The possibility of treatment-induced deterioration among psy- chiatric patients was first observed nearly 7 decades ago (Masserman & Carmichael, 1938) and has been noted by a number of authors since then (e.g., Stuart, 1970). Over the past several decades, two lines of evidence have traditionally been invoked to buttress the assertion that psychotherapy can sometimes be harmful: (a) deterioration effects and (b) negative effect sizes from meta-analyses of psychotherapy out- come.