Negative outcome in psychotherapy: subjective and societal factors

Abstract

Psychotherapy outcome research observes that approximately ten percent of patients come out of psychotherapy feeling psychologically worse than before. In the respective literature, we find a lack of thorough understanding of the contributing factors and a total neglect of psychodynamic factors. In our article, we use research findings, psychoanalytical theory and socio-psychological theory to throw light on negative outcome from a dynamic point of view. We advocate the thesis about negative outcome as dependent on the person’s psychopathology (masochism, narcissism) and on societal factors (therapist’s and profession’s societal image and notions about psychological growth as a process of suffering). These factors are interconnected. Our ultimate idea is that negative outcome as a phenomenon fits with the person’s pathology so that a person has some gain from it. We illustrate our theoretical thinking with three clinical cases and show how we can use the dynamic view on negative outcome in our work.