Your interview with Stephen Pilling (Therapy Today, November 2008) revealed just how yawning the gulf is between the state’s policy interventions into the psychological therapy world with their crass programmatic utilitarianism, on the one hand, and on the other, the radically different assumptive worldview that underpins the vast swathe of real world, nonmedical model therapy practice. Pilling’s assertion that ‘the good quality evidence at the moment largely comes from randomised controlled trials’ not only ignores the arguably devastating critiques of this methodology¹ that have even been made in critical medical circles, but it assumes quite uncritically that RCTs are an appropriate procedure for obtaining explanatory purchase on the effectiveness of therapy – which many practitioners and researchers would strongly refute.

Moreover, once these methodologies are so challenged, statements like ‘it’s pretty reasonable to say that CBT treatments are gold standard’, and claims for CBT’s ‘broad applicability’, quickly degenerate into little more than fanciful ideological assertion. The stark reality of the therapy world’s colonisation by these alien, anti-therapy values could hardly be clearer when we read of the importance of ‘spelling out... the range of competencies to deliver effective psychological interventions’. Is Pilling unaware of the seminal work by Terry Atkinson and Guy Claxton on the ‘intuitive practitioner’², and the argument that it is the tacit, intangible and often unconscious dynamics that are most important and efficacious in therapeutic change? If Atkinson and Claxton and others are anything like right about this, then the crass modernist bludgeon that is audit driven ‘competency frameworks’ is likely to do a terminal violence to much that is best in the subtleties of effective therapy practitionership – or in other words, it will tend to bring about the very opposite of its alleged intention.

Richard House Roehampton University, Research Centre for Therapeutic Education; Independent Practitioners Network

1. House R, Loewenthal D (eds). Against and for CBT: towards a constructive dialogue? Ross-on-Wye: PCCS Books; 2008. 2. Atkinson T, Claxton G (eds). The intuitive practitioner: on the value of not always knowing what one is doing. Buckingham: Open University Press; 2000.