Psychological Treatments That Cause Harm

Lilienfeld, Scott O.

doi:10.1111/j.1745-6916.2007.00029.x

Cited by 959Psychotherapy Techniques and ApplicationsCounseling, Therapy, and Family DynamicsPsychoanalysis and Psychopathology Research

Psychological Treatments That Cause Harm

Lilienfeld, Scott O.·2007·Perspectives on Psychological Science

DOI 10.1111/j.1745-6916.2007.00029.x

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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.

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Critical incident stress debriefing has been identified on a provisional list of potentially harmful therapies.
“Indeed, critical incident stress debriefing has been identified on a provisional list of potentially harmful therapies (Lilienfeld, 2007).”
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The active treatment will increase the variance compared to no treatment control.
“as it is likely that the active treatment will increase the variance compared to no treatment control [7].”
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Study drop-out can occur for a variety of reasons including dissatisfaction or harm experienced during therapy, circumstantial reasons, or early success of therapy, and it will not always be possible in randomised studies to ascertain which applies.
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Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation
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Psychological therapies for people with borderline personality disorder.
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Wise interventions: Psychological remedies for social and personal problems.
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Major Depression and Its Recurrences: Life Course Matters
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The Selection and Design of Control Conditions for Randomized Controlled Trials of Psychological Interventions
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Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1046177 · Cited by 557 · see citing works
Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature
Hom, M. A., Stanley, I. H., & Joiner, T. E. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.05.006 · Cited by 462 · see citing works
Psychological therapies for people with borderline personality disorder
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012955.pub2 · Cited by 450 · see citing works
Negative effects from psychological treatments: a perspective
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How to Define, Find and Classify Side Effects in Psychotherapy: From Unwanted Events to Adverse Treatment Reactions
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Evidence‐based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness.
Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., Phillips, L., Ward, A., Lynch, R., Trent, L., et al. (2011) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2011.01247.x · Cited by 393 · see citing works
Consensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371 · see citing works
Large language models could change the future of behavioral healthcare: a proposal for responsible development and evaluation
Stade, E. C., Stirman, S. W., Ungar, L. H., Boland, C. L., Schwartz, H. A., Yaden, D. B., Sedoc, J., DeRubeis, R. J., Willer, R., & Eichstaedt, J. C. (2024) · npj Mental Health Research · doi:10.1038/s44184-024-00056-z · Cited by 391 · see citing works
“Without an initial focus on EBPs, clinical LLM applications may fail to re ﬂ ect current knowledge and may even produce harm 63 .”
Background
Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies
Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.09.008 · Cited by 341 · see citing works
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How would we know if psychotherapy were harmful?
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Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings
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“Therapist variables include lack of skill in conducting an effective therapy (Lilienfeld, 2007), lack of empathy, underestimating the severity of the client's problems, and poor communication about the process and content of therapy (Crawford et al., 2016; Mohr, 1995).”
BackgroundMethod
Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs
Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021) · Clinical Psychological Science · doi:10.1177/2167702621996340 · Cited by 278 · see citing works
Evolving the future: Toward a science of intentional change
Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. D. (2014) · Behavioral and Brain Sciences · doi:10.1017/s0140525x13001593 · Cited by 255 · see citing works
Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application
Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K., Horsch, A., Holmes, E. A., & James, E. L. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.08.005 · Cited by 255 · see citing works
Definition, assessment and rate of psychotherapy side effects
