Any Treatment Is Better Than No Treatment At All

“Any treatment is better than no treatment at all.” I’ve drawn that quotation from the published work of an unconventional therapist who shall be nameless. It’s not just his idea-- plenty of people believe that this is a true statement about psychotherapies. It’s common to think that those who “seek help” always get help, rather than hindrance. But is it true?

Let’s just consider the logic of the whole thing. There are three logical possibilities for the outcome of psychotherapy. One is that the person being treated gets much better, and is both happier and more effective in his or her life. Another is that there’s really no change-- the patient is neither better nor worse during or following the therapy. And the third is that the treatment has an effect opposite from what was wanted: the person who was treated ends up in worse condition than before.

The clinical psychologist Scott Lilienfeld and others have referred to this third possibility as a matter of “potentially harmful treatments” (PHTs). Although a PHT may not harm everyone who experiences it, there is clear evidence that some persons treated in that way have suffered real worsening of their situations-- in some cases even dying as a result. It’s not too difficult to see that physical treatments could have harmful effects, because although medications may benefit people, they can also have adverse effects. Chelation therapy for autism and restraint therapies for “attachment disorders” are understandably potentially harmful. But people may have more trouble understanding how a non-physical psychotherapy of any kind could be a potentially harmful treatment. Cynics are far more likely to expect psychotherapies to be useless than to think they might cause emotional or other damage.

“Recovered memory’ treatments are a very good example of psychotherapies that are potentially harmful. When therapists suggest to patients that their symptoms must be the result of some long-repressed memory of abusive treatment or even of “Satanic rituals”, and when the patients then “recover” such memories with therapist encouragement--- in the absence of confirming evidence, or even the presence of disconfirming evidence----- harm to the individual, friends, and family can be very real. There are many substantiated cases of patients who “recovered memories” that accused family members of horrendously abusive behavior, followed by family alienation, divorce, criminal charges, and so on--- and in some cases eventually followed by the patient’s awareness that in fact the memory had been suggested by the therapist, not actually “recovered”. The potential for harm in this kind of treatment has become pretty clear over the years, although it was not necessarily obvious to the first therapists and patients who used it.

Programs like “boot camps” and “Scared Straight” programs, which lack evidence of effectiveness, may also be PHTs because of their deliberately traumatic components. It’s curious, isn’t it, that our society currently has so much concern with post-traumatic stress disorders, yet we accept some treatment programs based on trauma! It’s especially curious that we want young people from backgrounds of poverty and family dysfunction, who have already been exposed to emotional trauma in many cases and may be sensitized to it, to attend “boot camps” where programs will intentionally frighten and disturb them. (Surely the closest analogy would be a situation where traumatized combat veterans would be exposed to more fear and stress in the bizarre expectation that their original trauma would be defused by this.)

If adults want to choose PHTs, they have the right to do so. Under the First Amendment, advocates of PHTs have the right to state what they consider the strong points of their treatments, and those of us who oppose those treatments can only exercise our own First Amendment rights to state what we consider the problems of those treatments. When it comes to PHTs for children and adolescents, the matter is more complicated. Adults who make choices or recommendations about psychotherapy for children need to remember that they have a fiduciary responsibility-- not one that necessarily involves money, but one that involves guardianship or stewardship of a child’s developmental pathway. Choosing for another, dependent person, who may suffer from our mistakes, feels much more difficult to most of us than choices that affect ourselves alone. One of the first steps in such a choice should involve making sure that PHTs are not among the options we are considering.

In fact, some treatments for mental health problems appear to be potentially worse than no treatment at all, and not all psychotherapies are therapeutic. Let’s not fall for the idea that anything described as an intervention must either do good or do nothing.