Understanding the Risks of Psychotherapy: Study Takes a Closer Look at Adverse Events

A new review of reported adverse events in psychotherapy clinical trials reveals a lack of consistency in assessing harms, making it hard for service users to weigh risks and benefits.


While psychotherapy has been consistently established as an effective treatment for improving mental health, psychotherapy researchers have yet to provide a comprehensive picture of its potential risks. This interrupts the informed consent process, as it is difficult to explain the possible benefits and harms of treatment before a patient decides if they want to move forward.

A recent study published in Psychotherapy Research by four German researchers, led by Rahel Klatte, systematically reviewed the reporting of potential harm experienced by participants in psychotherapy clinical trials. This harmful information is known as an adverse event (AE) or serious adverse event (SAE). They discovered that researchers had different ways of reporting negative effects in their studies. These inconsistencies may make it harder for clinicians and patients to decide if therapy is worth it.

The authors provided recommendations for improving and standardizing how psychotherapy researchers think about and record (S)AEs. They also consider research that could allow therapists to understand and manage them more effectively in treatment.

Sometimes, in therapy, patients seem to get worse instead of better. It’s difficult to know if this is because of the treatment or other things happening in patients’ lives. Additionally, a difference is often made between adverse events representing explicit harm (e.g., treatment side effects) and indirect harm (e.g., patients dropping out of treatment before completion). The authors pointed out that:

“Conceptualizations of harms in psychotherapy have also addressed the question of causality or treatment-relatedness by differentiating between negative effects caused by correctly applied treatment and malpractice reactions caused by incorrectly or improperly applied treatment. Furthermore, (serious) adverse events can also occur in parallel to psychotherapy but might not be causally related to the treatment.”

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Javier Rizo
Javier Rizo is a graduate student-trainee in the Clinical Psychology PhD program at UMass Boston. His current area of research is qualitative psychotherapy research, with a primary interest in promoting human rights-based framework in psychiatry through the education and training of mental health clinicians and researchers. Javier is committed to building a social justice psychiatry, working to incorporate humanistic, interdisciplinary and critical perspectives on mental health, with particular interest in the role of healers and common factors models of psychotherapy.


  1. Pretty disgraceful that after over 100 years of psychotherapy the field doesn’t seem to bother itself with the harms its doing to people. Anyone working in the field who takes the care to ask about former therapy from their clients will hear a range of negative impacts and I’ve had my own personal negative experiences in therapy.

    Therapists are in positions of perceived cultural power and sanctioned by the state. The general public, generally put us on a pedestal and believe the hype of ‘evidence based’ etc. This means whatever we say can influence people positively or negatively we cannot know which.

    Consider therapy is mostly done on the therapists terms, in some office at a certain time/day. One is perceived as client the other professional, one discloses painful parts the other next to nothing, one is exposed the other protected.

    We’re all speaking from whatever complex interactions are going on for us in this moment along with being tied to an equally complex history. We have little access to some personal truth of things but come with our own biases, heuristics, and resources, often very limited.

    Most therapists haven’t a clue what life is actually like for the person sitting in front of them, so we’re operating in near total ignorance of the person devoid of living context.

    What could do wrong? a little self esteem raising or ‘assertiveness training’ maybe leads to being beaten up by a violent partner, or fill in a never ending blank of potential harms that most therapists and clients are oblivious to until the influences influence a life in random and unknowable ways.

    Just consider the drop out rate in state ran services such as Talking Therapies, formally IAPT, its massive!

    Yet no one bothers to follow these people up, no one seems to care and their place is immediately filled with another person on a sort of conveyor belt of suffering where success is measured by utter nonsense like a score on the PHQ9.

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    • Yes a truly draw dropping book exposing massive abuses of power and ultimate hubris. His other book the assault on truth is also a must read. Where are the exposures of all the modern schools? William m epstein’s books on psychotherapy are excellent at demonstrating the poor quality of the research and points to harms.

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  2. The only thing I learned from psychotherapy is how useless it is for me.

    Sitting through psychotherapy left me with a nagging sense of cognitive dissonance that lingered for days. Talking myself into believing that therapists or psychiatrists have anything worthwhile to offer was not only exhausting but also took a huge toll on my relationship with myself since deep down I knew I was wasting my time with people I didn’t respect. In any case, having to constantly bite my tongue so as not to deflate a therapist’s or psychiatrist’s oversized ego was a huge turn-off, but it was something I learned I had to do because most of them couldn’t handle being contradicted.

    I only have myself to blame for forcing myself to engage with people I considered incurably insecure overachievers unconsciously seeking validation from everyone they meet just because they have some stupid degree.

    What’s the best qualification for anybody wanting to help others? A huge amount of humility and enough personal experience to know what the heck they’re talking about, two qualities I found sorely lacking in most of the people working in the “helping professions”.

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  3. “The treatment process can often be uncomfortable for many patients as they often avoid experiences that have the potential to improve their lives.”

    THAT is an arrogant statement.

    I suggest the author put aside his therapist’s agenda and consider that maybe the “patient” knows best.

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