Читать книгу Practitioner's Guide to Using Research for Evidence-Informed Practice - Allen Rubin - Страница 23

In addition to cost considerations, as you search for the approach with the best effects, you should also bear in mind the possibility of harmful effects. There are two reasons for this. One is that some programs and interventions that were once widely embraced by helping professionals were found to be not only ineffective but actually harmful. Examples include Scared Straight programs; critical incidents stress debriefing; psychodynamic, in-depth insight-oriented psychotherapy for schizophrenia; and treating dysfunctional family dynamics as the cause of schizophrenia. (For a discussion of these approaches, see Rubin, 2012; and Rubin & Babbie, 2011.)

Some approaches that are effective overall can be harmful – or contraindicated – for certain types of clients. For example, consider two empirically supported treatment approaches for posttraumatic stress disorder (PTSD). In the early 1990s, trainees in one of these treatment approaches – eye movement desensitization and reprocessing (EMDR) – were cautioned to check for whether the client had a dissociative order or physical eye ailments before providing it because it could be harmful for such clients. The other empirically supported treatment approach – prolonged exposure therapy – can have unintended harmful effects for people whose PTSD is comorbid with suicidality or substance abuse, in that recalling and retelling in minute detail their traumatic events before their substance abuse or suicide risk is resolved can exacerbate both of those conditions (Courtois & Ford, 2009; Rubin & Springer, 2009). Even if a client doesn't have any characteristics that are a risk for harm from interventions, every client is different. In some cases, clients may experience an intervention negatively or may have a mix of both positive and negative outcomes – even if research suggests that the intervention on the whole works well for many people. The need to consider such harmful effects pertains to the aspect of EIP discussed earlier in this chapter – regarding the importance of integrating the best research evidence with your practice expertise and knowledge of client attributes, including the assessment intervention outcomes for each client individually.