısının çokluğu göze çarparken, psikoterapinin olası olumsuz etkilerini ele alan çalışmaların sayısının az olduğu görülmektedir. Ancak sayıları henüz az olsa da son yıllarda psikoterapilerin olası olumsuz etkilerine dair kuramsal ve uygulamalı çalışmalar yapılmaya başlamıştır. Bu yazıda psikoterapilerin etkinlik ve etkililiğine dair yapılan tartışmalar kısaca özetlenmiş, olası olumsuz etkilerin nasıl tanımlandığı, kaynaklarının neler olabileceği, nasıl tespit edilebileceği ve tespit edilmesinin ardından bunlara nasıl müdahale edilebileceği tartışılmıştır.

Keywords

Psikoterapi, istenmeyen etki, yan etki

References

• Berk M, Parker G. The elephant on the couch: side-effects of psychotherapy. Aust NZ J Psychiatry 2009; 43:787-794.
• Dimidjian S, Hollon SD. How would we know if psychotherapy were harmful? Am Psychol 2010; 65:21-33.
• Foulkes P. The therapist as a vital factor in side-effects of psychotherapy. Aust NZJ Psychiatry 2010; 44:189-189.
• Rhule DM. Take care to do no harm: harmful interventions for youth problem behavior. Prof Psychol Res Pr 2005; 36:618-625.
• Lilienfeld SO. Psychological treatments that cause harm. Perspect Psychol Sci 2007; 2:53-70.
• De Roos C, Greenwald R, den Hollander-Gijsman M, Noorthoorn E, van Buuren S, De Jongh A. A randomised comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disaster exposed children. Eur J Psychotraumatol 2010; 1:1-11.
• Bamelis LLM, Evers SM, Arntz A. Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders. BMC Public Health, 2012; 12:75-86.
• Costa RTD, Cheniaux E, Rosaes PAL, de Carvalho MR, Freire RCDR, Versiani M et al. The effectiveness of cognitive behavioral group therapy in treating bipolar disorder: A randomized controlled study. Rev Bras Psiquiatr 2011; 33:144-149.
• Rosner R, Lumbeck G, Geissner E. Effectiveness of an inpatient group therapy for comorbid complicated grief disorder. Psychother Res 2011; 21:210-218.
• Reger GM, Holloway KM, Candy C, Rothbaum BO, Difede J, Rizzo AA et al. Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. J Trauma Stress 2011; 24:93-96.
• Farkas L, Cyr M, Lebeau TM, Lemay J. Effectiveness of mastr/emdr therapy for traumatized adolescents. J Child Adolesc Trauma 2010; 3:125-142.
• Westen D, Novotny CA, Thompson-Brenner H. The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull 2004; 130:631-663.
• Okajima I, Komada Y, Inoue Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms 2011; 9:24- 34.
• Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003; 160:1223-1232.
• Barak A, Hen L, Boniel-Nissim M, Shapira NA. A comprehensive review and a meta- analysis of the effectiveness of internet-based psychotherapeutic interventions. J Technol Hum Serv 2008; 26:109-160.
• Rosenzweig S. Some implicit common factors in diverse methods of psychotherapy. Am J Orthopsychiatry 1936; 6:412-415.
• Luborsky L, Rosenthal R, Diguer L, Andrusyna TP, Berman JS, Levitt JT et al. The dodo bird verdict is alive and well - mostly. Clin Psychol 2002; 9:2-12.
• Wampold BE, Mondin GW, Moody M, Stich F, Benson K, Ahn HN. A meta- analysis of outcome studies comparing bona fide psychotherapies: empirically, ''all must have prizes''. Psychol Bull 1997; 122:203-215.
• Beutler LE. The dodo bird is extinct. Clin Psychol 2002; 9:30-34.
• Chambless DL. Beware the dodo bird: the dangers of overgeneralization. Clin Psychol 2002; 9:13-16.
• Türk Psikologlar Derneği. Türk Psikologlar Derneği etik yönetmeliği. http://www.psikolog.org.tr/medya/belgeler/1-turk-psikologlar-dernegi-etik- yonetmeligi.doc (accessed at May 1, 2012).
• American Psychological Association. Ethical principles of psychologists and code of conduct. Am Psychol 2002; 57:1060-1073.
