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Purpose of this Blog

March 26, 2010

Recently in the mental health field, a great deal of attention has been focused on what is called Evidence-Based Practice (EBP). What this means is that therapists are now expected to provide research evidence to support the therapies they offer and to inform the clients of the state of the evidence. While a number of such therapies have been identified, what has been generally not discussed until recently, is the equally important flip side to EBP, therapies that could potentially cause harm. Within the past few years, however, several articles have been appearing in professional journals discussing this important topic and proposing a system to classify these therapies. Given that the first principle of any code of ethics is, First Do No Harm, attention to this topic is long overdue. The initial article on this topic was written by Scott Lilienfeld, a Psychologist and Psychology Professor at Emory University. This article, entitled Psychological Treatments that Cause Harm is available online and can be accessed directly by clicking on this link

Lilienfeld’s article proposes a system for classifying such treatments and identified a preliminary list of potentially harmful therapies (PHTs). He emphasized that this list is not meant as a closed, definitive list and is open to changes and additions.

The January 2010 issue (volume 65, issue 1) of the APA journal,  American Psychologist had three additional articles elaborating on this topic. The text, unfortunately, is not available online, but here are the references:

Barlow, D. H. (2010). Negative effects of psychological treatments. American Psychologist, 65, 13-20.

Dimidjian, S. & Hollon, S. D. (2010). How would we know if a psychotherapy were harmful? American Psychologist, 65, 21-33.

Castonguay, L. G., Boswell, J. F., Constantino, M. J., Goldfried, M. R. & Hill, C.  E. (2010). Training implications of effects of harmful therapies. American Psychologist, 65, 34-49.

As these articles point out, there are many ways in which a therapy can cause harm, either directly or indirectly. For example, even a seemingly benign but untested therapy can cause indirect harm to a client if the claims are overinflated leading the client to spend undue amounts of time and money on the therapy and worse, be kept from using a more effective therapy that might have helped. There are also procedures that can cause direct harm in some clients. In the past, this topic has been downplayed by people who have urged the profession, in essence, to accentuate the positive. More recently, however, given the harm that has been done to some in the name of “therapy” study of harmful effects has begun to receive the attention it deserves.

What it comes down to is that mental health professionals can no longer get away with waving their licenses around and silencing those who would question the safety and efficacy of their treatments. More and more therapy consumers are being educated about what questions to ask and coming to realize that licensed professionals have a responsibility to their clients to demonstrate that the procedures they are using are safe and efficacious.

Arguments from authority will no longer do. The fact that something is being used by an licensed authority does not necessarily mean that it is safe and effective, as plenty of casualties at the hands of such licensed professionals have made all too clear. It is time to hold licensed mental health professionals accountable for the treatments they offer and this means asking for evidence to support claims. If such a professional responds by attacks on critics and implying that no one but other licensed professionals have the right to question and challenge, rather than responding directly to such questions, that is a major red flag.

The mental health profession has reached a critical point. On the one hand, more and more attention is being focused on the need for EBP and exposure of PHTs. On the other hand, critics who attempt to expose unsupported claims that are being made are being personally attacked and having their reputations tarnished or even ruined, as doing a Google search on my name, “Monica Pignotti” will demonstrate. It is time for professionals to decide whether they want the profession to be run by scientific evidence or Google and in so deciding, people will get the profession they deserve.

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