Psychological Treatments That Cause Harm

Abstract

The phrase primum non nocere (“first, do no harm”) is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

“…PTSD trials were by far most likely to include harmrelated data. There are two plausible reasons for this: First, within the field of trauma several well-known ineffective and potentially harmful treatments have been and still are used [5], which probably have increased the sensitivity for…”

“…Although an increasing number of RCTs show that psychological interventions can be successfully applied to a wide range of mental disorders [3,4], less is known about potential harms (i.e., adverse events, side effects, and symptom deterioration). However, some psychological treatments might induce harm in a significant number of patients [5][6][7][8]. A review from 2007 lists some bona fide therapies that are potentially harmful, such as critical incident stress debriefing, grief counseling for normal bereavement, and boot camp interventions for conduct disorder [5].…”

“…However, some psychological treatments might induce harm in a significant number of patients [5][6][7][8]. A review from 2007 lists some bona fide therapies that are potentially harmful, such as critical incident stress debriefing, grief counseling for normal bereavement, and boot camp interventions for conduct disorder [5]. The author stresses that the potential harms are likely to be multidimensional, and not merely restricted to deterioration of target symptoms.…”

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

“…Some authors have suggested that DD treatment is harmful (Lambert & Lilienfeld, 2007; Lilienfeld, 2007); if this viewpoint is accurate, specialized treatment would likely also increase the economic burden of DD patients on the health care system. This is an important area that merits more research.…”

Iatrogenia y prevención cuaternaria en salud mental

“…Un problema metodológico importante es que gran parte de los estu dios solo compara a los pacientes que han finalizado el tratamiento y desechan a los que lo abandonaron. La débil alianza tera péutica es un buen predictor de abandono y en sí misma es un indicador o una con secuencia de una terapia fallida 82 .…”