We share Yates and Mengistu's surprise at how little attention has been given to negative effects of psychological treatments. Throughout medicine, patients are given information about potential for negative effects of treatments, so that they can make informed choices about them. The principle that people should be given information about risks as well as benefits holds true in other areas of life, such as choices that people make about investing their money. So it really is surprising that people can be referred to and take up offers of psychological treatment without being told about the potential risks of treatment.

In the past, paternalism meant that people could be given treatments in the belief that these were ‘in the patient's best interests’. However, this approach is no longer acceptable when discussing pharmacological treatments, and we believe it is no more acceptable when discussing talking treatments.

As Yates and Mengistu point out, the low response rate to this national survey means that the data do not provide a reliable estimate of how often people experience harm from psychological treatments. Ongoing research by the study team and others will hopefully ensure that a clearer picture of the features, prevalence and risk factors for the negative effects of psychotherapy will emerge, allowing strategies to be developed that reduce these effects. Only then will patients be able to provide fully informed consent for the psychological treatments that may help their condition.