Psychological therapies can have side effects – however, when a treatment error?

Prior to the inpatient psychotherapy, Mrs. D. long years, suffered from social Anxiety. She had hardly any friends, the Main caregiver was her husband. Through individual and group therapies, learns their needs and to talk about it; it’s also your Hobbies. However, it is a crisis in the relationship. Mrs D. says: “For us, it was probably only good for as long as I was shy. I’ve always done everything for my husband. With my new self-assured manner, he is not clear, unfortunately, that is every weekend visit home more and more clearly. He can not compromise. Unfortunately, he wants to start neither with in this therapy a couple therapy. I think I need to separate myself from him. He just does me good!” In fact, Ms. D. leaves shortly after her release, her husband – after 20 years of marriage.

Mr. S. is suffering since his Childhood, of a chronic Depression. In the course of outpatient therapy, he’s improving. His therapist he trusts a lot of difficult experiences from his Childhood, about which he has never previously spoken. His therapist reacts in a very understanding and empathic. He helps Mr. S., to understand current problems better and to decrypt the biographical pattern. As the approved hours of bend toward the end, a deterioration in the condition of Mr. S. suddenly, rapidly. “We can’t end the therapy,” says Mr. S. “I know how to do this without you and our conversations create. I need you. Please extend the therapy!”

Mr x, who has already received a lot of diagnoses, opened the meeting with the words: “for Me, it goes so well as already long not more. It is up to you. You are such a great therapist and a really impressive and so good looking woman. You have taught me, Yes, to talk about everything here. Therefore, I have to tell you something now: I can only think of you, day and night. I fell in love with in you.”

These are three case examples where psychotherapy called “interpersonal consequences” has. In the first case, they relate to the partnership, in the other two cases, the relationship between the Patient and the therapist. It is an effect or side-effect of the psycho-therapies? How to go to a therapist for a professional? And the success justifies the negative effects of a therapy?

… “DR. v. hirschhausen’s STAR live a HEALTHY LIFE”. The issue is now on newsstands, or here to buy. Topics in this issue:

Hardly explored: side effects of psychotherapy

First of all: Any treatment effect, also has side effects. Of course, this applies also for psychological therapies. The good news, which goes hand in hand with this message is that psychotherapy will help the person Concerned. Also, for heavily loaded patients, psychotherapy is effective, more often at least in the same way as medication, which has been demonstrated beyond doubt by many studies. The other side of the coin, the side-effects of psychotherapy, has been paid for a long time little attention. So far, there is little research. Depending on the survey method and type of treatment are estimated to occur in three percent to virtually 100 percent of the patients in the course of a psychotherapy side effects.

However, the other side of the coin is not so bad. The cry of a patient, the remember, during the meeting the questions of the therapist to stressful experiences, is a short-term negative effect, but usually not relevant, if the Patient feels then, not emotionally charged, or before therapy fears. Usually the comparison with a festering wound (the same mental disorder) applies here: as Long as they fester, not heal. Therefore, it is advisable to open them again, for example, by editing the difficult experiences from Childhood, so that it can then heal properly.

Side effects of a psychotherapy cannot be defined as easily as in the case of medicines, where chemically main result of the side effect of clear distinction. In the case of a psychotherapy inter-two individuals interact with each other: The therapist asks and the Patient responds, he opens. They interact verbally and non-verbally, through Gestures, Silences, looks. Together, they develop a goal and try to achieve it. For this it needs a robust emotional bond between Patient and therapist. According to the Definition of the RINEPS working group (risks and side-effects of psychotherapy) side effects are events, the

1. undesirable are,

2. through therapy caused, the

3. is done correctly, and

4. at least one function or area of life of the patients concern.

When an event occurs, it must be clarified First, whether it is an adverse event, such as separation from a Partner, or a desired event, for example, more Lust and passion. Undesirable anything that would be problematic is if it were also different. A separation may be inevitable, Yes, you can even be in the course of a therapy to the target, and the patient ultimately facilitate – as in the case of Mrs D. However, this therapeutic approach would be problematic, if there was an Alternative, which would make the patient and their Partner happy.

In the case of an adverse event it is important to clarify in the second step, whether this was caused by the psychotherapy, or whether this is independent of which occurred. Of course, a termination, or the death of a loved one burdened about the patient regardless of the treatment. In the case of a therapy-induced adverse event, it is important to clarify in the third step, whether the psychotherapy was properly and professionally carried out or whether a art is present, and the therapist’s behavior is unethical has. This distinction is particularly important, because the side effects of any therapy are errors, however, are often set equal. Errors are to be penalized a clear indicator of a bad therapeutic treatment, the liability or even criminal prosecution: If a therapist, for example, use drugs, or physically or sexually grip will be. Negative effects occur, however, even when correctly performed treatments.

