Before being used for treatment, medicines undergo years of testing. In the United States, the Food and Drug administration requires several levels of research that investigate the effectiveness and the potential harm of a new drug. Traditionally, therapy has not been held to these same standards. While tests of psychotherapy efficacy are common, studies of the dangers are rare.
Despite the recent push for empirically supported therapies, clinicians still have the ability to apply treatments with little or no scientific basis. Research of psychotherapy rarely examines what doesn't work, and more importantly, what might hurt. In a 2007 paper, Scott O. Lilienfeld tackled this problem by asking the question: "What psychological treatments cause harm?" Below are some of his findings.
Outcome studies of psychotherapy indicate that 3 to 10% of clients actually fare worse after treatment. In substance abuse treatment, these numbers are as high as 10 to 15%. These harmful effects include the worsening of symptoms, dependency on the therapist, the development of new symptoms, and a reluctance to seek future treatment.
Crisis Counseling (Sometimes)
Interventions immediately following a traumatic event frequently do the exact opposite of what is intended–they increase the likelihood of a client developing symptoms of PTSD. During crisis counseling clients are often asked to "process" their emotions, which may result in over-focusing on the negative and dramaticizing the events. Even when clients report that the intervention has been helpful, objective measures indicate a worsening of symptoms.
Recovered Memory Techniques
Hypnosis, guided imagery, and the repeated questioning of memories may result in the development of false memories. In several high-profile cases clients have unintentionally created false memories of traumatic sexual abuse and even alien abductions. Other consequences of these treatments have included significant increases in suicidal ideation and psychiatric hospitalizations.
Dissociative Identity Disorder (DID)-Oriented Psychotherapy
In DID-oriented therapy clients are asked to bring forward their many different personalities. Hypnosis and other techniques are sometimes used to allow each personality to meet, and clients are encouraged to leave messages to be shared between personalities. Unfortunately, research indicates that these techniques may result in the development of additional new personalities. Additionally, some clients experience symptoms such as suicidal ideation and self-harm only when they have taken on alternative personalities.
Grief Counseling for Normal Bereavement
Studies indicate that therapy for grief should be reserved for cases of long lasting grief and grief triggered by sudden or unexpected deaths. In cases of regular grief, therapy has been found to result in negative outcomes for about half of all participants.
Treatments that focus on experiencing or releasing powerful emotions can be helpful for some, but harmful for others. This form of emotional catharsis has been found to result in an increase of negative emotion rather than a reduction. These findings are similar to those indicating that catharsis for anger, such as punching a pillow, results in even more anger.
Other Harmful Treatments
- DARE Programs: Children are taught by uniformed police officers about the dangers of drugs. Studies indicate that these programs are completely ineffective and may even increase experimentation with alcohol and other drugs.
- "Scared Straight" Programs: At-risk youths are exposed to prisons in an attempt to scare them away from committing crimes. Participants in these programs are more likely to offend in the future.
- Boot Camps for Conduct Disorder: Adolescents are taught to respect authority in military-style boot camps. Boot camps have been found to have no significant effect on behavior.
- Relaxation for Panic-Prone Clients: Because of a heightened focus on bodily sensations, some panic-prone clients can experience panic attacks as a result of relaxation techniques.
1. Lilienfeld, Scott (2007). Psychological Treatments That Cause Harm. Association for Psychological Science, 2 (1).