Professional Psychology: Research and Practice, Vol 56(3), Jun 2025, 181-190; doi:10.1037/pro0000620
Childhood trauma is devastatingly prevalent in the United States. A first-line, empirically supported treatment for youth with posttraumatic stress disorder is trauma-focused therapy (TFT). However, ethical dilemmas associated with therapies that evoke distressing trauma-related memories, thoughts, and feelings remain underacknowledged in the literature. We performed a systematic review of 17 studies in youth samples, which revealed that both TFTs and non-TFTs have demonstrated strong efficacy in reducing posttraumatic stress disorder symptoms. In studies reporting attrition, TFTs generally reported more dropouts than non-TFTs, yet reasons for attrition remain largely unknown. Relevant iatrogenic considerations, such as the potential for excessive distress in TFT, and associated ethical implications have been widely ignored. To address this gap, we present potential risks that may arise in TFT for youth and make 12 recommendations to assist practitioners in upholding their ethical responsibilities while delivering treatment that may cause some degree of distress. (PsycInfo Database Record (c) 2025 APA, all rights reserved)