Trauma therapy: risks, side effects, and the forensic implications of treatment history

Many victims of sexual violence develop trauma-related disorders, often requiring early trauma-focused psychotherapeutic treatment. Guideline-compliant treatments can effectively alleviate PTSD symptoms; the positive effects of recommended trauma-focused techniques are undisputed. Nevertheless, it is important to critically discuss potential risks. Several recent publications on effects of trauma therapy report no cause for concern, emphasising that trauma-specific treatment has no negative effects on the memories of patients who have experienced trauma. This line of reasoning overlooks the fact that patients may already develop trauma-related beliefs or memories through counselling, prior treatments, or content on social media before starting their current trauma-specific treatment. In such cases, even trauma therapy conducted according to standard practice can cause harm. In this article, we focus on such case scenarios, which are encountered in forensic practice. We use case examples to discuss the significance of widespread misconceptions regarding the accessibility of traumatic memories and their role in the iatrogenic development or consolidation of false memories. As will be shown, it is necessary to raise awareness on these risks and on misconceptions which have been disproved. We recommend psychoeducation on the susceptibility of autobiographical memory to errors and a systematic anamnesis prior to the start of trauma-focused interventions.