Unexpressed Wishes and Unmet Needs: a Mixed Methods Study of Youth Negative Experiences in Psychotherapy

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