How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions

Clin Psychol Psychother. 2013 Jul-Aug;20(4):286-96. doi: 10.1002/cpp.1765. Epub 2012 Jan 18.


Objective: Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of theoretical concept on how to define, classify and assess psychotherapy side effects. This paper proposes a model for the definition, classification and assessment of psychotherapy side effects.

Method: Definitions are provided for 'unwanted events', 'treatment-emergent reactions', 'adverse treatment reactions', 'malpractice reactions', 'treatment non-response', 'deterioration of illness', 'therapeutic risks' and 'contraindications'. We describe processes analysing the causality of negative events and the correctness of treatment.

Result: A procedural model on how to find, classify and evaluate negative events is described, the unwanted event to adverse treatment reaction (UE-ATR) checklist.

Conclusion: Recognition of adverse treatment effects is a characteristic of good therapists and treatments. Psychotherapists should be sensitive for negative effects. This can help improve the quality of treatment. The UE-ATR checklist can be used in psychotherapy trials, quality assurance, clinical practice and training of psychotherapists.

Keywords: adverse treatment reactions; malpractice; psychotherapy; quality assurance; side effects; unwanted events.

Publication types

  • Review

MeSH terms

  • Clinical Competence*
  • Disease Progression
  • Humans
  • Malpractice
  • Mental Disorders / therapy*
  • Professional-Patient Relations
  • Psychotherapy / methods*
  • Psychotherapy / standards*
  • Quality of Health Care*
  • Treatment Failure