Despite numerous systematic efforts to assess the efficacy of structured treatment protocols, there has been little research done on how treatment interventions could be potentially harmful to clients. Treatment interventions are not assessed thoroughly, nor have there been proper standards upheld with regards to harmful events being reported. Harmful effects could be multifaceted, encompassing factors such as deterioration of functioning and worsening of symptoms, client dropout within the interventions due to deterioration of functioning, the therapeutic alliance and its role in symptom improvement being uncertain other than for the prevention of client dropout, family members and loved ones viewing interventions as a form of abuse; producing false allegations against the practicing clinician, and interventions assuaging the initial presenting symptom but then causing adverse effects to develop in other areas functionally.
Evaluation of harm from interventions need to be regularly and systematically assessed. Solutions would entail statistical evaluation of potential benefits and harm from treatment based upon routine reporting of the number of clients needed to be treated to attain clinically notable improvement (NNT) and the number of clients needed to be treated before one is harmed (NNH). Measurement-based care (MBC) and the systematic collection of patient-reported measures are also important for improvement of assessing possible harm. Overall, these routine assessments can help clinicians better determine when their treatment is becoming insufficient or aversive and modify their choice of interventions accordingly.
References: McKay, D., & Jensen-Doss, A. (2021). Harmful treatments in psychotherapy. Clinical Psychology: Science and Practice, 28(1), 2–4. https://doi-org.ruby.uhv.edu/10.1037/cps0000023