Why do psychiatrists give such inadequate advice

Psychiatry, Psychosomatics & Psychotherapy

Psychotherapy carries the risk that it is not only helpful, but can also be harmful. While the majority of patients benefit from psychotherapy, negative effects of psychotherapeutic treatment can be expected in 10-30 percent, and in some cases permanent deterioration can occur. The evaluation of the success or failure of psychotherapy depends in particular on the therapy goals of the patient and therapist. The improvement of the symptoms and the satisfaction of a patient with the therapy are among other things criteria for a successful therapy.

Failures can be caused by the patient, the therapy concept and / or the treating therapist. One can differentiate between different forms of negative effects, such as B .:

  • Worsening of symptoms (intensification, expansion)
  • Treatment risks due to unexpected complications
  • Unwanted treatment effects and side effects (also for the environment)
  • Interactions with medical or social interventions
  • Medical malpractice damage

However, deterioration during therapy is not necessarily due to the psychotherapy, but in individual cases this can also be caused by the course of an illness or disorder that cannot be influenced. A positive outcome from psychotherapy cannot be expected in all patients. If the condition deteriorates, it is also possible that there are developments that are initially perceived as problematic by the patient, but must be viewed as part of the therapy process. Exposure treatment (stimulus confrontation), for example, can initially be perceived as very stressful and place great demands on the patient. There may also be a temporary deterioration in the course of the therapy, which then leads to the success of the therapy.

The range of effects of psychotherapy is large, because the patients change through the therapy, which can also have effects on their environment. Possible side effects of psychotherapy affect not only the patients themselves, but also those around them. For example, if a patient strengthens his will and assertiveness, this can lead to conflicts with the family, life partner or work colleagues. The social structure can change - also because patients are now weighing up which relationships are good for them and which are not.

People who take part in psychotherapy and think that their symptoms are unfavorable or that new symptoms appear should generally discuss this with their therapist. If there is no improvement in the first 30 hours of therapy, it should be considered together with the therapist whether the procedure should be changed or whether the therapist should be changed. A high level of suffering, a great motivation for change, a benevolent confrontation with oneself, the courage to be honest and the reliable adherence to appointments and agreed tasks increase the chances of success of psychotherapy.

Causes of Psychotherapeutic Failures

A possible reason for a deterioration in condition can be, for example, a suboptimal patient-therapist relationship, in which the patient cannot open up properly. The fact that the "chemistry" is right with each other is an elementary prerequisite for the success of the therapy and should be guaranteed. Reasons on the patient's side can be, for example, an overly severe clinical picture as well as a lack of therapy motivation, difficult living conditions or inadequate social support from the patient's environment. On the part of the psychotherapist, the following factors, among others, can contribute to the failure: a wrong indication decision, insufficient ability of the psychotherapist (empathy, mastery of therapeutic techniques), lack of agreement with the patient about the therapy process.

Education and consent

Any psychotherapeutic treatment requires the patient's consent and requires that he or she be informed. This information transfer takes place mainly in the first discussions and often continues in the course of therapy. The psychotherapist's duty to provide information exists even if the patient does not expressly request it. The following points are addressed so that a patient can give their consent to treatment on the basis of comprehensive information:

  • Aim and purpose of psychotherapy
  • the psychotherapeutic method used
  • Probability of success
  • Frequency and duration of the meetings
  • approximate duration of treatment
  • possible settings
  • fee
  • Mode in the event of an hour's failure
  • Vacation policy
  • Confidentiality and limits to confidentiality
  • Risks, side effects and possible emotional and physical stress from psychotherapy
  • Alternatives to psychotherapy
  • Opportunities to interrupt or end psychotherapy.

The clarification is usually not a one-off affair. Because some information is not yet available in the initial phase and is only available later, patient education is a continuous process. Sometimes the modalities or circumstances change, so that timely and appropriate information is required for the patient.