A new study has shed light on the significant, yet often overlooked, negative experiences clients encounter during psychotherapy. This qualitative meta-analysis, carried out by a group of researchers at Masaryk University under the direction of Zbynk Vybral, combined information from 51 primary studies involving 1,267 clients from various nations. The study’s findings highlight a range of adverse experiences that clients have faced, categorised into four main clusters: therapist misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. The findings were published in the journal Psychotherapy Research.
The study aims to bring attention to the complexity and diversity of client dissatisfaction in therapeutic settings. It also calls for a deeper understanding and acknowledgement of these issues within the mental health profession, where the focus often remains on positive outcomes.
Therapist misbehaviour
The researchers’ first big cluster is “therapist misbehaviour”, which includes actions and attitudes that clients view as harmful or unprofessional. This category encompasses various behaviours such as the therapist not listening or understanding, being perceived as incompetent, devaluing the client, and even judging or using the client for personal gain. These negative experiences can significantly damage the therapeutic relationship, leading to feelings of rejection, humiliation, and a breakdown in trust.
One of the most troubling findings in this category is the issue of therapists imposing their own values on clients, particularly in cases involving cultural or religious differences. Clients reported feeling disrespected or dismissed, with one participant recounting how a therapist made them feel “really small” after challenging their authority. Such experiences highlight the importance of cultural competence and the need for therapists to maintain a non-judgmental, supportive stance throughout the therapeutic process.
Hindering aspects of the relationship
The second cluster, “hindering aspects of the relationship”, focuses on the difficulties clients face when the therapeutic alliance is weakened or disrupted. Clients often described feeling a lack of empathy or distance from their therapist, which can result in a breakdown of trust. This distrust can manifest in various ways, including insecurity about the confidentiality of the sessions or confusion about the therapeutic process itself.
The study underscores that trust is the foundation of any effective therapeutic relationship. When this trust is compromised, whether through perceived indifference or a lack of clear communication, the effectiveness of the therapy is severely undermined. Clients expressed frustration and anxiety when they felt that their therapists were not genuinely engaged or failed to create a safe and supportive environment.
Poor treatment fit
A significant portion of client dissatisfaction stems from a poor fit between the client’s needs and the treatment provided. The “poor treatment fit” cluster includes issues such as unmet expectations, a lack of personalisation in therapy, and dissatisfaction with the practical aspects of the treatment. Clients often reported that the therapy was either too structured or too unstructured, leading to feelings of frustration and disillusionment.
For example, some clients felt that their therapy sessions were too rigid, with therapists imposing a fixed agenda that did not align with the clients’ needs. Others found the sessions too unstructured, leaving them feeling lost and unsupported. This mismatch between client expectations and the therapeutic approach not only hampers the therapeutic process but can also contribute to long-term dissatisfaction and reluctance to seek future help.
Negative impacts of treatment
The final cluster, “negative impacts of treatment”, addresses the long-term effects that negative therapeutic experiences can have on clients. Some clients reported that their mental health actually deteriorated as a result of therapy, with increased feelings of depression, anxiety, and hopelessness. Others described a loss of motivation to continue therapy or seek further psychological help, citing their negative experiences as a deterrent.
The study also revealed that some clients experienced unpleasant emotions during therapy, such as anger, resentment, or a sense of being overwhelmed. The therapist’s actions frequently made these feelings worse, which resulted in a vicious cycle of unfavorable emotions and decreased therapeutic effectiveness. In some cases, clients even blamed themselves for the perceived failure of the therapy, which can have profound implications for their self-esteem and overall mental health.
