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Major investigation backs use of talking therapies

But chief researcher says there must be recognition that some counselling could make people worse

Mark Gould

Tuesday, 27 May 2014

Counselling and other psychological therapies can do more harm than good if they are of poor quality or the wrong type, according to a senior psychologist who has just completed a major government-funded analysis of their outcomes.

In an interview with The Guardian*, Prof Glenys Parry, chief investigator of the government-funded AdEPT (Adverse Effects of Psychological Therapies) study, said that in general terms her team found that although psychological therapies had a positive impact, there needs to be greater recognition of the potential for counselling to make people worse.

"Most people are helped by therapy, but … anything that has real effectiveness, that has transformative power to change your life, has also got the ability to make things worse if it is misapplied or it's the wrong treatment or it's not done correctly," she said.

Talking therapies, such as Cognitive Behavioural Therapy which is prescribed extensively in the NHS, are usually helpful to people who are distressed, she said, but in a minority of cases where it goes wrong it can leave vulnerable people more depressed than when they first sought help.

Parry and colleagues at Sheffield University's School of Health and Related Research (ScHARR) and the Department of Psychology have just completed a three-year project which analysed data routinely collected by therapists as well as the results of clinical trials.

They included point scores of the levels of depression before and after courses of treatment and self-reported levels of wellbeing. They also interviewed therapists and clients to find out what goes wrong and when and how.

Although she says that in general terms the results of the analysis are positive, they found that they were variable across every type of psychological therapy. Some therapists had a lot more clients whose state of mind deteriorated than others although, Parry pointed out, that could be because they had more difficult cases. And some may have got worse whether they had therapy or not.

"Somebody could deteriorate during therapy but if they hadn't had the therapy, they could have been dead," she explained.

There have been widespread reports of "transgressive behaviour" by therapists who abuse the trust of their clients, but less so about poor quality support. "There has always been the risk of a therapist misbehaving," she said, "but we are talking about something much broader than that - not just a very, very small minority of people who fall into the hands of somebody who's not practising properly."

"I'm very keen that we grow up as a profession and start to look at these issues. If airline pilots said we get some people who crash, we'd all be worried about it. We have got to learn from when things go wrong and get much more scientific about it and much more careful about it, but not making out that it is a big drama," she said.

The study was funded by the government's National Institute for Health Research which is now considering the findings.

* Sarah Boseley. Misjudged counselling and therapy can be harmful, study reveals. The Guardian. 26 May 2014

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