Department of Psychology and Neuroscience, University of Colorado, Boulder, CO 80309-0345, USA.
Am Psychol. 2010 Jan;65(1):21-33. doi: 10.1037/a0017299.
Patients can be harmed by treatment or by the decisions that are made about those treatments. Although dramatic examples of harmful effects of psychotherapy have been reported, the full scope of the problem remains unclear. The field currently lacks consensus about how to detect harm and what to do about it when it occurs. In this article, we define the ways in which treatment (or the inferences about treatment) can do harm and discuss factors that complicate efforts to detect harm. We also recommend methods to detect and understand harm when it occurs, drawing from and modifying many of the same strategies that are used to detect benefit. Specifically, we highlight the value of establishing independent systems for monitoring untoward events in clinical practice, reporting descriptive case studies and qualitative research, and making use of information from randomized clinical trials, including examining potential active ingredients, mechanisms, moderators, and a broad range of outcomes measured over time. We also highlight the value of promoting discussion in the field about standards for defining and identifying harm.
患者可能会因治疗或关于这些治疗的决策而受到伤害。尽管已经报道了心理治疗产生有害影响的戏剧性例子，但问题的全貌仍不清楚。该领域目前对于如何发现伤害以及在发生伤害时如何处理伤害还没有共识。在本文中，我们定义了治疗（或关于治疗的推论）可能造成伤害的方式，并讨论了使发现伤害变得复杂的因素。我们还建议了在发生伤害时检测和理解伤害的方法，这些方法借鉴并修改了许多用于检测益处的相同策略。具体而言，我们强调了建立独立的系统来监测临床实践中不良事件、报告描述性病例研究和定性研究，以及利用随机临床试验信息（包括检查潜在的有效成分、机制、调节剂和随着时间推移测量的广泛的结果）的价值。我们还强调了在该领域内促进关于定义和识别伤害的标准的讨论的价值。
