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Flower, S. (2020). Knox, Jean. (2019). ‘The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails’. British Journal of Psychotherapy, 35, 2, 245-63.. J. Anal. Psychol., 65(4):754-756.

(2020). Journal of Analytical Psychology, 65(4):754-756

Journal Reviews

Knox, Jean. (2019). ‘The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails’. British Journal of Psychotherapy, 35, 2, 245-63.

Review by:
Steven Flower

In a JAP interview conducted by Warren Colman, it became clear that early in her career Jean Knox recognized that psychotherapists and analysts, mostly inadvertently, can harm their patients (Colman, 2019). Misunderstanding, rigid application of the wrong models and bad technique all impact negatively on patients we are trying to help. In this British Journal of Psychotherapy paper Knox underlines that it is insufficient to investigate good practice. We need also to ‘identify harmful aspects and define poor clinical practice’.

Knox begins by identifying three aspects, evidencing each. First, exploring the nature of the psychotherapy itself, she points to negative outcomes, under certain conditions, of a range of approaches, from Critical Incident Stress Debriefing to psychodynamic psychotherapy. Second, she tackles the characteristics of the therapist that may lead to deterioration in the patient. Examples of this are: being overly confrontative, lacking empathic warmth, relying defensively on theory. Knox also cites research showing that avoidant attachment styles in therapists are also associated with more negative outcomes. Third, the focus shifts to the dynamics of the patient-therapist relationship. Here, she highlights ways in which patients can feel confused, coerced or intruded upon and end up blaming themselves for not eliciting empathic responses, their sense of agency further undermined.

Avoiding the harmful effects of psychotherapy rests on the therapist's capacity for imaginative play, an interplay between associative and directed thinking.

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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