The Side Effects of Psychotherapy

There's a tendency to consider that psychotherapeutic interventions lack adverse effects. However, is this really so?

Written and verified by the psychologist Gorka Jiménez Pajares.

Last update: 14 March, 2023

Many people consider psychotherapy to be an intervention that’s devoid of any unwanted side effects. Indeed, if we were to ask people to compare the side effects they’d expect from a therapeutic intervention with those of a pharmacological intervention, they’d likely express this opinion.

However, research reports that psychological intervention could frequently have relevant adverse side effects. Furthermore, this should be expected, since most effective interventions tend to have a number of adverse effects.

The perception that psychotherapy has no side effects

Some factors have been mentioned that could explain why we tend to think that psychotherapy has no side effects. That said, the volume of research on this subject is pretty low.

Among the reasons for this perception is the fact that the therapist is the author of the psychological intervention. Thus, they’re seen as responsible for any adverse effects of an intervention. This means their perception is biased. In effect, they tend to be more interested in the beneficial effects than the adverse kinds.

Pharmacological intervention only focuses on symptoms. On the contrary, psychological intervention focuses on both symptoms and context. This additional element could generate a greater number of adverse side effects (Linden, 2014).

Finally, there’s disagreement around the concept of adverse psychotherapeutic effects. In addition, there are difficulties when it comes to differentiating between an adverse effect and the absence of a positive effect (or therapeutic failure) after the application of a psychological intervention.

Side effects of psychotherapy

With regard to adverse psychotherapeutic effects, secondary effects could refer to those that occur while the intervention is administered and that pose a problem, both for the individual and their environment.

It should be remembered that the fact that side effects are present doesn’t mean that the intervention is negative. In fact, to draw a parallel with biological treatments, a patient suffering from an illness might be prescribed an antibiotic. Eventually, they’re cured. However, they’ve also developed an adverse side effect of diarrhea.

Some possible candidates

In another sense, it’s interesting to evaluate how these adverse psychotherapeutic effects are produced and how they impact. The evaluation of the repercussion at the clinical level should be done in topographic terms. This means considering how intense the effects are, how long they last, and how they alter the individual. Among the considered side effects (Linden, 2014) are:

• Production of new, previously non-existent, symptoms.
• Exacerbation of pre-existing symptoms.
• Absence of improvement or greater severity of the clinical picture.
• Excessive temporality of the intervention.
• Lack of adherence or poor compliance with psychotherapeutic tasks.
• Absence of a stable therapeutic alliance.
• An excessive therapeutic alliance. This could be a sign of dependence.
• Discomfort in the family or socio-professional context.
• The appearance of behaviors related to stigma.

There’s currently little research that’s specifically tracked the side effects of psychotherapeutic interventions. However, we’re going to review some possibly relevant data.

An approach to the side effects of psychotherapy.

In the case of cognitive behavioral therapy (CBT) applied to trauma, up to three possible candidates could be considered side effects (Linden, 2014). For instance, the fear of environments with no light or dark, and urinating or defecating in inappropriate places. This is known as enuresis and encopresis respectively.

In one instance, when intervening in Tourette syndrome, Piacentini (2015) found up to 200 side effects of the treatment. They included bone and neck injuries, and bruises. But, it’s still unknown whether these side effects were from the disorder itself or as a consequence of the intervention.

Evidently, it’s essential to incorporate the variable of adverse psychotherapeutic effects in any future research on the cost-effectiveness of treatments. In fact, it’s expected that they occur in almost 20 out of 100 patients receiving psychotherapy (Linden, 2014).