Psychology
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View SourceWhile some studies have found that more therapy is more effective (Shadish, Navarro, Matt, & Phillips, 2000), a classic meta-analysis (Howard, Kopta, Krause, & Orlinsky, 1986) identified a negatively accelerating improvement curve over the course of treatment length. Based on these findings the authors argued that, because about 75% of clients had shown some benefit after 26 sessions, and the increased rate of improvement would be relatively low over subsequent sessions, 26 sessions might be a ‘rational time limit’ (p. 163) for psychotherapy. However, more recent studies have challenged this account, suggesting that time limits for treatment uniform to all clients are unlikely to meet clients’ differing needs.
Do some patients get worse?
In the case of pharmacological and other medical interventions, information about possible side effects or adverse reactions is usually a prominent feature of their packaging and marketing material. But no such warnings typically exist for psychological therapies. We must ask, can psychological therapies be harmful? Might symptoms become worse over the course of therapy, or might new problems emerge as a consequence of psychological interventions? On closer inspection it seems logical that anything that is powerful enough to change the way we think and feel about ourselves and the world could, if applied without care, lead to negative consequences (Barlow, 2010; Lilienfeld, 2007).
One example of this is critical incident stress debriefing (CISD). This is a therapeutic technique designed to help people immediately after experiencing a trauma in their lives (such as a natural disaster or car accident). The common wisdom is that counselling immediately after a trauma is likely to be beneficial to the victims. But what the research has found is that CISD may actually impede natural recovery, at least for some people (McNally, Bryant, & Ehlers, 2003).
Lilienfeld (2007) suggests an evidence-based list of potentially harmful therapies – including CISD, recovered memory techniques, grief counselling for individuals with normal bereavement reactions, and boot-camp interventions for conduct disorder – and argues that, in order to take reasonable steps to avoid harm, psychologists need to become more aware of the risks associated with some interventions.
Do the treatment effects generalize to routine care settings?