Far-reaching consequences can have side effects for relationships. When patients learn in therapy, for example, to pay attention to their own needs, and better delineate, you can’t provoke by their different behaviour conflicts with family members, partners, friends, or colleagues – because they do not meet their expectations, and old patterns to break.

In severe cases, it can even come to contact terminations to a parent or separation from a Partner. As in the case of Mrs. D., who is ready to meet your needs assign your dominant husband under. In addition, disturbances in the relationship between therapist and Patient, or between patients can occur in group therapy to discontinuation of therapy. In the case of a ostensibly, a particularly good therapist-patient relationship is a problematic dependency may arise, which can result in symptomatic deterioration as is the case of Mr. D., the feels without the therapist left alone and helpless. The uniqueness and closeness of the therapeutic relationship can even lead to the Patient, so as Mr X., idealized his therapist and in love with her.

For the protection of patients

The German Bundestag has adopted in 2013, the law to improve the rights of patients. Since then, Doctors and psychotherapists are legally obliged to provide their patients prior to any treatment oral on possible side effects and risks of a therapy, to educate, for example, that it can go from bad to worse.

A side effect is that in the course of the therapy, this should be named and edited to be discussed. Whenever possible, should be included at the beginning and, if needed, in the course of the therapy to family, friends and teachers with – what of the husband of Mrs. D. refused, unfortunately. If a Patient or a patient such as Mrs D. thinks during therapy, a separation, should appeal to the therapist to possible negative consequences such as the loss of the circle of friends and with the patient strategies for dealing with feelings of Loneliness and Anxiety, develop.

According to the above-described Definition, we have to fall in love to do it in all three cases, with side-effects: separation, depending on the therapist feel in the therapist – even if the question of whether these are undesirable or not, will be answered by the people involved may initially have different. It is also important, as the three therapists respond. And the negative effects justify the success of the therapies?

The husband of a woman d. the therapist wrote in a letter that he knew his wife again, he was very frustrated and angry about their change and separation. Mrs D. who went there first, for example, reported three weeks after her dismissal that she would feel – not surprising – all of which are stable, but often sad, be in doubt, and lonely feel. Especially when she noticed that her husband already has a new girlfriend. “I have, however, tried to continue the strategies that I learned in the clinic, I visited my self-help group and it is so managed, out of the Deep to come out again,” she says. The therapist offers, Mrs D., during this difficult period to come every two weeks for therapy in the outpatient Department, which Mrs. D. accepts gratefully. A year after the dismissal of Mrs D. has a friend again and reported: “I have Finally found a Partner on eye-level.”

The dependence of Mr S. to the therapy or his therapist, both the therapist and Mr. s. find distressing, especially as it comes to a clear symptom of the deterioration in Mr s. The therapist speaks with Mr. S. very open about it. And Mr S. a sees that an extension of the therapy would only defer the Problem. He uses, therefore, the possibility of exploiting rst of the remaining ten sessions: First of all, he comes every 14 days, then monthly and at the end of half a year. In the process, he learns to make Autonomous decisions and reduces Fears.

Mr x does not feel his feelings of being in love first, of course, undesirable – his therapist, however, already. After you have encouraged him in his openness, she tells him clearly that you have not fallen in love with. However, this can be good, because only in this way, the therapy could continue to run. When therapists fall in love with patients and nevertheless, the therapy will continue, this is a unique art error! Together, they consider why and what are the properties of Mr X. has fallen in love with. In this, he realizes: “you listen to me and are there for me, I know women.” His therapist, Yes, there is a decisive note: “, but I can also, since they trust me with their problems. At the beginning you have to weigh just swollen or did not want to talk about inconsequential things. You have changed in the therapy. I’m curious to see how women react to your new, open behavior.”

Side effect with a Happy ending

In all three cases, undesirable due to the therapy events caused, in the case of Mrs D. even serious. However, these side effects are all three in the long term, not a negative. Therefore, you can be as “short – term side effect” – and thus can also be stopped dramatising the notion of side-effect. Because, as in the case of the side-effects of drugs must Use in the field of psychotherapy, the history, and the “cost-effectiveness” be considered: “cost” (divorce with feelings of Loneliness, deterioration of symptoms, unerwidertes in love back be) in all patients in the long term, behind the Benefit: Mrs D. begins a new, self-determined life. Mr S. wins autonomy, and Mr x is in touch with his feelings, and he talks about you. In fact, Mr. x learns towards the end of his therapy, a woman and falls in love with her. And the best thing about it is that His feelings are reciprocated by her.

About the author Eva-Lotta brake Meier

As a newly appointed Professor of Clinical psychology and psychotherapy at the University of Greifswald and her research focuses, among others, adverse therapy effects and develops individualized therapy concepts as well as Apps.

New in health