Date of Award

2026

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Graduate Department of Clinical Psychology

First Advisor

Rodger K. Bufford, PhD

Second Advisor

Nancy Thurston, PsyD

Third Advisor

Jory Smith, PsyD

Abstract

Psychotherapy is widely assumed to be beneficial, yet research consistently shows that a meaningful proportion of patients experience deterioration or harm. Adverse therapy experiences (ATEs) may intensify distress, undermine trust in clinicians, and elevate risk for self-harm, particularly among psychiatric inpatients who are already in crisis; ATEs may thus contribute to deterioration while undergoing psychotherapy. This study examined whether ATEs predicted psychological distress, suicidal ideation, and perceived risk of harm to self or others among adult psychiatric inpatients. Data were obtained from 56 voluntary and involuntary inpatients using a newly developed measure of ATEs, the Multidimensional Scale of Perceived Social Support (MSPSS), archival PHQ-9 scores, and risk assessments. Hierarchical regression analyses showed that ATEs added significant incremental prediction of perceived risk of harm, beyond that predicted by demographic factors and social support. ATEs demonstrated a marginal association with depressive symptoms and suicidal ideation, suggesting a potentially meaningful but complex relationship. Social support did not significantly buffer the effects of ATEs. These findings underscore the clinical importance of identifying and addressing negative therapy experiences, particularly within high‐risk inpatient settings, and highlight the need for measurement‐based approaches that systematically assess therapy harm.

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