a Clinical Psychology Unit, Department of Psychological Services Research Centre , University of Sheffield , Sheffield , UK.
b School of Health and Related Research , University of Sheffield , Sheffield , UK.
Psychother Res. 2019 Apr;29(3):403-414. doi: 10.1080/10503307.2017.1393575. Epub 2017 Oct 27.
It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this.
The aim of this study was to investigate the factors associated with patients' negative therapy experiences.
The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis.
There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience.
Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of "unwanted effects," including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.
据估计，3%至 15%的患者在心理治疗中有负面体验，但对此知之甚少。
本研究旨在调查与患者负面治疗体验相关的因素。
数据包括 185 名患者和 304 名治疗师的问卷、20 名患者和 20 名治疗师的访谈。患者报告了治疗无益或有害的经历，治疗师报告了他们认为患者治疗经历不佳或有害的经历。这些被转录并使用主题分析进行分析。
患者需求、治疗师技能和服务结构之间存在不匹配。这可能导致出现故障线，即安全和包容与权力和控制之间的紧张关系。这种紧张关系导致紧张和不良参与，从而导致负面治疗体验后的后果。
患者需要明确的信息、选择、参与决策、明确的合同以及关于治疗次数和进展的清晰度。患者反馈的机会应该成为常态，治疗师和服务机构应该警惕恶化的迹象，并考虑解决方案。本文在临床和方法学方面的意义：对心理治疗“不良影响”（包括长期影响）的估计范围为 3%至 15%。在这一领域进行的实证研究很少。本研究旨在解决这一差距，并为临床医生提供一个关于负面治疗效果风险因素的模型。这项研究的结果表明，为患者提供一个提供明确信息、选择和参与决策的支持性服务结构的重要性。在治疗开始时明确合同，并明确治疗次数和进展情况，对于管理患者的期望也很重要。应提供患者反馈的机会。
