Navigating Through the Darkness: An Exploratory Study Unraveling the Experience of Hospitalization of Adolescents and Their Caregivers Amid Suicidal Presentations

Considering Historical Context, Current Societal Trends, and Implications for Understanding Harm in Youth Mental Health Treatment: A Broader Lens to the Primum Non Nocere Special Issue

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.

Primum non nocere: Toward a Greater Understanding of the Potential for Harm in Psychological Treatments for Youth

The field of clinical psychological science has made considerable progress over the years in developing, testing, and disseminating psychological interventions for youth mental health conditions. Despite these achievements, the question of whether certain treatments may actually be inert, or at worst, iatrogenic, has been relatively underexamined compared to affirmative questions of efficacy. Fortunately, interest in the topic of harm within psychological treatments is growing. However, much of this work has taken place from a general theoretical perspective and has primarily focused on adults, and adaptations to youth populations remain limited. Thus, this special issue fills an important gap in the literature in terms of furthering our understanding of the potential for harm in youth mental health treatment. The articles in this collection contain a balance of conceptual, methodological, and empirical research focused on better understanding the potential for harm in youth mental health treatment with regard to particular populations, settings, and psychological disorders. In this introductory article, we: (a) explicate a brief background review of previous conceptual and empirical knowledge development efforts concerning potential for harm in psychological treatments, (b) outline unique considerations for specifically addressing this topic in youth, and (c) provide an overview and synthesis of articles in the collection. This special issue raises awareness of the ways in which youth may inadvertently be adversely affected by psychological interventions. We hope this will lead to greater refinement of beneficial evidence-based interventions and more nuanced attention given to potential areas of pitfall in clinical practice with youth.