The Negative Outcome of Psychotherapy
2009, 17 (6):
Psychotherapy negative outcome is defined as the process of worsening in psychotherapy, and implies an impairment of vigor, resilience, or usefulness from a previously higher state of functioning. The constitutions of negative outcome varied much and the identification should be carried carefully. Patient, therapist, and therapy variables are examined, and tentative conclusions are drawn from the existing data. Patients who are diagnosed personality disorders, have severe interpersonal difficulties, are judged more severe, have unrealistic expectation about psychotherapy, and who are poorly motivated, have been found at risk for negative outcome. On the part of therapist, lack of empathy, negative countertransference, underestimation of the severity of the patient’s problems, and poor technique all have been associated with negative outcome. Potentially harmful therapies are thought to produce higher rates of negative outcome than others. The approaches that may help prevent or decrease the incidence of negative outcome in psychotherapy include supervision of therapists and therapies before a treatment and client-focused research in treatment. Issues in research are discussed, including negative outcome measurement, unit of investigation and the ethical dilemmas. The future research directions should include full presentation of research data, obtaining the actual incidence by RCTs, learning risk factors by an interactional model, and studying mediators to discover the mechanisms.
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