By:
Prof. Hani Hamed Dessoki, M.D. Psychiatry
Prof. Psychiatry
Acting Head, Psychiatry Department
Beni Suef University
201...
Agenda
 History
 Introduction
 Prospectives on
psychotherapy
 Suicide and Psychotherapy
 How could psychotherapy
ever...
Definition of Psychotherapy
 A classic definition of psychotherapy is use
of interpersonal influence skills and
psycholog...
History
 The possibility of treatment-induced
deterioration among psychiatric patients
was first observed nearly 7 decade...
Introduction
 Effective treatment causes side effects; this
applies for medical interventions and
psychotherapy alike.

...
Introduction
 When ascertaining negative effects from
treatment, one might look for slower
response, less remission or re...
Introduction
 Every guideline for management of
psychiatric disorders in the world contains
the suggestion and recommenda...
Introduction
 In contrast to all the pharmacotherapy
studies, there is precious little information
about the safety of ps...
Perspectives on Psychotherapy
The Bottom Line: Does Psychotherapy Work?

The Benefits of Psychotherapy

 Based on the res...
Perspectives on Psychotherapy
What is the Future of Psychotherapy?
Orientations of Psychotherapists

Eclectic: Borrowing i...
Prroblems
 Empirical research on the negative effects of
psychotherapy is insufficient, partly
because there is a lack of...
Introduction
 Most clinical studies reported a complete
lack of side effects of psychotherapy and
related therapies, like...
Paradoxal findings: Psychotherapy
diminishes side effects
 A number of the studies found associated
paradoxically psychot...
Suicide and Psychotherapy
 Suicide is normal in the mentally ill
population, but there is no documentation
that psychothe...
Suicide and Psychotherapy
 Sometimes, although rarely, mentally
patients did commit suicide during
psychotherapeutic trea...
How could psychotherapy ever be
harmful?
 Negative side effects for a therapeutic
technique is the use of breathing retra...
How could psychotherapy ever be
harmful?
 In addition, there have been increased
reports of family conflicts, with aggres...
Psychotherapy among patients with
OCD
 Although very effective for reducing the frequency
and severity of OCD symptoms, m...
“Side effects” of psychotherapy are
unpredictable
 In psychotherapy, you never know what to
expect.
 Any behaviour modif...
The negative effects of psychotherapy
 Psychotherapy can lead to the occurrence of
new symptoms or problems which are not...
The negative effects of psychotherapy
 The clients will go through a period of feeling
worse as their old habits of copin...
The negative effects of psychotherapy
 Acquiring new symptoms
 Worsening of symptoms (3-10%) and
regression
 Depdendenc...
Causes of negative effects of
psychotherapy
 Negative effects may be due to techniques,
client variables, therapist varia...
Psychotherapy and Informed
Consent
 Informing clients about the potential risks
and benefits of psychotherapy is a
fundam...
Difficulties
 The lack of consensus in existing literature related
to what constitutes negative effects of
psychotherapy ...
Indicators of Potential Deterioration
 The five indicators for “potential deterioration,” as a
result of interaction betw...
Termination
 Over 4-6 monthly sessions
 Review patient success
 Discuss potential vulnerabilities
– Identify strategies...
Psychotherapy and Pharmaceutical
Companies
 Drug companies have been sold on the idea
that their troubles stem from a "ch...
Biopsychosocial model
 The biopsychosocial model (abbreviated "BPS") is a
general model or approach positing that biologi...
Biopsychosocial model in
depression
Effective treatment of severe or chronic
unipolar depression requires the combination
...
Psychotherapy
 Psychotherapy focuses on the therapeutic
relationship with the client / patient as well
as their social en...
Take Home Massage
 Recognition of adverse treatment
effects is a characteristic of
good therapists and treatments.
 Psyc...
Stress reduction
Hani hamed dessoki, side effects of psychotherapy
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  • Figure 17-6 from:
    Kassin, S. (2001). Psychology, third edition. Upper Saddle River, NJ: Prentice Hall.
    Source:
    Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.
  • Figure 17-8 from:
    Kassin, S. (2001). Psychology, third edition. Upper Saddle River, NJ: Prentice Hall.
    Source:
    Smith, D. (1982). Trends in counseling and psychotherapy. American Psychologist, 37, 802-809.
  • Hani hamed dessoki, side effects of psychotherapy

