Psikoterapideki tabu: Olumsuz etkilere dair sistematik bir gözden geçirme

Psikolojik tedaviler ne kadar iyi niyetli şekilde planlanıp uygulansa da danışanlara olumsuz etki etme veya beklenmedik şekilde sonlanma ihtimaline sahiptir. Bu olumsuz/negatif etkiler, alanyazında çok farklı terimler ile temsil edilmektedir. Öte yandan, olumsuz etkilerin nasıl tanımlanacağı, nasıl değerlendirileceği veya onlarla karşılaşıldığında neler yapılması gerektiği açık değildir. Bu sistematik derlemenin amacı, alanyazında psikoterapinin olumsuz etkileri ile ilgili yapılmış çalışmaları bir araya getirmek ve bu kavramın nasıl ele alındığını ve terapist ve danışanların gözünden bu etkilerin neler olabileceğini incelemektir. Sistematik alanyazın taraması sonucunda bu konuda toplam 58 çalışmaya ulaşılmış, tarama kriterlerine uyan 14 makale ayrıntılı olarak incelenmiştir. Bulgulara göre, bu olgu için kullanılan terimler arasında olumsuz etkiler, olumsuz göstergeler, yan etkiler, semptomların bozulması-kötüye gitmesi ve istenmeyen etki yer almaktadır. Farklı bozukluklardan mustarip farklı sayıdaki katılımcı ve çeşitli yöntemlerle yapılan bu çalışmalarda belirtilen olumsuz etkiler ise özetle teknik problemler, terapötik ilişki ile ilgili problemler, belirtilerin artması/ kötüleşmesi, danışanın ve terapistin psikoterapiden beklentilerinin karşılanamaması olarak tanımlanmaktadır. Nihayetinde bu konuda doğru bir çıkarım yapmak için daha fazla sayıda seçkisiz kontrollü araştırmaya ihtiyaç olduğu düşünülmüştür. Terapilerdeki olumsuz etkilerle ilgili yapılan bu tür araştırmaların yaygınlaşmasının ruh sağlığı çalışmalarını geliştireceği, tabu gibi görünen bu kavrama odaklanarak terapistlere farkındalık kazandıracağı, danışanlara daha faydalı olma ve psikoterapilerin daha işlevsel olması yönünde etkileri olacağı düşünülmektedir.

The taboo in psychotherapy: A systematic review of negative effects

No matter how well-intentioned psychological treatments are planned and implemented, they have the potential to affect clients negatively or to end unexpectedly. These negative effects are represented by very different terms in the literature. It is not clear how to define negative effects, how they will be evaluated, or what to do when encountered with them. The purpose of this systematic review was to bring together the studies on the negative effects of psychotherapy and to examine how this concept is handled and what these effects can be from the perspective of therapists and clients. As a result of the systematic literature review, 58 studies on this subject were reached, and 14 articles meeting the screening criteria were examined in detail. According to the findings, the terms used for this phenomenon include negative effects, negative indicators, side effects, deterioration- worsening of symptoms and undesirable effect. The negative effects stated in these studies with different numbers of participants suffering from different disorders and various methods are defined as technical problems, problems with the therapeutic relationship, increase or worsening of symptoms, failure to meet the expectations of the client and therapist from psychotherapy. It was thought that more randomized controlled trials were needed to make a clear conclusion on this issue. It is thought that the widespread use of such research will improve mental health studies, bring awareness to therapists by focusing on this concept that seems taboo, will have effects on being more beneficial to clients and making psychotherapies more functional.

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