Counselling and other psychological therapies can do more harm than good if they are of poor quality or the wrong type, according to a major new analysis of their outcomes.
Talking therapies are usually helpful to people who are distressed, but in a minority of cases where it goes wrong it can leave vulnerable people more depressed than when they first sought help, the authors say.
Prof Glenys Parry, chief investigator of the government-funded AdEPT (Adverse Effects of Psychological Therapies) study, said that there needs to be greater recognition of the potential for counselling to make people worse.
“Most people are helped by therapy, but … anything that has real effectiveness, that has transformative power to change your life, has also got the ability to make things worse if it is misapplied or it’s the wrong treatment or it’s not done correctly,” she said.
Very little research has been done on the negative impact of psychological therapies, even though they are increasingly prescribed in the NHS as well as being very widely available privately. Cognitive behaviour therapy is recommended in preference to pills for mild to moderate depression and anxiety.
Parry and her colleagues at Sheffield University’s School of Health and Related Research (ScHARR) and the Department of Psychologyanalysed data routinely collected by therapists as well as the results of clinical trials. They included point scores of the levels of depression before and after courses of treatment and self-reported levels of wellbeing. They also interviewed therapists and clients to find out what goes wrong and when and how. The study was funded by the government’s National Institute for Health Research.
Although they say in general the results, which they have not yet published in detail, are positive, they found that they were variable across every type of psychological therapy. Some therapists had a lot more clients whose state of mind deteriorated than others although, Parry pointed out, that could be because they had more difficult cases. And some may have got worse whether they had therapy or not.
“Somebody could deteriorate during therapy but if they hadn’t had the therapy, they could have been dead,” she explained.
But, said Parry, both therapists and clients need to be more aware of the potential dangers and those who feel they are getting worse need more help. Her team have used the findings from the research project to set up a website to help people going through any form of psychological counselling called supporting safe therapy, which offers guidance on what to expect and advice if things go wrong.
“We have just got to be grownup about it – counselling treatments are effective but we need to understand more about the circumstances in which they can go wrong.”
There have been widespread reports of “transgressive behaviour” by therapists who abuse the trust of their clients, but less so about poor quality support. “There has always been the risk of a therapist misbehaving,” she said, “but we are talking about something much broader than that – not just a very, very small minority of people who fall into the hands of somebody who’s not practising properly.”
“I’m very keen that we grow up as a profession and start to look at these issues. If airline pilots said we get some people who crash, we’d all be worried about it. We have got to learn from when things go wrong and get much more scientific about it and much more careful about it, but not making out that it is a big drama,” she said.
Therapy does not work for everyone, says the website, which quotes the words of clients themselves. “I was coming out of therapy with no skills to deal with the emotions that it brought out,” said one. “I was starting to feel like I was at fault for not making it work,” said another. “The therapist verbally attacked my character and told me I was being over the top. The next week she said she was sorry for what she had said while also blaming me for provoking the outburst!” said a third. The website also advises people on how to make a complaint.