Silverman Wendy K, Spencer Samuel D
Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06510, USA.
Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
Res Child Adolesc Psychopathol. 2025 May;53(5):817-830. doi: 10.1007/s10802-025-01324-y. Epub 2025 Apr 30.
Potential for harm or non-beneficence in psychological treatments remains understudied compared to questions of benefit or efficacy, especially in youth populations. Further study is critical for upholding the ethical mandate to both maximize salutary outcomes and minimize harm/non-beneficence. In the present special issue, authors of target articles incisively delineate parameters of harm and associated clinical strategies for measuring and addressing it, along with recommendations for research advancing understanding of harm in youth mental health treatment. In this commentary, we synthesize key points across the articles and offer future directions for advancing knowledge on treatment harm. First, we provide historical context that includes the origins of the concept of Primum non nocere, its initial linkages with clinical psychology, and controversies relating to the scientific study of psychotherapy. Second, we leverage lessons learned from the evidence-based treatment movement to advance the study of harm. We suggest that research aimed at advancing understanding harm in youth treatment ought to transpire concurrently with research examining putative benefits of such interventions, including a deliberate focus on mechanisms and moderators of both benefit and harm. Third, we identify several contemporary societal trends relevant to our understanding of harm, including current skepticism of science and proliferation of pseudoscientific interventions. We conclude by discussing implications for furthering knowledge of potential harms in youth mental health treatment across the domains of theory, research, and dissemination. We hope this special issue and commentary stimulate further thought and research in this heretofore understudied area.
与心理治疗的益处或疗效问题相比,心理治疗中潜在的危害或非益处问题仍未得到充分研究,尤其是在青少年群体中。进一步的研究对于坚持道德要求至关重要,即既要最大限度地提高有益结果,又要尽量减少危害/非益处。在本期特刊中,目标文章的作者精确地描述了危害的参数以及测量和应对危害的相关临床策略,同时还提出了推进对青少年心理健康治疗中危害理解的研究建议。在这篇评论中,我们综合了各篇文章的要点,并为推进治疗危害知识提供了未来方向。首先,我们提供历史背景,包括“首要的是不伤害”这一概念的起源、它与临床心理学的最初联系,以及与心理治疗科学研究相关的争议。其次,我们借鉴循证治疗运动的经验教训来推进危害研究。我们建议,旨在增进对青少年治疗中危害理解的研究应该与考察此类干预假定益处的研究同时进行,包括有意识地关注益处和危害的机制及调节因素。第三,我们确定了几个与我们对危害的理解相关的当代社会趋势,包括当前对科学的怀疑态度和伪科学干预的泛滥。我们通过讨论在理论、研究和传播领域推进青少年心理健康治疗中潜在危害知识的意义来得出结论。我们希望本期特刊和这篇评论能激发在这个迄今为止研究不足的领域进行进一步的思考和研究。