Preface

There has never been a greater interest in evidence-based psychotherapies. Therapists more than ever wish to evaluate their clinical practice and develop their skills using such evidence in a self-reflective manner; healthcare managers want the best supported practices for psychological therapies run in a cost-efficient way and our patients and clients themselves surely also want some reassurance that there may be some support for the practices that they may be subjected to at times when they are likely to be in considerable distress.

So why might there be problems with such a noble cause? Since at least the early 1950s the general area of psychotherapy has been beset by a considerable degree of inflammatory accusation and counter-accusation that at times has felt like a religious war. The politics of established psychotherapies versus newcomers vying for position has seen considerable polarisation around the issue of which therapy tries to monopolise science while accusing other therapies of being non-scientific. All therapies, of course, are capable of using the practices of the scientific method in order to establish an evidence base and to amend, adapt and alter practices accordingly. This scientific approach is possible whatever the extreme claims of individual practitioners from the different psychotherapies might reflect. Psychoanalysis is neither more nor less capable of being evaluated than is behaviour therapy.

The main issues for the current volume are therefore, first, to accept that there is a need for an evidence base for the psychotherapies but, second, to cast a highly critical eye on many of the assumptions about the collection of that evidence base and to be critical of the so-called evidence base itself. We have therefore asked our contributors not simply to sing the praises of their preferred approach nor to over-state the strength of the relevant evidence base but rather to maintain a critical and honest stance regarding the strengths and weaknesses of the claimed evidence. We have also sandwiched the overview of psychological therapies and the disorder-by-disorder reviews between an introductory chapter that provides a critical starting point or perspective from which to approach the subsequent chapters and a concluding chapter that provides a critical framework for the evaluation of approaches to the evidence base together with a way forward for the future.

Our hope therefore is that the challenges that face the philosophical and practical issues of the concept and collection of evidence in psychotherapy are all debated in this volume in a manner that will be useful and enlightening to everybody involved in research on or the delivery of psychotherapy. We hope, too, that our clients and patients may also benefit from these debates for otherwise our efforts will be hollow.

Chris Freeman and Mick Power

PART I

Overview of Therapies

CHAPTER 1

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