Limitations of Psychotherapy
Abstract
Relevance. Today’s researchers of psychotherapeutic interventions mainly highlight positive aspects and results of psychotherapy. They only consider limitations of psychotherapy in connection with contraindications to psychological interventions. Meanwhile, in a subjective intrapersonal reality of another person, psychological interventions inevitably have their limitations caused by differences between individuals, their views, beliefs, and values. Objective. The research aims to analyse the limitations of psychotherapy. Material and methods. The methods used include the literature review on the data presented in randomized controlled trials, reviews of meta-analyses, and systematic reviews. The search was performed through Medline, PsycINFO, Embase, ProQuest Dissertations, Web of Science, and Theses Global, as well as in the Cochrane Library. Works published in the recent 5 years were preferential ones. Research results. The paper presents psychological factors that make psychotherapy more complicated and less effective. We discuss the client factors such as poor contacts with his or her feelings, difficulties in problem identification and problem statement, insufficiently developed capacities for reflection and mentalization, as well as characterological features. The paper also presents the therapist factors that relate to an insufficient ability to accept patient's personality, insufficient capacity for empathy, tolerance, sincerity, and trueness in relationships with the patient. We analyse the factors within the psychotherapeutic process that are caused by fixation on problems that generate too strong feelings. If our client has no adequate psychological resources, this makes him or her affectively overloaded with probably disorganized mental behaviours. Conclusion. Intervention in the world of client psychology requires that we consider the limitations associated with his or her psychological features, therapist’s limitations, as well as the limitations of the therapeutic process itself.
About the Author
S. L. Solovyova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Russian Federation
Saint Petersburg
References
1. Bastine R. Psychotherapie-Effekte. In R.B. e.a. (Hrsg.), Grundbegriffe der Psychotherapie. – Weinheim: Edition Psychologie, 1982. – Pp. 318-322.
2. Syropyatov O.G., Dzeruzhinskaya N.A. Short-term Clinical Psychotherapy. – Kyiv: Ukrainian Military Medical Academy, 2012. – 80 p.
3. Strupp H.H. The Vanderbilt Psychotherapy Studies: Synopsis. Journal of Consulting and Clinical Psychology, 1993;61(3):431–433. doi:10.1037/0022-006X.61.3.431.
4. Karvasarsky B.D. (Ed.) Psychotherapeutic Encyclopaedia. – St. Petersburg: Piter, 2002. – 1024 p.
5. Aivy Е. Aivy В. Saimak-Donning L. Consulting and Psychotherapy. Combination of Methods, Theory and Practice. – New York, 1987.
6. Aivy Е. Aivy В., Saimak-Donning L. Psychological Counselling and Psychotherapy. Methods, Theories, and Techniques: A Practical Guide. – Moscow, 1999. – 487 p.
7. Rout Sh. Psychotherapy. The Art of Comprehending the Nature. – Moscow: Cogito-Centre, 2022. – 346 p.
8. Kernberg O.F. Severe Personality Disorders: Psychotherapeutic Strategies. – Moscow: Klass, 2001. – 464 p.
9. Gridaeva G.V. Three Facets of Omnipotence. Space of Psychoanalysis and Psychotherapy, 2022; 1:32-43.
10. Jaspers K. General psychopathology. – Moscow: KoLibri, Azbuka-Atticus, 2022. – 1056 p.
11. Leakhy R. Overcoming Resistance in Cognitive Therapy. – St. Petersburg: Piter, 2021. – 352 p.
12. Benedetti F. Placebo and the New Physiology of the Doctor-patient Relationship. Physiological Reviews, 2013;93(3):1207–1246.
13. Vasilyeva A.V., Karavaeva T.A., Neznanova N.G. (Eds.). Psychotherapy: coursebook. – Moscow: GEOTAR-Media, 2022. — 864 p. doi: 10.33029/9704-6485-4-VKN-2022-1-864.
14. Vasileva A.V., Karavaeva T.A., Radionov D.S. Post-Traumatic Stress Disorder Psychotherapy – Integrating the Experience of an Emergency. Counseling Psychology and Psychotherapy, 2023;31(3):47–68. doi: 10.17759/cpp.2023310303.
15. Kholmogorova A.B., Garanyan G.G., Nikitina I.V., et al. Scientific Research of the Process of Psychotherapy and its Effectiveness: The Current State of the Problem. Part 2. Social and Clinical Psychiatry, 2010;20(1):70–79.
16. Flemming E. et al. Allgemeine Empfehlungen für die Strukturierung von Prozessen, die sie von Wehrlauf Hintergrund der stationären Psychotherapie erhalten [Bindung sagt Veränderungen im Funktionsniveau des Individuums nach einer psychotherapeutischen stationären Behandlung voraus]. Psychosom. Med. Psychother., 2022;68(1):6-23. doi: 10.13109/zptm.2022.68.1.6.
17. Nikendei C. et al. Persönlichkeitsstruktur und Bindungstil als Prädiktoren für die erfolgreiche Aufnahme einer ambulanten psychotherapeutischen Behandlung. Psychosom Med Psychother., 2020;66(2):178-192. doi: 10.13109/zptm.2020.66.2.178.
18. Alann S. et al. Predicting the Improvement of Working Capacity in the Modalities of Short-term and Long-term Psychotherapy: The Different Effects of Reflexive Abilities and Other Aspects of the Patient's Fitness. J Clin Psychol., 2021;77:1905-20. doi:10.1002/jclp.23128.
