The Alleged Risks of Psychotherapies
> 6/20/2007 12:38:23 PM

A column in the most recent edition of Newsweek addresses a sometimes-controversial topic in mental health circles: negative outcomes of psychotherapy. The subject is tackled by science writer Sharon Begley, and throughout her piece she raises many legitimate concerns about the potential for risk and even harm during therapy. Begley points to the fact that the FDA requires warning labels for known side-effects of drugs, but no similar warnings have ever been required of psychotherapeutic techniques. While Begley takes  an extreme, cynical stance toward the value of therapy, playing up potential risks for individual therapies and de-emphasizing the all-around benefits of treatment, her article does point to a larger question about the use of therapeutic techniques that haven't been thoroughly vetted and the responsibility of therapists to communicate any potential negative effects to their clients.

In her column, Begley refers often to Scott Lilienfeld, a professor of psychology at Emory University, who has been at the front of a push to more closely examine the negative impact of therapy, which is referred to technically as "deterioration effects". In his work Psuedoscience, Nonscience, and Nonsense in Clinical Psychology, Lilienfeld has pulled together a large number of studies that contain evidence of deterioration effects. He goes beyond just debunking the curative power of dubious methods like eye movement desensitization and reprocessing to claim that many patients are actually harmed by their treatments.

Lilienfeld's work focuses on the dangers of pseudo-scientific techniques with no regulation, but others have found evidence of negative effects in more well grounded treatments. Rudolf Moos, a researcher from Stanford University, found in a May 2005 study that 7-15% of participants in substance abuse therapy programs exited worse-off than they began.

Despite evidence of some negative outcomes, there is no queston that psychotherapies have a net positive effect. For confirmation of this, one has only to look at the extensive list that the APA compiled of studies that proved the efficacy of psychotherapy. Just a small sample:  Mary Smith and Gene Glass examined 375 evaluations of psychotherapy to show that 75% of patients were better off than untreated individuals. An even more precise study was later done to break down the amount of benefit that patients received at different stages of therapy. It not only confirmed the earlier finding by showing that 75% of patients were improved after 26 sessions, but it also revealed that 50% were improved after 8 sessions. This sort of rigorously quantified study is very healthy for psychiatry. There are admittedly some obstacles in the way of scientific comparison because of confidentiality concerns. In addtion, therapists are increasingly moving away from a strict reliance on Freud, Jung or Adler to an ecclectic mix of methods, which is harder to evaluate. Even so, the many studies complied by the APA show that all of these obstacles can be overcome.

Evidence-based treatment has been tightening up many of the psychiatric fields where positive therapeutic claims were once accepted. One treatment method particularly suited for evidence based outcomes is Cognitive Behavioral Therapy (CBT), which finds a solid middle ground between the strict claim of behaviourism that internal mental states are irrelavent and the hard-to-test claims of methods that utilize psychoanalytic techniques. Even though cognitive therapy can be successfully evaluated, most mental health practitioners do not have their patients fill out extensive psychological tests before, during  and after treatment. There is no incentive for this type of data gathering by clinicians because insurance plans will not pay for routine test administration or the scoring of such tests.

Of all the areas that receive attention for deterioration effects, grief counseling is among the most hotly debated. At the center of this storm is a meta-analysis presented by R.A. Neimeyer in 2000, which concluded that 38% of the recipients of grief counseling would have been better off without treatment. This statistic has been widely cited in prestigious journals such as the Journal of Clinical Psychiatry and American Psychologist, yet, as the authors of "What has become of grief counseling?" make clear in their article, there is very little support for these numbers. Their close examination yielded some troubling findings: Neimeyer's oft-cited article did not contain the statistics that it was based on. Instead, diligent digging revealed that the statistic was published only in a thesis, and not in a peer-reviewed journal. The flimsiness of this statistic, so central to the arguement of psychotherapy's risk, should be taken as a warning that all such claims must be carefully evaluated before laying heavy conclusions upon them.

The subject of deterioration effects is understudied. Psychiatry and psychology have not spent enough time proving the efficacy of the treatments that have become mainstays in working with the mentally anguished. But as Begley points out, that type of critical work needs to happen. It will make for better treatments and better service to clients. As Lillenfeld and others have shown, the bulk of the negative outcomes arise from methods that have not been rigorously tested, but even for the most well vetted therapies, there may be those clients who do not respond well. Good therapists will work with clients to find an approach that will work, and will be attuned enough to the course of each individuals' progress to know when something may be amiss.

By continuing to look for places to improve, therapists and others in the field of mental health will only further legitimize their science and empower practitioners to do more good in the future. The movement for this scientific validation needs to come from a collective effort on the part of all the stakeholders in behavioral health. They include employers, employees and health care providers. It is these stakeholders that are at the center of the Consumer Directed Health movement.

No comments yet.

Post Your Comments

Post a comment
Email Address:
Verification Code:
Input the 8 characters you see above:


Drug Abuse
Sexual Addiction
Eating Disorders
Alzheimer's Disease

About TOL | Contact Us | Defining Behavioral Fitness | For Healthcare Professionals | Links | Privacy Policy