David Baxter PhD
Late Founder
Psychological Treatments That Cause Harm
by Scott O. Lilienfeld, Ph.D.
Emory University, Georgia, USA
Association for Psychological Science, 2007. Vol.2, No. 1, pg. 53-70.
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.
Dr. Lilienfeld?s article addresses:
I. The Efficacy of Psychotherapy
II.Harmful Effects in Psychotherapy: Earlier Conclusions
III. Identifying Potentially Harmful Therapies (PTHS): Methodological Issues
TABLE 1. Provisional List of Potentially Harmful Therapies
IV. A Provisional List of Potentially Harmful Therapies
Level I: Treatments That Probably Produce Harm in Some Individuals
Level II: Treatments That Possibly Produce Harm in Some Individuals
V. Implications of Research on Potentially Harmful Therapies
VI. Future Research Directions
V. Concluding Thoughts
VI. References
Free, full pdf file Lilienfeld-Psychological-Treatments-That-Cause-Harm.pdf
by Scott O. Lilienfeld, Ph.D.
Emory University, Georgia, USA
Association for Psychological Science, 2007. Vol.2, No. 1, pg. 53-70.
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.
Dr. Lilienfeld?s article addresses:
I. The Efficacy of Psychotherapy
- Empirically Supported Therapies
- The Dodo Bird Effect
- Reasons Why Harmful Treatments Are Important
II.Harmful Effects in Psychotherapy: Earlier Conclusions
- Deterioration Effects
- Negative Effect Sizes in Meta-Analyses
III. Identifying Potentially Harmful Therapies (PTHS): Methodological Issues
- Increases in Variance
- Differences Across Symptom Domains
- Multiple Forms of Harm
- Harm to Relatives or Friends
- Short-Term Versus Long-Term Deterioration
- Client Drop-Out
- Independent Replication
- Strength of Evidence
- Identifying and Operationalizing Potentially Harmful Therapies
TABLE 1. Provisional List of Potentially Harmful Therapies
IV. A Provisional List of Potentially Harmful Therapies
Level I: Treatments That Probably Produce Harm in Some Individuals
- Critical Incident Stress Debriefing (CISD)
- ??Scared Straight?? Programs
- Facilitated Communication (FC)
- Attachment Therapies
- Recovered-Memory Techniques
- Dissociative Identity Disorder (DID) Oriented Psychotherapy
- Grief Counseling for Normal Bereavement
- Expressive-Experiential Psychotherapies
- Boot Camp Interventions for Conduct Disorder
- Drug Abuse and Resistance Education (DARE) Programs
Level II: Treatments That Possibly Produce Harm in Some Individuals
- Peer-Group Interventions for Conduct Disorder
- Relaxation Treatments for Panic-Prone Patients
V. Implications of Research on Potentially Harmful Therapies
- Is the Dodo Bird Extinct?
- Potentially Harmful Therapies Should Come Before Empirically Supported Therapies
VI. Future Research Directions
- Prevalence of Potentially Harmful Therapies
- Therapist Variables
- Client Variables
- Mediators
V. Concluding Thoughts
VI. References
Free, full pdf file Lilienfeld-Psychological-Treatments-That-Cause-Harm.pdf
