Objective: This article examines the methodological and systemic mechanisms that contribute to underestimating psychotherapy’s adverse effects. It addresses the paradox that, despite strong evidence for psychotherapy’s effectiveness, its potential harms remain insufficiently recognised in both empirical research and clinical practice. Method: The article presents a narrative review of the literature combined with a methodological analysis. Consideration was given to quantitative research, including randomised controlled trials and meta-analyses, qualitative studies of patients’ experiences, and conceptual work on psychotherapy safety and iatrogenic harm. Literature was purposively selected to identify recurring mechanisms that may contribute to the under-recognition of psychotherapy-related harm. Results: Dominant research approaches that focus primarily on symptom deterioration and average treatment effects may miss clinically important forms of harm. Limitations of randomised controlled trials, selective sampling, inadequate systematic reporting of adverse events, reliance on average effects that may obscure heterogeneity in individual outcomes, short follow-up periods, the ambiguous status of treatment dropout, and insufficient attention to the patient perspective can all contribute to an incomplete picture of psychotherapy safety. In clinical practice, limitations of clinical judgment, the absence of routine outcome monitoring, and a professional culture that discourages acknowledgment of treatment failure may further reduce the likelihood that adverse effects are recognised. Conclusions: Psychotherapy safety should not be inferred from evidence of effectiveness alone. It requires separate conceptualisation and assessment, integration of quantitative and qualitative evidence, and a clinical culture that openly acknowledges the possibility of adverse effects and systematically monitors them as an integral part of responsible psychotherapeutic practice.
Introduction and objective: This study presents findings from a clustered randomised controlled trial evaluating the Support for Students Exposed to Trauma (SSET) intervention among trauma-exposed adolescents in public schools of Azad Jammu and Kashmir, Pakistan. Against a backdrop of political unrest, war-related escalations, disasters, and chronic displacement, children in this region face heightened psychological vulnerability. The 10-week intervention was designed to address core trauma-related difficulties using structured, evidence-informed techniques appropriate for low-resource educational settings. Materials and methods: A total of 131 students aged 10–16 were assigned to intervention and control clusters. To assess the effectiveness of SSET, five outcome domains – post-traumatic stress symptoms, psychological distress, behavioural/emotional problems, perceived social support, and resilience – were measured at pre-, post-, and 3-month follow-up stages. These indicators were selected based on the SSET programme’s theoretical foundations in cognitive-behavioural and trauma-informed approaches, each targeting specific emotional and interpersonal capacities expected to change through intervention. Results: Statistical analysis using mixed-design ANOVA revealed significant improvements across all five indicators in the intervention group. Notably, reductions in post-traumatic stress disorder symptoms, emotional/behavioural problems, and psychological distress were accompanied by increased perceptions of social support and resilience. Conclusions: The findings provide strong evidence of the intervention’s effectiveness and demonstrate how schools in under-resourced regions can serve as vital platforms for delivering early psychological interventions.
Introduction and objective: This study aimed to explore relational depth as a key indicator of the development of group processes during a five-day interpersonal training. The focus was placed on how participants’ experiences of relational depth changed from day to day throughout the training. In addition, the study examined whether specific relational qualities – such as openness, empathy, and understanding – could serve as early predictors of increased relational depth on subsequent days. Materials and methods: Data were collected from 278 adult participants who completed the Relational Depth Frequency Scale (RDFS) daily over the five-day group training. To examine trends over time and predictive relationships across days, repeated-measures ANOVA and stepwise multiple regression were applied. Results: Perceived relational depth increased significantly over time, F(4, 268) = 262.34, p < 0.001, η2 = 0.797, with a strong linear trend. However, regression analyses showed that relational qualities from prior days had limited predictive power. Only specific aspects – such as “understanding” on Day 1 and “openness” on Day 3 – emerged as significant predictors of later relational depth, yet the overall explained variance remained below 10%. Conclusions: The findings support the effectiveness of group-based interpersonal training in deepening relational experience. However, the results also point to the contextual and emergent nature of relational depth, which appears to depend less on prior relational states and more on present-moment dynamics.
Introduction and objective: Mental disorders are a major global health concern, with psychodynamic psychotherapy recognised as an important treatment option. The optimal duration of psychodynamic therapy – short-term (≤6 months) vs. long-term (>6 months) – remains a subject of debate, with implications for clinical practice, treatment outcomes, and healthcare resource allocation. Materials and methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines, synthesising randomised controlled trials published between 2000 and 2025 that directly compared short-term and long-term psychodynamic psychotherapy in adults with mental disorders. Two studies involving 493 participants met the inclusion criteria. Outcomes included symptom severity, interpersonal and psychosocial functioning, remission rates, and treatment dropout. Results: Both short-term and long-term psychodynamic psychotherapy resulted in significant symptom reduction. Short-term therapy led to faster initial improvement (15–27% greater reduction during the first year), whereas after three years, long-term therapy demonstrated superior outcomes (14–37% greater reduction; higher remission rates at ten-year follow-up). The presence of a personality disorder moderated treatment efficacy: patients with personality disorders benefited more from long-term therapy, whereas those without personality disorders achieved similar outcomes with either treatment duration. High levels of social support were associated with better long-term outcomes; low social support favoured short-term therapy. Long-term therapy was associated with higher dropout rates (33% vs. 9%). Conclusions: Comparative efficacy of psychodynamic psychotherapy depends on patient characteristics and the timing of outcome assessment. Long-term therapy is recommended for patients with personality disorders; short-term therapy may be sufficient for other patients. Personalised treatment selection and strategies to support treatment continuation are essential for optimising outcomes and healthcare resource use.
Introduction and objective: Assessing the effectiveness of integrative psychotherapy is a key element of both clinical practice and scientific research. The aim of the study was to evaluate the effectiveness of integrative psychotherapy in reducing psychopathological symptoms in patients undergoing long-term individual therapy. Materials and methods: This longitudinal study was conducted at the “Ogród” Centre for Psychotherapy and Health Promotion (Non-Public Healthcare Facility) in Warsaw between 2005 and 2023. It involved a group of 127 patients who completed a full cycle of psychotherapy delivered by integrative-modality psychotherapists. The SCL-90 questionnaire was used to assess the severity of psychopathological symptoms. Measurements were taken twice for each participant: before the start of treatment and after its completion. The normality of distribution for each scale was evaluated using the Shapiro–Wilk test. Due to significant deviations from normality in most variables, the nonparametric Wilcoxon signed-rank test for dependent samples was applied to compare the results. Results: Following the completion of therapy, lower values were observed across all scales of the SCL-90 questionnaire compared with baseline. The severity of all psychopathological symptoms decreased, and the differences were statistically significant. The direction of change indicates improvement across all analysed domains of psychological functioning. Furthermore, the findings show that, in addition to statistical significance, strong therapeutic effects occurred. Effect sizes point to substantial clinical relevance of the observed changes. Conclusions: The findings suggest that the therapeutic intervention was effective in a multidimensional manner. Improvements across all scales indicate that integrative psychotherapy may have a broad impact on patients’ psychological functioning.
