Some psychotherapeutic approaches are not only ineffective, they’re actively harmful. We’re now starting to identify them
Yevgeny Botanov is a licensed clinical psychologist and assistant professor at Pennsylvania State University York.
Alexander Williams is programme director of psychology and director of the Psychological Clinic, both at the University of Kansas, Edwards Campus.
John Sakaluk is an assistant professor in psychology at Western University, Ontario, Canada.
In 2000, Jeane Newmaker took her adopted 10-year-old daughter Candace to an ‘attachment therapy’ retreat designed to increase their emotional bond. While there, Candace underwent an intervention that’s supposed to replicate the birthing process. Therapists wrapped her in a flannel sheet and covered her with pillows to simulate a womb or birth canal. Then they instructed her to fight her way out while four adults (weighing nearly 700 lbs in total) tried to stop her. Candace complained and screamed for help and air, unable to escape from the sheet. After 70 minutes of struggling, pleading that she was dying, and vomiting and excreting inside the sheet, Candace died of suffocation. This tragic case highlights an important but often overlooked aspect of psychological interventions designed to help people – sometimes they can be harmful, or even fatal.
Candace Newmaker’s death is a shocking and obviously recognisable example of an alleged treatment causing immense harm. However, there are innumerable psychological treatments on offer, many of which are not so obviously harmful but that can also carry risks. Consider that, before her rebirthing treatment, Candace underwent other forms of attachment therapy, such as ‘holding therapy’ wherein her mother Jeane held her for an extended, uncomfortable period and restricted her movements. Candace was also pinned under her mother during a session of so-called ‘compression therapy’. Throughout these different psychological treatments, her mother licked her to induce rage. These strange interventions are perhaps harmful too, but less strikingly so than the rebirthing procedure. Yet they all continue to be practised in some US states and elsewhere around the world.
Assessing whether a psychological treatment causes harm can be surprisingly difficult, and intuition is an unreliable guide. Take the popular school programme Drug Abuse Resistance Education (DARE) founded in Los Angeles in 1983. The idea of DARE, consistent with the wider ‘war on drugs’ in the United States, is straightforward: uniformed police officers visit classrooms to warn children and teens about the dangers of drug and alcohol use, thereby reducing underage use of alcohol and illicit substances, or so it is hoped. On the surface, DARE appears to be potentially beneficial and unlikely to harm. However, in 2001, the US surgeon general deemed DARE ineffective. Decades after it was developed, and despite millions of dollars spent annually on its implementation, the data indicated that DARE was no better than doing nothing.
Or was it worse than that? Was DARE potentially leading to an increase in alcohol and drug use among children and teens? The history of interventions such as rebirthing and DARE highlights important questions that should concern anyone involved in therapy, clients and therapists alike: how do we know if a certain treatment or intervention helps people as proclaimed, or if it is ineffective, even potentially harmful? And whom do we trust to make these judgments?
In the US, one might assume a government agency is responsible for the oversight of psychological interventions such as mental health treatments or larger intervention programmes. After all, the Food and Drug Administration (FDA) regulates numerous products including food, tobacco, some supplements, pharmaceutical drugs, vaccines, medical devices and cosmetics. Yet the FDA has no oversight over psychological interventions, and neither does any other agency. And while every state and territory in the US has licensing boards to oversee mental health practice and safeguard the wellbeing of the public, these boards rarely prohibit types of treatment or interventions; instead, they focus on unethical therapist behaviour, such as sexual relationships with clients and the false claiming of qualifications.
Nor are clients protected from given forms of therapy or large-scale interventions by state or federal law. A notable exception is that about half of US states have banned ‘conversion therapy’ or ‘reparative therapy’ for minors, which attempts to change their sexual orientation. But we know of no other psychological interventions that are so widely banned by law. Importantly, Candace Newmaker is not the only victim of attachment therapies such as rebirthing and, since her death, only two states have outlawed the practice. Without a governing body or lawful regulations, the people providing psychological interventions and the people receiving those interventions are left to figure out on their own whether there is any potential for harm…