Potentially Harmful Treatments.

I found the article of Lilienfeld(2007) very much informative and provocative. The article is comprehensively informative by 1) critically evaluating and updating earlier conclusions regarding deterioration effects in psychotherapy, 2) outlining methodological obstacles standing in the way of identifying potentially harmful therapies(PHTs), 3) providing a provisional list of PHTs(p.53). What I mean by “provocative” is that his argument of listing “PHTs” and calling for mental health professionals’ being aggressive in confronting the hazard posed by PHTs is compelling and legitimate with a possibility of inviting confrontation and complaints from those who have been and is using the treatments(i.e CISD, DARE, Boot-camp intervention, and so on). Even Lilienfeld was cautious by stating that the list of PHTs was tentative, I had a feeling that he must’ve had guts to put it forward in a public arena. Lilienfeld has my support on this move of heightening awareness of PHTs as he is indeed right that “knowing possible harms of therapies” is an obligation to therapists. Prior to reading the article, my knowledge and awareness on PHTs was very limited. I was surprised to know that 5 to 10% of clients(at maximum, p.54) could experience deterioration effects and the prevalence of PHTs was quite high(for example, about 25% of psychotherapists in the mid 1990s use two or more recovered-memory techniques, such as hypnosis and guided imagery…). I’m glad to have an opportunity to think about PHTs and issues related to them.

In the section of future research directions, Lilienfeld mentioned therapist variables and client variables. Specifically, clients can be at risk for deterioration when working with charismatic yet highly confrontational and intrusive encounter-group leaders. And client individual differences, such as high levels of borderline personality disorder traits, sometimes contribute to deterioration(p.64). As it is valuable to search for therapist variables and client variables in a respective manner, exploring a good match between them(so to speak “a goodness of fit”) will be intriguing and beneficial to therapy outcomes. This is rather off the topic, but I’ve seen many couples and parent-child relationships in conflict or trouble just because of the goodness of fit. One of my close friends who were very sensitive and anxious had hard time brining up her difficult daughter. Distressed by stress from the rearing, she came near to depression, and her girl had to go through play and speech therapies. Had my friend, I think, been easy going with the daughter, or had the daughter’s temperament been easy, things would not been exacerbated to the extent. Also, in my anecdotal experiences with many married couples around me, a couple gets to fight just because they are so different in personality wise. A husband is very much plan-driven, organized, and anxious while his wife being rather impulsive and enjoying spontaneity. The difference first appears to be not so significant, but accumulations and repetitive exposure to the difference results in a great deal of emotional conflicts. For a long time, I’ve been thinking a lot about compatibility among certain characteristics or personalities or traits, when involving in a relationship whether parent-child or marital ones. I do believe that the compatible or synergetic effects do exist in a working relationship as a therapist and a client, although no data or evidence is provided, and thus it does not sound scientific. My goal as a therapist if I becomes one someday is to know myself, letting along knowing harm. And by 1)actively and consciously searching for client variables compatible with my therapist style, 2) keeping myself exposed to ESTs and PHTs outcome literatures, I want to avoid potential harms at my best strength.