Identifying Harmful Therapies: Setting the Research Agenda

This special issue points to both the progress we have made in learning which interventions may be potentially harmful, and the many gaps in our knowledge about how to define and identify iatrogenic effects. We are thankful to the authors of these articles for raising many important questions and providing direction for the field to improve the state of our understanding. We first review the articles in the special issue, focusing initially on those that can help us better define and identify potentially harmful therapies in more reliable and valid ways, both in the context of clinical practice guidelines and in the evaluation of the statistical validity and evidential strength of trials examining iatrogenic effects. Next, we discuss lessons learned from articles that consider interventions for various clinical problems, including suicide, obsessive-compulsive disorder. and substance use. The final articles reviewed discuss potentially harmful interventions designed to address some aspect of relational behavior that counters a societal norm or expectation in some way, including sexual orientation change, attachment, and gang-focused interventions. We then consider common methodological, theoretical, and ethical challenges highlighted by the articles and close with our top ten recommendations for the field and directions for future research. It is our strong hope that the next decade of research will allow for a more comprehensive evidence base to draw from so that clinics, therapists, and consumers can make informed choices to avoid pursuing care that can cause harm.