Psychotherapy is an increasingly sought-after tool for psychological help. Those who place their trust in it expect relief or a desired change. In some cases, however, they may also experience disappointment. In a new study, Tomáš Řiháček from the INPSY/Center for Psychotherapy Research scientific team, together with his co-author from the prestigious Swedish university, Alexander Rozental, focuses on understanding the possible negative experiences in psychotherapy. The authors have compiled the latest studies and meta-analyses and described their findings on measuring these negative effects. The authors call on psychotherapists to measure the negative effects after therapy, ideally in a systematic and transparent manner.
Why measure negative experiences?
The aim of the study was to contribute to maximizing what people can gain from therapy by identifying aspects that may negatively affect the psychotherapeutic process. Most often, the negative effect of psychotherapy is measured by a deterioration in mental well-being or a situation where therapy remains ineffective. Understanding the negative experiences after psychotherapy can help psychotherapists tailor the process to be as beneficial as possible for their clients. What problems complicate comparability and prevention of negative effects?
- Too many different questionnaires
- Timing of measurement
- Dealing with inaccuracies
Complication in the measurement No. 1: Too many questionnaires
In recent years, more than eight types of questionnaires have been used, three of which measure the negative effects of psychotherapy, while the others also cover positive aspects. The questionnaires also differ in content, for example in what negative aspects they focus on and what they consider negative. All these differences complicate the comparison of the results.
According to the authors, in order to successfully compare the responses obtained, it is important to use a questionnaire that takes into account the specific goal of the session. For example, an increase in anxiety during a therapeutic session when a person is exposed to a feared stimulus may be part of the healing process and thus an important step in psychotherapy. However, an insensitive measurement tool may evaluate this experience of anxiety as a negative effect of psychotherapy and, as the authors point out, distort the results, which then do not reflect reality.
Complication in the measurement no. 2: Timing of the measurement
Psychotherapists are most often interested in whether there has been a deterioration or whether the therapy has benefited the client, which they determine after the therapeutic session. However, some changes cannot be detected with certainty immediately after the session. In addition, the client's view of the benefits or adverse effects of therapy may change over time. Assessing negative effects over time can therefore provide respondents with perspective on their experiences in therapy, but it can also be influenced by other events that may have occurred in the meantime.
Complication in the measurement no. 3: Dealing with inaccuracies
When measuring negative effects, inaccuracies must also be taken into account. The authors point out the double-edged nature of repeated questioning of respondents. Repeated questioning can sensitize a person to the subject being asked about, which then comes to mind more often than would naturally occur. It also appears that people sometimes do not want to share the negative experiences from therapy with their psychotherapist. This then makes it difficult to obtain information about the course of therapy. But that's not all — concerns that are not shared in therapy and therefore cannot be addressed by the psychotherapist can hinder the formation of a therapeutic alliance, i.e., the relationship between the therapist and the client, which is essential for the therapeutic process to be successful.
People also naturally differ in what they perceive as negative. The authors therefore again emphasize the importance of a transparent measurement process. They refer to the new research showing that people's pre-shared expectations of psychotherapy can help mitigate the negative effects.
Conclusion
According to the authors, all of the aforementioned measurement limitations can be addressed through a systematic and transparent approach to information gathering, i.e., by sharing the specific form of the questionnaire or the procedure used in the interviews. According to the authors, it is important to incorporate more qualitative methods into the research to complement the blind spots of questionnaire measurement. According to the authors, research supplemented by qualitative investigation can help to understand the individual perceptions of therapy, which positively influences engagement in the therapeutic process. This creates a safe environment and helps to choose the right effective individualized help.
Psychotherapy is a highly effective tool for long-term psychological help, and in order to increase its effectiveness and reduce possible disappointment, the authors believe it is necessary to continue searching for answers to uncomfortable questions. The authors thus contribute to a discussion on a new topic that has set a clear goal — to improve psychotherapy and defend its well-deserved, historically proven place in the annals of mental health care.
Recommended citation:
Rozental, A., & Řiháček, T. (2025). How to measure negative effects of psychological interventions. Current Opinion in Psychology, 65, 102084. https://doi.org/10.1016/j.copsyc.2025.102084
