Harmful Psychological Treatments

Scott O. Lilienfeld

A widely accepted credo among medical and mental health professionals, attributed to the Greek physician and “father of medicine” Hippocrates, is Primum non nocere (“First, do no harm”). Yet, despite the signal importance of this credo, the field of psychotherapy has displayed relatively little interest in the question of potentially harmful psychological treatments. For example, in 2006, the American Psychological Association (APA) Presidential Task Force on Evidence-Based Practice barely mentioned the problem of harmful treatments. There is no question that psychotherapy is helpful on balance. Meta-analyses consistently demonstrate that a broad spectrum of psychotherapies, including behavior, cognitive-behavioral, interpersonal, and insight-oriented therapies, exert positive effects on a variety of psychological problems. These problems include mood disorders, anxiety disorders, insomnia, and bulimia nervosa. Nevertheless, this positive assessment of the state of the psychotherapy literature must be balanced against one sobering fact: A nontrivial number of clients become worse following psychotherapy. Estimates of ...

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