    1. 1. By: Prof. Hani Hamed Dessoki, M.D. Psychiatry Prof. Psychiatry Acting Head, Psychiatry Department Beni Suef University 2013
    2. 2. Agenda  History  Introduction  Prospectives on psychotherapy  Suicide and Psychotherapy  How could psychotherapy ever be harmful?  Negative effects of psychotherapy
    3. 3. Definition of Psychotherapy  A classic definition of psychotherapy is use of interpersonal influence skills and psychological techniques by trained professionals toward the goal of relieving the signs and symptoms of psychiatric disorder.  Psychotherapy is defined as a “procedure,” similar to that of a medical procedure.
    4. 4. History  The possibility of treatment-induced deterioration among psychiatric patients was first observed nearly 7 decades ago (Masserman & Carmichael, 1938).  Psychotherapy can sometimes be harmful: (a) deterioration effects and (b) negative effect
    5. 5. Introduction  Effective treatment causes side effects; this applies for medical interventions and psychotherapy alike.  Due to its specific setting it is unusual to focus on risks and damages within psychotherapy.
    6. 6. Introduction  When ascertaining negative effects from treatment, one might look for slower response, less remission or recovery, higher rates of relapse or recurrence, or some combination of these.
    7. 7. Introduction  Every guideline for management of psychiatric disorders in the world contains the suggestion and recommendation to include psychotherapeutic intervention.  Cognitive-behavioral therapy is probably the most researched and best-established treatment method in this respect.
    8. 8. Introduction  In contrast to all the pharmacotherapy studies, there is precious little information about the safety of psychotherapeutic interventions -- which are also, in some patients and in some instances, associated with adverse events that need to be noted.  These may include undue stress and potential overstimulation.  Both of these issues may contribute to the potential for symptom exacerbation.
    9. 9. Perspectives on Psychotherapy The Bottom Line: Does Psychotherapy Work? The Benefits of Psychotherapy  Based on the results of 475 studies (Smith et al., 1980), the average psychotherapy client shows more improvement than 80% of those in the no-treatment Psychology, 4/e by Saul control group. Kassin ©2004 Prentice Hall
    10. 10. Perspectives on Psychotherapy What is the Future of Psychotherapy? Orientations of Psychotherapists Eclectic: Borrowing ideas and techniques from different approaches Psychology, 4/e by Saul Kassin ©2004 Prentice Hall
    11. 11. Prroblems  Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of theoretical concept on how to define, classify and assess psychotherapy side effects.
    12. 12. Introduction  Most clinical studies reported a complete lack of side effects of psychotherapy and related therapies, like cognitive-behavioural treatments, also in schizophrenia, behavioural treatments, hypnotherapy, hypnosis, alcoholics anonymous.
    13. 13. Paradoxal findings: Psychotherapy diminishes side effects  A number of the studies found associated paradoxically psychotherapy to the reduction of side effects of other treatments.  This indicates that psychotherapy in general is balancing the patient and helping the patient with physical, mental, existential and sexual problems.
    14. 14. Suicide and Psychotherapy  Suicide is normal in the mentally ill population, but there is no documentation that psychotherapy provokes suicide; quite contrary it seems therapy with intimacy and closeness between therapist and patient can prevent suicide.
    15. 15. Suicide and Psychotherapy  Sometimes, although rarely, mentally patients did commit suicide during psychotherapeutic treatment caused by their mental illness not their therapy.  In comparison, psychiatric treatment with drugs is known to provoke suicide in 2% in the beginning of treatment .
    16. 16. How could psychotherapy ever be harmful?  Negative side effects for a therapeutic technique is the use of breathing retraining and relaxation procedures during exposurebased procedures for individuals with panic disorder with agoraphobia.  Just because a therapeutic technique is useful in one situation — outside of exposure procedures, for instance, to help reduce anxiety or tension — doesn’t mean it might not be harmful in other situations.
    17. 17. How could psychotherapy ever be harmful?  In addition, there have been increased reports of family conflicts, with aggressive or suicidal behavior in people undergoing various psychotherapeutic interventions.
