Informing patients about possible negative effects of psychological treatment: A survey of Swedish clinical psychologists’ attitudes and practices

Figures & data

Table 1. Demographic information of the respondents.

Gender: n (%)	Female	211 (76.2)
	Male	64 (23.1)
	Other	2 (0.7)
Age (years): M (SD)		38.6 (10.3)
Therapeutic orientation: n (%)	Cognitive Behavior Therapy	214 (77.3)
	Psychodynamic Psychotherapy	38 (13.7)
	Humanistic/Existential Psychotherapy	2 (0.7)
	Other	23 (8.3)
Years of experience as clinical psychologist^a: M (SD)		8.71 (8.36)
University for degree as clinical psychologist^b: n (%)	Gothenburg University	31 (11.2)
	Karlstad University	6 (2.2)
	Karolinska Institutet	11(4.0)
	Linköping University	23 (8.3)
	Linnaeus University	5 (1.8)
	Lund University	34 (12.3)
	Mid Sweden University	14 (5.0)
	Stockholm University	31(11.2)
	Umeå University	32 (11.5)
	Uppsala University	55 (19.9)
	Örebro University	23 (8.3)
	Foreign degree	12 (4.3)
Year of one's university degree: n (%)	1981–1985	4 (1.5)
	1986–1990	3 (1.1)
	1991–1995	7 (2.5)
	1996–2000	12 (4.3)
	2001–2005	17 (6.1)
	2006–2010	31 (11.2)
	2011–2015	59 (21.3)
	2016–2020	99 (35.7)
	> 2021	45 (16.3)
Further education^c: n (%)	Psychotherapist	46 (16.6)
	Specialist degree^d	32 (11.6)
	Doctoral degree	6 (2.2)
	Other	33 (12)
	None	41 (14.3)
Workplace: n (%)	Adult psychiatry	80 (28.9)
	Child and adolescent psychiatry	34 (12.3)
	Private clinic	45 (16.2)
	Habilitation	9 (3.2)
	Occupational health	11 (4)
	Primary care	65 (23.5)
	Somatic care	8 (2.9)
	Inpatient care	2 (0.7)
	Other	23 (8.3)
Number of patients per week: M (SD)		14.9 (9.11)
Informing about possible negative effects: n (%)	Yes	171 (74)
	No	60 (26)

Note. In total, 277 respondents completed most demographic questions, and 43 chose not to respond to these. A total of 287 respondents completed the question about further education, but 33 chose not to complete this question.

^a Including practical training.

^b The listed universities provide the educational program to become a clinical psychologist in Sweden.

^c Several options were available, the total percentage is therefore not 100%. A total of 287 respondents completed this question.

^d Specialist degree is a title issued by the Swedish Psychological Assocation following several years of further education and a research thesis.

Table 2. Themes and sub-themes of the domain Expectations.

Themes	Sub-themes	Examples	Frequency^a	Label
1. Familiarity with the treatment process	1.1 Realistic expectations	“ … trying to nuance the idea that a treatment will solve ‘everything’.”	43	Variant
	1.2 Increased participation	“ … include the patient in his care —> increases the patient's sense of self-efficacy? Make the patient an active participant in the treatment.”	11	Variant
	1.3 Mental preparedness and resilience	“Joint working alliance, motivation and resilience against potential aspects of deterioration.”	62	Variant
	1.4 Normalizing initial negative emotions and experiences	“Just as with the introduction of SSRI, it is important to convey that a temporary increase in symptoms, behavioral changes, that exposure is usually difficult, can make you feel worse before you feel better.”	27	Variant
	1.5 Decreased motivation and trust in treatment	“Reduced commitment, reduced trust in the treatment, feeling of hopelessness or helplessness.”	99	Typical
2. Increased focus on negative effects	2.1 Detecting negative effects	“It is good that the person is aware of possible risks and can recognize himself if he were to suffer any negative effect.”	5	Variant
	2.2 Excessive worry	“That they exaggerate the negative effects, for example due to an anxiety problem, which is what they are seeking help for.”	22	Variant
	2.3 Negative impact on expectancy	“Of course, in some cases this could make the patient to look for symptoms of deterioration + nocebo.”	21	Variant
3. Improved collaboration	3.1 Increased trust in the therapist	“Being open about the fact that a treatment is not suitable for everyone, that it is not certain that it will help, to precede and to have talked about what we do then - instills trust and increases trust.”	27	Variant
	3.2 Increased reporting and handling of negative effects	“ … That they are more sincere in verbal reports and estimates, because they know that we are trying to manage and make a plan together.”	35	Variant
4. Professional and ethical responsibility		“So that patients can make an informed choice as to whether they want to start treatment or not, so that the timing is right and you have good conditions to cope with treatment."	56	Variant

Note.^a The total number of responses composing the sub-theme.

Table 3. Themes and sub-themes of the domain Hindrances.

Theme	Examples	Frequency^a	Label
1. Lack of knowledge	“I feel that much of my work is from what I learned during my educational program and a lot of the books I bought then are the same ones I use now, or later updated copies. These lack information about negative treatment effects … ”	28	Variant
2. Fear	“Fear in me of dropout … ”	41	Typical
3. Lack of time	“The time limitation prevents me from always being able to prioritize discussing the negative effects of treatment … ”	13	Variant
4. Patient characteristics	“In a patient group with severe symptoms and high co-morbidity, it is sometimes difficult to work according to a set method. Also difficult with diagnostics. This makes it difficult to talk about treatment effects … ”	14	Variant

Note. ^aThe total number of responses composing the sub-theme.