Academic journal article Journal of Psychology and Christianity

Potentially Harmful Therapies: Psychological Treatments That Can Cause Harm

Academic journal article Journal of Psychology and Christianity

Potentially Harmful Therapies: Psychological Treatments That Can Cause Harm

Article excerpt

Brief reviews and summaries of the research literature relevant to clinical practice have previously been published in this section of the Journal of Psychology and Christianity, in the following specific areas: ESTs or empirically supported treatments (Tan, 2001; see also Chambless & Ollendick, 2001); empirically informed principles of treatment selection (Tan, 2002; see also Beutler, 2000); ESRs or empirically supported therapy relationships (Tan, 2003; see also Norcross, 2002); empirically based principles of therapeutic change or principles of therapeutic change that work (Tan, 2007; see also Castonguay & Beutler, 2000), that some authors have referred to as ESPs or empirically supported principles of change (Rosen & Davison, 2003); and EBPP or evidence-based practice in psychology (Tan, 2007; see also APA Presidential Task Force on Evidence-Based Practice, 2000). The present article will briefly review and summarize the recent research literature on another crucial topic relevant to clinical practice: PHTs or potentially harmful therapies referring to psychological treatments (excluding pharmacological therapies) that can cause harm to patients or clients (see Lilienfeld, 2007).

Potentially Harmful Therapies (PHTs): Psychological Treatments That Can Cause Harm

Lilienfeld (2007) recently provided an important review and critical evaluation and update of deterioration effects in psychotherapy, including describing a tentative, provisional list of potentially harmful therapies (PHTs). He noted that both psychotherapy outcome research as well as an international survey of 12 leading researchers involved in evaluating psychotherapy outcomes (see Boisvert & Faust, 2003) lend support to the conclusion that about 10% of clients seen in therapy experience deterioration effects or get worse due to therapy. Lambert (2007) also recently concluded that the results of randomized clinical trials (RCTs) show that about 5% to 10% of patients deteriorate or get worse, and about 35% to 40% do not derive any benefit from therapy (Hansen, Lambert, & Forman, 2002). Although the generally positive effects of psychological treatments have been documented for several decades (see Lambert & Ogles, 2004), such deterioration or negative effects of psychotherapy warrant more careful and serious attention, because they point to the existence of some PHTs. Such PHTs, if they can be identified based on the research literature available, should be avoided, or at least cautiously and carefully used when appropriate, for obvious ethical and clinical reasons, focusing on doing no harm to patients or clients.

Methodological Issues in Identifying PHTs

Lilienfeld (2007) discussed several important methodological issues or obstacles that need to be addressed in the process of identifying and listing PHTs (see pp. 55-57): increases in variance in treatment groups compared to no-treatment control groups should be more carefully studied to determine if deterioration effects are present; differences across symptom domains, found in treatments that may produce improvement in some symptoms but deterioration in other symptoms, or different findings of symptom improvement depending on the source (e.g., therapist versus client reports); multiple forms of harm referring to the multidimensional nature of deterioration effects of psychotherapy (e.g., worsening of symptoms, occurrence of new symptoms, overdependency on therapists, greater concern about existing symptoms, hesitation in obtaining future therapy, and physical harm) and hence the need for comprehensive assessment of the client's functioning in many areas, and not only in target symptoms; harm to relatives or friends and not only to clients, as a result of therapy that clients have received, and therefore the need to include the assessment of this possibility in evaluating harmful effects of therapy; short-term versus long-term deterioration should be assessed; client drop-out is another crucial dimension of possible harmful effects of therapy, especially if it is early or premature client termination; independent replication of possible deterioration effects of therapy is ethically problematic, so it is crucial that researchers report their results fully in psychotherapy outcome studies, including deterioration effects; and strength of evidence is an important consideration in defining PHTs as probably harmful or only possibly harmful. …

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