• Friedman RA. A case in point for the maxim 'do no harm', in The New York Times, 30 Mayıs 2006. http://www.nytimes.com/ 2006/05/30/ health/psychology/ 30beha.html (accessed at May 1, 2012).
• Barlow DH. Negative effects from psychological treatments: a perspective. Am Psychol 2010; 65:13-20.
• Boisvert CM. Negative treatment effects: is it time for a black box warning? Am Psychol 2010; 65:680-681.
• Linden M. How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions. Clin Psychol Psychother 2012; doi: 10.1002/cpp.1765.
• Hatfield D, Mc Cullough L, Frantz SHB, Krieger K. Do we know when our clients get worse? An investigation of therapists' ability to detect negative client change. Clin Psychol Psychother 2010; 17:25-32.
• Bergin AE. Some implications of psychotherapy research for therapeutic practice. J Abnorm Psychol 1966; 71:235-246.
• Roback HB. Adverse outcomes in group psychotherapy: risk factors, prevention, and research directions. J Psychother Pract Res 2000; 9:113-122.
• Tindle K. Negative therapeutic reaction. Br J Psychother 2006; 23:99-116.
• Bergin AE. The empirical emphasis in psychotherapy: a symposium. The effects of psychotherapy: Negative results revisited. J Couns Psychol 1963; 10:244-250.
• Mohr DC. Negative outcome in psychotherapy: a critical review. Clin Psychol 1995; 2:1-27.
• Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol 2002; 9:329-343.
• Moos RH. Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention. Addiction 2005; 100:595-604.
• Ilgen M, Moos R. Deterioration following alcohol-use disorder treatment in project MATCH. J Stud Alcohol 2005; 66:517-525.
• Hannan C, Lambert MJ, Harmon C, Nielsen SL, Smart DW, Shimokawa K et al. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol 2005; 61:155-163.
• Boisvert CM, Faust D. Iatrogenic symptoms in psychotherapy: a theoretical exploration of the potential impact of labels, language, and belief systems. Am J Psychother 2002; 56:244-259.
• Nonanno GA, Lilienfeld SO. Let’s be realistic: when grief counseling is effective and when it’s not. Prof Psychol Res Pr 2008; 39:377-380.
• Larson DG, Hoyt WT. What has become of grief counseling? an evaluation of the empirical foundations of the new pessimism. Prof Psychol Res Pr 2007; 38:347-355.
• Sachs JS. Negative factors in brief psychotherapy: an empirical assessment. J Consult Clin Psychol 1983; 51:557-564.
• Nutt DJ, Sharpe M. Uncritical positive regard? issues in the efficacy and safety of psychotherapy. J Psychopharmacol 2008; 22:3-6.
• Gaudiano BA, Herbert JD. Methodological issues in clinical trials of antidepressant medications: perspectives from psychotherapy outcome research. Psychother Psychosom 2005; 74:17-25.
• Szapocznik J, Prado G. Negative effects on family functioning from psychosocial treatments: a recommendation for expanded safety monitoring. J Fam Psychol 2007; 21:468-478.
• Lambert MJ, Whipple JL, Hawkins EJ. Is it time for clinicians to routinely track patient outcome? a meta-analysis. Clin Psychol 2003; 10:288-301.
• Slade K, Lambert MJ, Harmon SC, Smart DW, Bailey R. Improving psychotherapy outcome: the use of immediate electronic feedback and revised clinical support tools. Clin Psychol Psychother 2008; 15:287-303.
• Shimokawa K, Lambert MJ, Smart DW. Enhancing treatment outcome of patients at risk of treatment failure: meta-analytic and mega-analytic review of a psychotherapy quality assurance system. J Consult Clin Psychol 2010; 78:298-311.
• Castonguay LG, Boswell JF, Constantino MJ, Goldfried MR, Hill CE. Training implications of harmful effects of psychological treatments. Am Psychol 2010; 65:34- 49.
• İ. Volkan Gülüm, Uzm. Psk., Hacettepe Üniv. Psikoloji Bölümü, Ankara.