19. Hardy G.E. et al. Risk Factors for Negative Experiences During Psychotherapy. Psychotherapy Research, 2019;29(3):403–414. doi:10.1080/10503307.2017.1393575.
20. Kryuchkov K.S. Ongoing Disputes on Therapy Efficacy: ‘Golden Standards’ and ‘Common Factors’ in Psychotherapy. New Psychological Research, 2021;2:100–114. doi:10.51217/npsyresearch_2021_01_02_06
21. Sokolova A.V. Conditions for Effective Psychotherapy. Journal of Practical Psychology and Psychoanalysis, 2021;2:16-24.
22. Rogers K. Client-centred / Person-centred Approach in Psychotherapy. Moscow Psychotherapeutic Journal, 2002;1:54-66.
23. Wilber K. Religion of the Future. The Comprehensive Potential of Great Traditions of Spiritual Wisdom. – Moscow: Mann, Ivanov, and Ferber, 2023. – 752 p.
24. Mac Williams N. Psychoanalytic Diagnostics. Understanding the Personality Structure in Clinical Process. – Moscow: Klass, 2015. – 592 p.
25. McWilliams N. Psychoanalytic Psychotherapy. A Practitioner’s Guide. –Moscow: Gnosis, 2016. – 416 p.
26. Avasthi A., Grover S., Nischal A. Ethical and Legal Issues in Psychotherapy. Indian Journal of Psychiatry, March 2022;64(Suppl 1):47-61. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_50_21.
27. Yao L. et al. Influencing Factors and Machine Learning-based Prediction of Side Effects in Psychotherapy. Front. Psychiatr., 2020;5(11):37442. doi: 10.1016/j.heliyon.2022.e11821.
28. Ajzenk G.D. Forty Years Later: A New Look at the Problems of Effectiveness in Psychotherapy. Psychological Journal, 1994;14(4):3-19.
29. Ladwig I., Rief W., Nestoriuc Y. Was sind die Risiken und Nebenwirkungen der Psychotherapie? - entwicklung einer Liste zur Bewertung der negativen Auswirkungen der Psychotherapie (INEP). Verhaltenstherapie, 2014;24:252–63.
30. Simon E.B., Thomas H. Cognitive Behaviour Therapy at the Crossroads. International Journal of Cognitive Therapy, 2021;14(1):1-22. doi: 10.1007/s41811-021-00104- г.
31. Sukhorukov S.D., Golovanova I.V., Zhukova M.A. Session Quality in Psychotherapy and Counseling: A Narrative Review of Assessment Methods and Main Characteristics. Journal of Modern Foreign Psychology, 2024;13(1):21–32. doi:10.17759/jmfp.2024130102.
32. Ladwig I., Rief W., Nestoriuc Y. Was sind die Risiken und Nebenwirkungen der Psychotherapie? – entwicklung einer Liste zur Bewertung der negativen Auswirkungen der Psychotherapie (INEP). Verhaltenstherapie, 2014;24:252–63.
33. Lodewick K. et al. Monitoring and Reporting of Adverse Events in RESEARCH on Child Psychosocial Interventions: A Systematic Review. Child and Adolescent Mental Health, 2023;28(3):425-437. doi:10.1111/camh.12661.
34. Parry G.D., Crawford M.J., Duggan S. Iatrogenic Harm from Psychological Therapy – It's Time to Move On. Br J. Psychiatry, 2016;208:210-216.
35. Nikendei C. et al. Persönlichkeitsstruktur und Bindungstil als Prädiktoren für die erfolgreiche Aufnahme einer ambulanten psychotherapeutischen Behandlung. Psychosom Med Psychother., 2020;66(2):178-192. doi: 10.13109/zptm.2020.66.2.178.
36. Strauss B. et al. Negative Effects of Psychotherapy: Estimating the Prevalence in a Random National Sample. BJPsych Open, 2021;7(6):e186:1–8. doi:10.1192/bjo.2021.1025.
37. Borodin V.I., Mironova N.V., Novikov D.D. Adverse Events in Psychotherapy (Literature Review). Review of Psychiatry and Medical Psychology named after V.M. Bekhterev, 2004;1(3):22-25.
38. Klatte R. et al. Side Effects of Psychotherapy: A Protocol for Systematic Review and Meta-analysis. Syst Rev., 2018;7:135. doi:10.1186/s13643-018-0802-x.
39. Mohr D.K. The Negative Result of Psychotherapy is a Critical Review. Clinical Psychology, 1995;2(1):1–27.
40. Linehan M.M. Dialectical Behaviour Therapy. Skill Training Manual. – Moscow: Dialektika Publishing House (Williams), 2020. – 880 p.
41. Chapman A.L., Rosenthal M.Z. Managing Therapy-interfering Behaviours. Strategies for Dialectical Behaviour Therapy. – Moscow: Dialektika Publishing House, 2023. – 352 p.
42. Kleiman А. Culture, Bereavement, and Psychiatry. The Art of Medicine, 2012;379(9816):608-609.
43. Fortunatova O. Depression: Possibilities and Limitations of Psychotherapy in the Current Model of Care. The Global Psychotherapist, 2022;2(1):96–103. doi:10.52982/lkj165
44. Marie M. The Diagnosis Trap. On Psychotherapists Who Invent More and More Diseases and Help People Less. – Moscow: AST Publishing House, 2023. – 288 p.
Review
For citations:
Solovyova S.L. Limitations of Psychotherapy. Medical Psychology in Russia. 2024;16(2):49-58. (In Russ.)
Views:
123
Email this article 