On Side Effects, Destructive Processes, and Negative Outcomes in Psychoanalytic Therapies: Why Is It Difficult for Psychoanalysts to Acknowledge and Address Treatment Failures?

Abstract

Side effects, adverse treatment reactions, and negative outcomes are relatively neglected topics in the vast clinical literature on psychoanalytic therapies. This article discusses numerous contributory elements and zooms in on the contribution of therapist factors. We present definitions, briefly summarize the state of outcome research, and specifically mention the high attrition rate in psychotherapy and psychoanalysis. Factors shown to contribute to negative effects include incorrect diagnoses, unfavorable external conditions, constitutional factors, and modifications of the ego. We concentrate on examining the role of countertransference and other therapist factors. The article closes with a clinical perspective that raises a question about the analyst's ethical responsibility to inform new patients about the possibility of side effects, damaging consequences, and incomplete or negative outcomes.

Keywords:

• dropping out of treatment
• negative treatment outcomes
• negative therapist factors
• countertransference
• positive treatment outcomes
• ethical responsibility to inform

Notes

¹ In Germany, “long-term mortality” means the death toll computed for a longer time span.

Additional information

Notes on contributors

Horst Kächele

Horst Kächele, M.D., Ph.D., was born in 1944. After his study of medicine and training in psychotherapy and psychoanalysis, he was chair of the Department of Psychosomatic Medicine and Psychotherapy at Ulm University, 1990–2009. Since 2010, he has been a professor at the International Psychoanalytic University, Berlin. He is a member of the International Psychoanalytic Association and received the Mary Sigourney Award in 2004. He is a member of the International Psychoanalytic Association and an honorary member of the William Alanson White Institute.

Joseph Schachter

Joseph Schachter, M.D., Ph.D., Columbia University Psychoanalytic Center for Training and Research, $2,253,000 Research Grants. Recently, Chair, Committee on Evaluation of Research Proposals and Results, IPA, Author of “Transference: Shibboleth or Albatross?”; “Transforming Lives”; and with Horst Kächele and Helmut Thomä, “From Psychoanalytic Narrative to Empirical Single Case Research” and 60 papers. He is a member of the International Psychoanalytic Association and an honorary member of the William Alanson White Institute.