    18. 18. Psychotherapy among patients with OCD  Although very effective for reducing the frequency and severity of OCD symptoms, many people undergoing psychotherapy, such as cognitive behavior therapy (CBT) and exposure and response prevention (ERP), notice that a side effect of treatment is that their anxiety actually increases in the beginning stages of therapy.
    19. 19. “Side effects” of psychotherapy are unpredictable  In psychotherapy, you never know what to expect.  Any behaviour modification technique can be misused or misapplied.  "positive thinking" can actually have a negative impact on the mental health of some people (and this has been known for years in regard to trauma counselling and sexual assault counselling).
    20. 20. The negative effects of psychotherapy  Psychotherapy can lead to the occurrence of new symptoms or problems which are not themselves resolved in the course of management.
    21. 21. The negative effects of psychotherapy  The clients will go through a period of feeling worse as their old habits of coping are replaced with new strategies and ways of thinking.  This process can temporarily highten anxiety and insecurity and negative thoughts, feelings of helplessness, hopelessness etc.
    22. 22. The negative effects of psychotherapy  Acquiring new symptoms  Worsening of symptoms (3-10%) and regression  Depdendence  False memories  Superficial insight (acquiring empty language)  Iatrogenic malingering
    23. 23. Causes of negative effects of psychotherapy  Negative effects may be due to techniques, client variables, therapist variables, or some combination of these.
    24. 24. Psychotherapy and Informed Consent  Informing clients about the potential risks and benefits of psychotherapy is a fundamental component of obtaining informed consent, analogous to a physician’s informing a patient about the risks and benefits of medication or treatment.
    25. 25. Difficulties  The lack of consensus in existing literature related to what constitutes negative effects of psychotherapy reflects the conceptual complexities in this area.  One classic definition states that negative effects occur “when there is no meaningful positive change in a client due to some aspect of the treatment process”.  The most extreme negative effect is related to “client deterioration in functioning that is attributed to the course of therapy”.
    26. 26. Indicators of Potential Deterioration  The five indicators for “potential deterioration,” as a result of interaction between therapeutic techniques, psychotherapists, and clients include, (a) the role of anticipation of emotional pain and therapeutically induced arousal (b) client suspiciousness toward the therapist and therapist empathy (c) level of interpersonal functioning and the focus of treatment (d) diagnosis and treatment modality (e) relaxation therapy and clients’ need for control
    27. 27. Termination  Over 4-6 monthly sessions  Review patient success  Discuss potential vulnerabilities – Identify strategies for management of interpersonal difficulties and symptom relapses  Encouragement about ability to use strategies independently
    28. 28. Psychotherapy and Pharmaceutical Companies  Drug companies have been sold on the idea that their troubles stem from a "chemical imbalance," the solution to which, of course, involves rebalancing their chemicals, just like diabetics taking insulin.
    29. 29. Biopsychosocial model  The biopsychosocial model (abbreviated "BPS") is a general model or approach positing that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness.  Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms
    30. 30. Biopsychosocial model in depression Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Schotte et al., 2006;23(5):312-24
    31. 31. Psychotherapy  Psychotherapy focuses on the therapeutic relationship with the client / patient as well as their social environment.  The healing process is dialogical and polylogical as well as vulnerable throughout all schools of psychotherapy.  The quality of the therapeutic relationship is central to a cure.
    32. 32. Take Home Massage  Recognition of adverse treatment effects is a characteristic of good therapists and treatments.  Psychotherapists should be sensitive for negative effects.  The detection and management of adverse treatment effects is not a sign of bad but of good clinical practice.
    33. 33. Stress reduction
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