The Elephant on the Couch: Side-Effects of Psychotherapy

Although we take it as a given that many psy-chotherapies are efficacious, form a cornerstone of much current practice, and are valued by many patients, there is a dissonance in the way in which physical therapies and psychotherapies are consid-ered in terms of their costbenefit ratio. Any potent intervention has both the capacity to cure and to harm. For drug-based therapeutic trials, adverse event monitoring is mandatory. By contrast, evalua-tion of psychotherapy has historically weighted the ‘benefit ’ side of the equation. For example, is a particular type of psychotherapy effective, is one psychotherapy superior to another, or does psy-chotherapy benefit a particular condition? At first pass it might appear bizarre to question