You cannot look up drug information on the Internet today without coming across at least one page about the negative side effects of taking the drug. In fact, such side effects are deemed so important, their publication alongside the benefits of a drug are strictly regulated by the U.S. Food and Drug Administration (FDA). But the FDA requires no such warnings connected to other mental health treatments, including the use of psychotherapy.

How could psychotherapy ever be harmful?

That’s a good question, and one explored in three articles in the January issue of American Psychologist. The one I’ll focus on is the one by David Barlow (2010). David Barlow is a well-respected psychologist and researcher, with a long career made on studies examining the positive impact of cognitive behavioral techniques for a variety of serious mental health concerns like anxiety and panic disorder.

In the article, Barlow notes how now that psychotherapy has become an accepted and effective treatment option within the health care community, researchers need to do a better job of describing and examining the negative side effects of psychotherapy. We can no longer make the claim that psychotherapy can have no negative side effects, even when wielded by an ethical and experienced therapist.

One of the best examples of this that Barlow noted is the research into something called “critical incident stress debriefing” (CISD). This is a therapeutic technique meant to help people immediately after experiencing a trauma in their lives (such as a natural disaster or car accident). The common wisdom is that counseling immediately after a trauma is likely to be beneficial to the victims.

But what the research has found is that in groups of people who have been treated with CISD actually experience greater and more severe symptoms when later measured. This made little sense to researchers — how could people who’ve actually been given a psychological intervention then later go on to experience even worse symptoms?

A more refined analysis found that it was actually only people who had high scores on a measure of the impact of the traumatic event who fared much worse later on after the psychological intervention. People with low scores on the same measure did just fine with the intervention. Barlow’s point is that we often can’t see the important variables that could have a negative impact in treatment until we take apart the data and examine it more closely.

Another example Barlow noted of negative side effects for a therapeutic technique is the use of breathing retraining and relaxation procedures during exposure-based procedures for individuals with panic disorder with agoraphobia. People who were taught these techniques actually fared worse off in coping with their panic than those who were not taught to use them. In other words, just because a therapeutic technique is useful in one situation — outside of exposure procedures, for instance, to help reduce anxiety or tension — doesn’t mean it might not be harmful in other situations.

These are often difficult cases to find, because just like psychiatric medications’ side effects, not everyone will experience them in every setting. There are specific traits or symptoms that may preclude the use of specific therapeutic techniques. To say nothing of normally-beneficial therapeutic techniques used inappropriately by inexperienced or poorly trained therapists.

Psychotherapy is a powerful treatment for mental health concerns. It’s time that more focus be given not only to its beneficial effects, but also to better understand when certain techniques are best not used and could, in fact, be harmful.


Barlow, D.H. (2010). Negative effects from psychological treatments. American Psychologist, 65, 13-19.