Mapping negative experiences in psychotherapy: A network analysis

Objectives Negative experiences in psychotherapy can undermine treatment outcomes, yet the interrelations among different facets of these experiences remain poorly understood. Using the Negative Effects Questionnaire (NEQ), this exploratory study examined the network structure of negative experiences in psychotherapy and identified the most central domains within this network.Method NEQ was assessed in a naturalistic sample of 439 adult outpatients who are or previously were in psychotherapy. A network analysis was conducted using a Gaussian graphical model to estimate associations between domains of negative experiences, with network comparison tests conducted to evaluate structural differences across exploratory subgroups.Results The network was characterized by a hub centered on hopelessness, linking it with symptom deterioration, negative self-evaluation and negative appraisals of the therapeutic process. Hopelessness emerged as the most central node, whereas care dependency and stigma showed comparatively low centrality. Subgroup analyses indicated that, despite some structural variations, the core cluster retained comparable connectivity across comparisons.Conclusion The findings suggest that hopelessness occupies a central position in the network of negative experiences, with direct associations to symptom deterioration, negative self-evaluation and dissatisfaction with treatment. Monitoring and addressing hopelessness alongside symptom change may be important for mitigating the constellation of unwanted therapy experiences.