Rethinking Unsuccessful Psychotherapies: When and How do Treatments Fail?

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Background

As we underlined in our first research topic about the same issue, treatment failures remain a relatively neglected phenomenon in psychotherapy research. Probably, many variables such as psychotherapists’ technical mistakes or patients’ particular mental conditions, are related to unsuccessful and negative outcomes. In any case, we can learn a lot when something goes wrong.

In early pioneering psychoanalytical studies, we can observe variables related to both patient and psychoanalyst: we refer the transference/countertransference phenomena in Breuer’s case of Anna O and Dora’s drop out from treatment with Freud. Much time has passed since those early clinical experiences and the topic of treatment failures has been the subject of important reflection. Finally, a few years ago, Goldberg came back to this issue and proposed a 'taxonomy of treatment failures'. More recently, the journal of the Society for Psychotherapy Research devoted part of an issue to premature treatment interruptions. Generally speaking, several difficulties have arisen in the study of treatment unsuccessful psychotherapies: 1) the methodological proposals for studying positive effects often obscure negative effects; 2) the complexity of the therapeutic process; 3) the lack of agreement on the definition of treatment failures. Indeed, treatment failure has been used as an umbrella term for a broad array of unwished-for effects of psychotherapy, such as attrition, lack of change, relapse, and worsening of patient’s conditions. Additional challenges when measuring outcome and defining therapeutic success and failure include which perspective is being used (patient, therapist, or researcher), what types of outcomes are measured with which methods, and appropriate time point of outcome monitoring.

There is significant evidence of a substantial variance in treatment outcome between different therapists. Therapists may be more important for therapeutic success than the type of intervention they deliver. A recent concept capturing this connection between psychotherapist and patient is that of responsiveness: the goal is to enhance treatment effectiveness by tailoring it to the unique individual and her/his specific preferences. In other words, psychotherapists endeavor is to create a new therapy for each patient, taking into account the patient’s needs.

Furthermore, while therapists differ in their average outcomes, most therapists have at least some successful outcome cases. On the other hand, even the most effective therapists have experience of unsuccessful treatments where patients did not improve. Thus, most therapists have experiences of both successful and unsuccessful treatments. What makes the difference? Why does psychotherapy sometimes not work and what is preventable about that? Finally, is it possible to identify the reasons for underlying unsuccessful therapeutic processes within and across psychotherapeutic models?

In our opinion, understanding when and how treatments are unhelpful or have negative effects is a key question. This second volume Research Topic about unsuccessful treatments welcomes all psychotherapeutic models and orientations, as well as all different treatment settings. Research on unhelpful aspects of psychotherapy could be of immense help to clinical approaches as well as to theoretical developments. Such research is also a necessity if we do not wish patients to be harmed by psychotherapy. We would like to encourage the potential authors to present their research strategies, relevant results, and clinical implications from their studies. We welcome studies with different methodologies, both RCT and naturalistic, both quantitative and qualitative, conducted in different settings and focusing on different therapeutic orientations. Our ambition is to gather papers presenting different points of view and substantially contributing to the issue of what we, as researchers and clinicians, can learn from unsuccessful treatments.

Keywords: Unsuccessful Treatments, Nonresponse, Deterioration, Side Effects, Negative Processes

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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