Therapy can actually make things worse for some people

Talking to a therapist can help. But not always.
Talking to a therapist can help. But not always.
Image: Reuters/ Mark Blinch
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For all the talk about dangerous side effects from medication, you rarely hear about negative consequences from psychological treatment. But researchers have found a significant minority of people who feel they are worse off after therapy.

A team led by mental health research professor Mike Crawford, from Imperial College London, surveyed 14,587 people who were receiving or had recently received therapy for depression or anxiety, and found that 5.2% felt that they suffered “lasting bad effects” as a direct result of their treatment.

“Treatments affect people. And if you can affect people, you can’t be 100% confident what those effects are going to be,” Crawford told Quartz. “There’s an idea out there that psychological therapy is only helpful. But we think that patients who make choices about engaging in psychological therapy should be given information at the start, which is most people are going to benefit from an intervention, but some people may not.”

The researchers found that ethnic minorities and non-heterosexuals were more likely to experience lasting bad effects, though there’s no clear data on why that might be. Previous research has found that the positive effects of therapy are just as strong for ethnic minorities as for Caucasians. However, Crawford speculates that minority groups might be more likely to be misunderstood.

“In order to engage in a healthy and helpful therapeutic relationship, the therapist needs to understand the social and cultural context of the patient’s life,” he says. “For some who have experience of being marginalized, the experience of being offered help may not be inherently helpful.”

It’s extremely difficult to precisely quantify the effects of therapy, as it largely depends on self-reported answers. Though researchers recorded how patients felt their therapy had affected them, it’s technically possible that the symptoms could have simply worsened over time, with or without therapy.

However, Crawford points out patients were more likely to report lasting bad effects if they had not been told the details of what therapy they would receive beforehand. If patients first have a conversation about the type of treatment they’re receiving, how it can help, and realistic expectations, this could help prevent any negative effects, Crawford says. Patients should also feel free to talk if they think therapy is causing problems, and have the option of calling someone other than their therapist, such as a helpline.