Unsuccessful psychotherapies: When and how do treatments fail?

What is it about?

As humans, but also as researchers and clinicians, we can learn a lot from our failures. In our opinion, the issue of failures in psychotherapeutic treatments is extremely important: from them we could define the signals that precede them, and the strategies to deal with them. As in pharmacotherapy, so in psychotherapy we note an important fact: the amount of unwanted effects is very similar and ranges between 3% and 15% of cases (Berk and Parker, 2009). In 2012, Swift’s and Greenberg’s meta-analytic study suggested that approximately one in every five clients still chooses to end treatment prior to its completion. And again, Lambert (2013) has demonstrated that 5 to 10% of patients deteriorate in therapy, and 35 to 40% of the participants in clinical trials do not improve. How to deal with this situation?

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Why is it important?

Over the last decade, psychotherapy was considered a complex form of interaction, which in many ways is different to relationships in ordinary life. Regardless of the specific therapeutic method, the therapist’s role is to facilitate patients’ change and to improve functioning. From the researcher’s perspective, treatment failures have been related to negative interpersonal processes in psychotherapy. Furthermore, unrepaired ruptures are connected to patient's unilateral interruptions and drop out (Safran et al., 2011; Gülüm et al., 2018; Colli et al., 2019). There is significant evidence of a substantial variance in treatment outcome between different therapists. Therapists may be more important for therapeutic success than the type of intervention they deliver. Furthermore, while therapists differ in their average outcomes, most therapists have at least some successful outcome cases. On the other hand, even the most effective therapists have experience of unsuccessful treatments where patients did not improve.

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