Evidence-based therapy

*            Systematic collation & appraisal of findings is indispensable for informed practice &
policy making.



*            But debate about & distrust of the principles of applying research evidence to change
psychotherapy practice.



*            Fears that unreliable or misleading evidence may be prematurely & simplistically
applied.



*            Even that the nature of psychotherapy is inimical to the research paradigms of
evidence based medicine.









                                    Problems with RCT evidence

*            The RCT drug metaphor breaks down at a number of points.



*         Therapist and patient cannot be blinded to the intervention being delivered, and there
are profound difficulties with placebo treatments in therapy.



*         The intervention can never be entirely specified or standardised - therapists are
responsive to emergent issues, changing what is being delivered throughout the course of treatment



        So is evidence based therapy a special case or is there too much special pleading?

*            Perhaps predictably, both statements are true to an extent.



*            Evidence based therapy needs some modification of the rules of evidence based
medicine, but Parry (2000) argues that these adaptations are few.



*            Claims that psychotherapy, in any variant, is uniquely outside the discourse are
insupportable.