7 Jan

Barriers and facilitators in the implementation of routine outcome monitoring

Continuous monitoring of psychotherapy outcomes and systematic collection of feedback from clients — known as Routine Outcome Monitoring (ROM) — can significantly increase the effectiveness of therapeutic work. However, introducing such regular measurement into everyday practice presents a number of challenges. It is influenced, for example, by therapists' emotional reactions (e.g., fear of evaluation) or concerns that measurement will negatively affect the therapeutic relationship (research studies show that the opposite is actually true!). Obstacles may also lie in the lack of institutional support (e.g., lack of training in how to use ROM), practical aspects (e.g., the time needed for measurement), or on the client's side (e.g., acute condition). In this article, we draw on a meta-analysis of nearly 60 studies from different countries and contexts and offer practical suggestions for therapists who want to use ROM sensitively, effectively, and in line with their clinical work.

30 Sep 2025

A review on clients’ negative experiences in psychotherapy

Psychotherapy often brings people great relief and positive change. Yet research shows that alongside its benefits, negative experiences can also occur. These may include feelings of being misunderstood, worsening symptoms, boundary violations, or an ill-suited therapeutic approach. A new review article by Vybíral et al. highlights that such experiences are surprisingly common and diverse, but still insufficiently studied. The authors call for greater sensitivity from therapists and open dialogue with clients, as the “shadows of therapy” can significantly shape its outcomes.

28 Jul 2025

Contextualizing the negative effects of psychotherapy

Lately, it may seem like we've been focusing exclusively on negative experiences with psychotherapy. Which is far from the case, but here is another article dedicated to the topic: a comprehensive review study that looks at the precise definition of terms, ways of assessing negative effects, the frequency of their occurrence across a range of studies, and suggestions for therapeutic practice and training. In training, for example, the authors recommend making a clear distinction between side effects of correctly administered therapy and client harm. They also suggest focusing on developing a good therapeutic alliance, monitoring the client's progress, and developing the skill of responding to even small signals from the client.

7 Jul 2025

How to measure negative effects?

Monitoring the negative effects of psychotherapeutic interventions is one of the basic ethical standards of the profession. In practice, however, it is fraught with many challenges - e.g., which instrument to choose, how to time the measurement, or how to encourage clients to be honest in their responses. We summarize these and other topics in our short review study.

26 Apr 2025

Course on Deliberate Practice

This week, the FSS held a Deliberative Practice course led by Petr Doležal and Barbora Javůrková. We are pleased because this is one of our efforts to bring current topics in psychotherapeutic research to our colleagues in practice. We brought together a diverse group of psychotherapists from different psychotherapeutic orientations and together we explored and tested ways to further develop ourselves as psychotherapists. With kindness, playfulness and systematicity.

22 Dec 2024

Types, differentiation, frequency and causes of client’s negative experiences

Prof. Zbyněk Vybíral's new essay represents the most thorough review of negative experiences with psychotherapy published in the Czech language to date. Did you know that research studies repeatedly find that the incidence of adverse symptoms and outcomes ranges from 5 to 13%, and that therefore one in ten or eleven psychotherapies fails? Review the range of reservations or complaints that are mentioned and cited in research studies around the world. The article concludes with 145 references so that the reader can easily reach for further, expanding reading on this shady side of psychological treatment.

4 Dec 2024

What does successful psychotherapy look like through the eyes of clients?

Success in psychotherapy is often assessed as the relief of symptoms such as anxiety or depression. However, our qualitative meta-analysis of 177 studies shows that symptom relief accounts for only a fraction of the changes that clients describe after psychotherapy. Beyond symptom relief, clients talk about a deeper self-understanding, improved relationships with others, or a greater ability to actively influence their lives. These reports, based on the testimonies of 2908 clients, suggest that psychotherapy is not just a treatment of psychopathology, but also a process that promotes fundamental transformations in the perception of self, others and the world around us, and the ability to lead a fulfilling and meaningful life. These findings highlight the need for more comprehensive approaches to assessing psychotherapy outcomes that capture the overall quality of life and the unique meaning of therapeutic change for each client beyond symptom relief.

9 Oct 2024

Active inference and therapeutic change

Active inference is a theoretical framework from the realm of cognitive science, neuroscience, and computational psychiatry that helps in modelling perception, decision making, and learning. It portrays a person as someone who is not just a passive recipient of information, but whose internal (or generative) model actively shapes how they perceive and interpret the world around them. Clients' mental difficulties or psychopathologies are then seen as the result of an inappropriately "configured" (or suboptimal) generative model. We were interested whether therapeutic change itself can be explained within this theoretical framework. Our review study offers an answer: We identified a total of 22 studies that use the language of active inference to describe the psychotherapeutic process.