Linden, M., & Schermuly-Haupt, M.-L. (2014) · World Psychiatry · doi:10.1002/wps.20153 · Cited by 220 · see citing works
Patient experience of negative effects of psychological treatment: results of a national survey
Crawford, M. J., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., Clarke, J., & Parry, G. D. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.162628 · Cited by 225 · see citing works
Negative Effects of Psychological Treatments: An Exploratory Factor Analysis of the Negative Effects Questionnaire for Monitoring and Reporting Adverse and Unwanted Events
Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2016) · PLOS ONE · doi:10.1371/journal.pone.0157503 · Cited by 223 · see citing works
Ten good reasons to consider biological processes in prevention and intervention research
Beauchaine, T. P., Neuhaus, E., Brenner, S. L., & Gatzke-Kopp, L. (2008) · Development and Psychopathology · doi:10.1017/s0954579408000369 · Cited by 215 · see citing works
Targets and Outcomes of Psychotherapies for Mental Disorders: An Overview
Cuijpers, P. (2019) · World Psychiatry · doi:10.1002/wps.20661 · Cited by 206 · see citing works
Negative effects of internet interventions: a qualitative content analysis of patients' experiences with treatments delivered online
Rozental, A., Boettcher, J., Andersson, G., Schmidt, B., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1008033 · Cited by 189 · see citing works
Innovations in disaster mental health: Psychological first aid.
Vernberg, E. M., Steinberg, A. M., Jacobs, A. K., Brymer, M. J., Watson, P. J., Osofsky, J. D., Layne, C. M., Pynoos, R. S., & Ruzek, J. I. (2008) · Professional Psychology: Research and Practice · doi:10.1037/a0012663 · Cited by 185 · see citing works
Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial
Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.06.006 · Cited by 176 · see citing works
Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice
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Circle of Security–Parenting: A randomized controlled trial in Head Start
Cassidy, J., Brett, B. E., Gross, J. T., Stern, J. A., Martin, D. R., Mohr, J. J., & Woodhouse, S. S. (2017) · Development and Psychopathology · doi:10.1017/s0954579417000244 · Cited by 167 · see citing works
The recording of adverse events from psychological treatments in clinical trials: evidence from a review of NIHR-funded trials
Duggan, C., Parry, G., McMurran, M., Davidson, K., & Dennis, J. (2014) · Trials · doi:10.1186/1745-6215-15-335 · Cited by 165 · see citing works
Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials
Ebert, D. D., Donkin, L., Andersson, G., Andrews, G., Berger, T., Carlbring, P., Rozenthal, A., Choi, I., Laferton, J. A. C., Johansson, R., et al. (2016) · Psychological Medicine · doi:10.1017/s0033291716001562 · Cited by 154 · see citing works
Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder
Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000100 · Cited by 153 · see citing works
Pharmacological interventions for those who have sexually offended or are at risk of offending
Khan, O., Ferriter, M., Huband, N., Powney, M. J., Dennis, J. A., & Duggan, C. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007989.pub2 · Cited by 144 · see citing works
For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy.
Rozental, A., Magnusson, K., Boettcher, J., Andersson, G., & Carlbring, P. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000158 · Cited by 137 · see citing works
Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis
Okuyama, T., Akechi, T., Mackenzie, L., & Furukawa, T. A. (2017) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2017.03.012 · Cited by 132 · see citing works
Factors affecting recruitment into depression trials: Systematic review, meta-synthesis and conceptual framework
Hughes-Morley, A., Young, B., Waheed, W., Small, N., & Bower, P. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.005 · Cited by 132 · see citing works
Unwanted Events and Side Effects in Cognitive Behavior Therapy
Schermuly-Haupt, M.-L., Linden, M., & Rush, A. J. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9904-y · Cited by 132 · see citing works
Prevalence of meditation-related adverse effects in a population-based sample in the United States
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Authors: Lilienfeld, S. O.
Affiliations: Emory University (US)
Corresponding author: Lilienfeld, Scott O.
ORCID: Lilienfeld, Scott O.
Venue: Perspectives on Psychological Science
Publisher: SAGE Publications
Published: 2007-03
Volume: 2
Issue: 1
Pages: 53-70
ISSN: 1745-6916 (ISSN-L)
1745-6924
DOI: 10.1111/j.1745-6916.2007.00029.x
OpenAlex: W2135110234
Cited by: 959
References: 174
Citations by year: 2026: 28 · 2025: 37 · 2024: 30 · 2023: 50 · 2022: 48 · 2021: 94 · 2020: 75 · 2019: 52 · 2018: 59 · 2017: 64 · 2016: 55 · 2015: 67 · 2014: 71 · 2013: 47 · 2012: 58
FWCI: 28.38
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Perspectives on Psychological Science (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: non-maleficence, mechanisms of change

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