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No matter how well-intentioned psychological treatments are planned and implemented, they have the potential to affect clients negatively or to end unexpectedly. These negative effects are represented by very different terms in the literature. It is not clear how to define negative effects, how they will be evaluated, or what to do when encountered with them. The purpose of this systematic review was to bring together the studies on the negative effects of psychotherapy and to examine how this concept is handled and what these effects can be from the perspective of therapists and clients. As a result of the systematic literature review, 58 studies on this subject were reached, and 14 articles meeting the screening criteria were examined in detail. According to the findings, the terms used for this phenomenon include negative effects, negative indicators, side effects, deterioration-worsening of symptoms and undesirable effect. The negative effects stated in these studies with different numbers of participants suffering from different disorders and various methods are defined as technical problems, problems with the therapeutic relationship, increase or worsening of symptoms, failure to meet the expectations of the client and therapist from psychotherapy. It was thought that more randomized controlled trials were needed to make a clear conclusion on this issue. It is thought that the widespread use of such research will improve mental health studies, bring awareness to therapists by focusing on this concept that seems taboo, will have effects on being more beneficial to clients and making psychotherapies more functional.

Background: Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. A large number of randomised controlled trials (RCTs) have shown the efficacy of Internet-based guided self-help interventions in reducing symptoms of depression. However, study quality varies considerably. The aim of this study is to evaluate the efficacy of a new Internet-based guided self-help intervention (GET.ON Mood Enhancer) compared to online-based psychoeducation in an investigator-blinded RCT.Methods/design: A RCT will be conducted to compare the efficacy of GET.ON Mood Enhancer with an active control condition receiving online psychoeducation on depression (OPD). Both treatment groups will have full access to treatment as usual. Adults with MDD (n = 128) will be recruited and randomised to one of the two conditions. Primary outcome will be observer-rated depressive symptoms (HRSD-24) by independent assessors blind to treatment conditions. Secondary outcomes include changes in self-reported depressive symptom severity, anxiety and quality of life. Additionally, potential negative effects of the treatments will systematically be evaluated on several dimensions (for example, symptom deteriorations, attitudes toward seeking psychological help, relationships and stigmatisation). Assessments will take place at baseline, 6 and 12 weeks after randomisation.Discussion: This study evaluates a new Internet-based guided self-help intervention for depression using an active control condition (psychoeducation-control) and an independent, blinded outcome evaluation. This study will further enhance the evidence for Internet-based guided self-help interventions for MDD.Trial registration: German Clinical Trial Registration (DRKS): DRKS00005025. © 2014 Ebert et al.; licensee BioMed Central Ltd.