Academic journal article American Journal of Psychotherapy

Iatrogenic Symptoms in Psychotherapy: A Theoretical Exploration of the Potential Impact of Labels, Language, and Belief Systems

Academic journal article American Journal of Psychotherapy

Iatrogenic Symptoms in Psychotherapy: A Theoretical Exploration of the Potential Impact of Labels, Language, and Belief Systems

Article excerpt

Although the mental health professions are effective in ameliorating personal distress, treatment can sometimes have negative consequences. The authors explore causal mechanisms for iatrogenic symptoms in therapy by discussing the processes by which clients may he socialized into therapy and the potential impact that psychiatric labels and language may have in influencing clients' self-perceptions. The authors review research that has examined possible negative effects of psychiatric labels and then examine other forms of language, categorization, and conceptualizations that may contribute to negative effects in therapy. Iatrogenic symptoms may originate through the overreliance on a belief system within which therapists interpret, reinterpret, or label clients' characteristics or distress as pathological. Therapeutic communication that emphasizes pejorative language may introduce clients to this belief system. Iatrogenic symptoms may also provide clients and therapists with secondary gains. Possible approaches for minimizing iatrogenic symptoms are explored.

The core mental health professions-psychiatric nursing, psychiatry, psychology, and social work-embrace noble intentions, namely, to understand, predict, and alter behavior such that individuals, societies, and cultures will achieve greater well-being. However, acts of healing and associated treatments inevitably have not only curative, but also unwanted effects (1). Although the mental health professions serve a salutary function, they are not immune to deleterious or iatrogenic effects. We explore causal mechanisms for iatrogenic symptoms by discussing the processes through which clients are socialized into therapy and the potential impact of psychiatric language and belief systems in influencing clients' self-- perceptions. We conclude with suggestions for reducing iatrogenic symptoms. Many of the ideas we offer are generalizations, which require further formal investigation, and any one idea may or may not apply to a particular therapist. In general, we hope to raise therapists' awareness of the complex process of therapy and its potential to produce undesirable effects. We also hope to encourage further research and discussion in an area that seemingly has been given little attention in the literature.



The American Psychiatric Association defines iatrogenic illness as "a disorder precipitated, aggravated, or induced by the physician's attitude, examination, comments, or treatment" (2, p. 103). Although iatrogenic symptoms have often been associated with medication side effects (3, 4) or other forms of medical treatment (5), research shows that iatrogenic symptoms can result from other treatments, e.g., psychotherapy (6-11).


It would be utopian to believe that therapy with any particular patient produces effects that are exclusively positive. Mental health treatment is likely to produce some degree or type of negative effects as well. For example, a client may experience increased self-esteem and assertiveness after therapy, but feel less positive about family members and experience less acceptance from others who now feel threatened by the client's behavioral changes. Fortunately, in the majority of cases, positive treatment effects far outweigh negative effects (8, 12, 13). Research, however, shows that cases in which negative results predominate may not be that uncommon (8, 10, 14). Research finds that therapy leads to negative consequences for a considerable number of clients, perhaps about 10% (8, 10). This is a sobering statistic considering the number of people who receive therapy (15).

A fundamental goal of treatment is to shift the balance of positive and negative effects in an increasingly favorable direction, or to maximize benefits and minimize harm. Completely eliminating any negative treatment effects is unrealistic and perhaps only accomplished by ceasing all treatment, which, given the overall positive balance of treatment outcomes, would ultimately do considerably greater harm than good. …

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