Unlike best practice guidelines for detecting and addressing medication side effects, there are no widely adopted guidelines to help therapists identify and address the possible negative effects of psychotherapy. Psychotherapy is a first-line evidence-based intervention for youth depression and anxiety, but the literature contains few studies of psychotherapy’s potential negative effects, and even fewer direct youth reports of their negative psychotherapy experiences. A mixed-methods study design was used to study youth with self-reported depression and/or anxiety and measure negative experiences associated with psychotherapy treatment. Youth were recruited from a larger study. Qualitative and quantitative data were collected from 45 youth with psychotherapy experience. Study design was informed by feedback from youth with lived experience of mental health challenges. Youth completed standardized measures of psychopathology, treatment effects, and detailed qualitative interviews. All youth experienced at least one negative effect during psychotherapy, and 30 youth (66.7%) attributed a negative effect as ‘caused’ by psychotherapy. While this attribution did not significantly differ based on severity of underlying current psychopathology, effect size estimates suggest moderate to large group differences regarding internalizing issues and baseline coping skills. Four major qualitative themes were identified from the interviews, summarizing the negative experiences of psychotherapy: (1) Barriers Experienced in Psychotherapy; (2) Concerns about Therapist; (3) Concerns about Therapy Itself; (4) Negative Experiences as a part of the Therapeutic Process. No youth raised any of these concerns directly with their therapists. These data support the need for validated, systematic assessment of psychotherapy’s negative effects among youth, with the aim of improving engagement and treatment outcomes.

与检测和解决药物副作用的最佳实践指南不同，没有广泛采用的指南来帮助治疗师识别和解决心理治疗可能产生的负面影响。心理治疗是针对青少​​年抑郁和焦虑的一线循证干预措施，但文献中很少有关于心理治疗潜在负面影响的研究，更没有直接的青少年关于他们负面心理治疗经历的报道。混合方法研究设计用于研究患有自我报告的抑郁和/或焦虑的青年，并测量与心理治疗相关的负面体验。青少年是从一项更大的研究中招募的。从 45 名具有心理治疗经验的青少年中收集了定性和定量数据。研究设计是根据具有心理健康挑战生活经验的青年的反馈来制定的。青年完成了精神病理学、治疗效果和详细定性访谈的标准化测量。所有青少年在心理治疗期间都经历了至少一种负面影响，30 名青少年（66.7%）将负面影响归因于心理治疗“引起”​​。尽管基于当前潜在精神病理学的严重程度，这种归因没有显着差异，但效应量估计表明，在内化问题和基线应对技能方面存在中到大的群体差异。从访谈中确定了四个主要的定性主题，总结了心理治疗的负面经历：（1）心理治疗中遇到的障碍；(2) 对治疗师的担忧；(3) 对治疗本身的关注；(4) 作为治疗过程一部分的负面体验。没有年轻人直接向他们的治疗师提出任何这些担忧。这些数据支持对青少年心理治疗的负面影响进行经过验证的系统评估的必要性，目的是改善参与度和治疗结果。