Research Topic

Unsuccessful Psychotherapies: When and How do Treatments Fail?

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About this Research Topic

As humans, but also as researchers and clinicians, we can learn a lot from our failures. However, treatment failure is a relatively neglected phenomenon in psychotherapy research. Psychotherapists’ technical mistakes, or patients’ particular mental conditions, are typical variables related to unsuccessful and negative outcomes. In early pioneering clinical studies, both variables can be observed: the transference/countertransference phenomena in Breuer’s case of Anna O and Dora’s drop out from treatment with Freud. Subsequently, 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.

Over the last decade, psychotherapy was considered a complex form of interaction, which in many ways is different to relationships in ordinary life. Regardless of the specific therapeutic method, the therapist’s role is to facilitate patients’ change and to improve functioning. From the researcher’s perspective, treatment failures have been related to negative interpersonal processes in psychotherapy. 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. 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? How come psychoanalytic psychotherapy sometimes does not work and how can we prevent it? Finally, is it possible to identify the reasons of underlying unsuccessful therapeutic processes regardless of the psychotherapeutic model?

In our opinion, understanding when and how treatments are unhelpful or have negative effects is a key question. This Research Topic 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.

As humans, but also as researchers and clinicians, we can learn a lot from our failures. However, treatment failure is a relatively neglected phenomenon in psychotherapy research. Psychotherapists’ technical mistakes, or patients’ particular mental conditions, are typical variables related to unsuccessful and negative outcomes. In early pioneering clinical studies, both variables can be observed: the transference/countertransference phenomena in Breuer’s case of Anna O and Dora’s drop out from treatment with Freud. Subsequently, 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.

Over the last decade, psychotherapy was considered a complex form of interaction, which in many ways is different to relationships in ordinary life. Regardless of the specific therapeutic method, the therapist’s role is to facilitate patients’ change and to improve functioning. From the researcher’s perspective, treatment failures have been related to negative interpersonal processes in psychotherapy. 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. 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? How come psychoanalytic psychotherapy sometimes does not work and how can we prevent it? Finally, is it possible to identify the reasons of underlying unsuccessful therapeutic processes regardless of the psychotherapeutic model?

In our opinion, understanding when and how treatments are unhelpful or have negative effects is a key question. This Research Topic 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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