Psychotherapy has been proven to help, but not every experience with it is healing. A review article by authors Z. Vybíral, T. Řiháček, P. Borovička, and B. Oglese summarizes how clients describe negative experiences, how often they occur, who is more at risk, and what this means for practice. The term "negative experiences" encompasses everything from temporary worsening of symptoms to feelings of misunderstanding to boundary violations from the client's perspective. Although therapy helps most people, long-term reviews show that approximately 5-10% of clients experience worsening symptoms after therapy and that client dissatisfaction has long been overlooked in clinical studies. This is precisely what the team at the INPSY Center for Psychotherapy Research focused on.
The authors summarize that three themes of negative client experiences cut across psychotherapeutic approaches and forms:
- Emotional distress, such as overload, worsening functioning, return of painful memories, or hopelessness.
- Relationship with the therapist, which may include feelings of rejection, loss of trust, and an unformed or disrupted alliance.
- Discrepancies in the psychotherapy process—for example, unclear procedures, important topics not being addressed, therapy not "making sense" to the client.
All types of therapy can be accompanied by negative experiences
Negative experiences occur across all types of therapy—individual, couples, group, and online/intervention programs. With digital and internet-based approaches, people more often mention fatigue, frustration, more negative emotions, time pressure, and the impersonal nature of the techniques. Some clients also describe that becoming aware of the causes of their problems is stressful in itself if there is no safe space to process them. These experiences may be related to the fact that psychotherapy is not and cannot be only a positive experience – difficult topics are opened up in sessions and clients try to face them.
How often do negative experiences occur?
Of 85 studies, only about 60% monitored and reported negative experiences. In those that did monitor them, more than one in ten clients experienced some kind of adverse event. Approximately 1 in 21 clients even experienced a serious event, such as the need for acute psychiatric care. In common practice, approximately 2-14% of clients show that their condition has worsened after therapy more than would be considered a short-term fluctuation. However, it also depends on how the occurrence is measured: if the definition of a negative experience is broad, different estimates are obtained depending on the questions and scales used. Most often, clients reported the return of unpleasant memories and higher levels of stress directly related to therapy. Recently, new approaches to monitoring negative experiences have also emerged.This year, artificial intelligence was successfully used for the first time to search for client complaints, showing that the number of negative reactions to psychotherapy may in fact be significantly higher than previous estimates suggested.
Online programs, adolescents, and minorities face specific risks
The risk of negative experiences is higher for clients who enter therapy with more significant difficulties. In terms of personality traits, higher emotionality and conscientiousness appear to be more vulnerable, while extraversion and openness tend to have a protective effect. Younger clients may be more vulnerable, among other things because of the power imbalance and their reduced ability to challenge the psychotherapist if they wanted to. In addition, minority clients (sexual/gender, ethnic, or religious; also non-monogamous) describe experiences such as invalidation of identity, pathologization, or imposition of foreign values, which further increase the risk of negative experiences.
What does this mean for practice?
Negative experiences are not a failure of therapy, but a signal for change in the process. In practice, it helps to continuously ask what is helpful and what is harmful, and to clearly explain the framework: why we choose a particular approach and what to expect between sessions. If the discord or deterioration persists for a longer period of time, it is appropriate to adjust the approach or refer the client to another professional—especially in the case of online programs, adolescents, and clients from minority groups. In addition to questions about difficulties, it is worthwhile to ask more specifically what exactly is causing stress. It is precisely thanks to such questions that we can better distinguish between the level of difficulty that can be useful in therapy and excessive and undesirable stress.
Recommended citation:
Vybíral, Z., Řiháček, T., Borovička, P., & Ogles, B. (2026). Clients’ negative experiences in psychological treatment. Current Opinion in Psychology, 67, 102175. https://doi.org/10.1016/j.copsyc.2025.102175
