The Primum non nocere principle in psychotherapy: A science based approach

Is the principle of primum non nocere, to do no harm, applied by psychotherapists?

First, do no harm – a rule that enjoys practically unconditional acceptance by all of human civilization, at least when it concerns healthcare interventions. Students of medicine have this hammered into their heads beginning with their first lesson. It is so universal that we treat it as a part of the Hippocratic oath, while it in fact never was one; Hippocrates’ authorship itself is also frequently called into question.

If we consider the matter more carefully, it turns out to be not only inhumanly difficult to adhere to, but even cruel in a certain sense. A doctor, a physiotherapist, or a nurse is faced with a person who is suffering, in need of help, sometimes immediately; but before that help is given, it is necessary to take into consideration all of the surrounding circumstances and professional knowledge in order to be entirely sure that no harm will be done. And if they hesitate? If they aren’t completely sure? Should they refrain from intervening? The rule is clear – yes. Not doing harm takes priority over doing something which may be helpful, but which also bears too great a risk of harm. Thus, sometimes the principle of primum non nocere means we should refrain from providing assistance to a person who is suffering. It means that not-acting is better than rash, uncertain action.

And yet, when taking a closer look at medical practices, it turns out that this overarching principle is giving way to one that stands in opposition – melius anceps remedium quam nullum – an uncertain treatment is better than no treatment at all. Those who give care prefer to do anything at all rather than nothing. And what if it brings relief in suffering? The motives of the people inclined to follow the latter rule are diverse. They may attempt to do something out of pure sympathy, or due to pressure put on them by the patient. They may be pushed into doing something by their environment, the demands of the sick person’s family, or even their superiors. Sometimes they are driven by aversion to the helplessness which they feel when refraining from action, or by the need to verify their own competences and a feeling of their own professional value. Not infrequently, they are also motivated by economic considerations – after all, patients prefer to return to doctors or therapists who have done something, prescribed some medicine or performed some intervention, rather than to those who simply shrug their shoulders and say there’s no tried-and-true method, so the rule of primum non nocere means that nothing is to be done.

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The Primum non nocere principle in psychotherapy: A science based approach

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