Identifying harmful therapies: Setting the research agenda.

Abstract

This special issue points to both the progress we have made in learning which interventions may be potentially harmful, and the many gaps in our knowledge about how to define and identify iatrogenic effects. We are thankful to the authors of these articles for raising many important questions and providing direction for the field to improve the state of our understanding. We first review the articles in the special issue, focusing initially on those that can help us better define and identify potentially harmful therapies in more reliable and valid ways, both in the context of clinical practice guidelines and in the evaluation of the statistical validity and evidential strength of trials examining iatrogenic effects. Next, we discuss lessons learned from articles that consider interventions for various clinical problems, including suicide, obsessive-compulsive disorder, and substance use. The final articles reviewed discuss potentially harmful interventions designed to address some aspect of relational behavior that counters a societal norm or expectation in some way, including sexual orientation change, attachment, and gangfocused interventions. We then consider common methodological, theoretical, and ethical challenges highlighted by the articles and close with our top ten recommendations for the field and directions for future research. It is our strong hope that the next decade of research will allow for a more comprehensive evidence base to draw from so that clinics, therapists, and consumers can make informed choices to avoid pursuing care that can cause harm. Public Health Significance StatementThis special issue raises important questions about the extent to which the field of clinical psychology is embracing interventions that may not only be ineffective, but actively harmful for some people. The articles cover a wide range of problem areas, intervention types and delivery models, and point to unresolved questions about the methodologies needed to validly identify potentially harmful therapies. We first summarize the key lessons learned from these articles, and then consider common themes they highlight and close with a call for future research. This final call is central to our hopes for this special issue because, as these articles make clear, questions about potential harms have been sorely understudied despite their clear importance for providing ethical care.

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

“…2005; Hatfield et al. 2010; Teachman, White, and Lilienfeld 2021; Werbart, Annevall, and Hillblom 2019). Monitoring adverse events in psychotherapy may help overcome this blind spot for therapists and provide professionals with feedback on when to intervene, thereby reducing the risk of therapy failure.…”

“…Perhaps most importantly, unlike the other instruments, the PNEP invites clients to attribute positive and negative experiences and this information might provide a good starting point for a helpful dialogue between client and therapist. This thorough evaluation is especially important for addressing negative experiences or harmful effects of psychotherapy, which therapists often overlook or attribute to the patient's psychopathology (Hannan et al 2005;Hatfield et al 2010;Teachman, White, and Lilienfeld 2021;Werbart, Annevall, and Hillblom 2019).…”

A framework for assessment of adverse events occurring in psychedelic-assisted therapies

“…The development of criteria for psychotherapy-related AEs has been aided by the identification of harmful therapies (i.e., therapies that lead to harm when applied as intended), harmful practices in therapy (i.e., malpractice), and unintended harms in otherwise helpful therapies (Dandachi-FitzGerald et al, 2022;Linden, 2013). Examples of therapies known to be potentially harmful include conversion therapy, rebirthing therapies, and critical incident stress debriefing following trauma exposure (Teachman et al, 2021). These therapies, respectively, pose inappropriate goals and interfere with patients' values and communities (e.g., conversion therapy); produce psychological and physical harm while claiming that dangerous levels of distress are part of the therapeutic process (e.g., rebirthing), and apply a treatment that patients and therapists expect to be beneficial, but which interferes with the natural recovery from trauma (e.g., critical incident debriefing).…”