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• I guess I should thank Mick Cooper (‘The facts are friendly’, Therapy Today, September 2008) for inspiring me to write to Therapy Today for the first time. I have no particular issue with some of what he writes but his contribution to the ‘debate’ over relative efficacy/equivalence I feel needs challenging.
  
  In his article, Cooper references the National Institute of Mental Health (NIMHE Treatment of Depression Collaborative Research Program, 1989) study as an example of studies ‘carried out by independent bodies’ which find general equivalence when ‘bona fide therapies are compared’. I would say that suggesting that this study, or indeed any other, implies equivalence between therapies is at the least misleading. The facts are that this study tested four ‘bona fide’ treatments for depression: CBT, interpersonal therapy (IPT), Imipramine treatment and no treatment/placebo effect.
  
  The facts that emerged from this study were that there was a broad equivalence between CBT and IPT in the treatment of depression and that both were significantly more effective than drugs or no treatment/placebo. How then do these results get even remotely near to providing ‘evidence’ for the equivalence of all therapies or even just the ‘mainstream’ ones? Perhaps I am missing something. Are there other studies out there that do prove equivalence?
  
  Well, apparently not, as Cooper himself says somewhat in contradiction: ‘The reason why non-CBT therapies are not considered effective for particular psychological problems is simply because no one has tested them yet.’ Surely it is a fact that if no one has actually tested these ‘non CBT therapies’ there can be no evidence of equivalence for these therapies. But maybe there is something about ‘particular problems’, by which I’m guessing Cooper means problems like depression, anxiety, PTSD, phobias – hardly minor issues. Why haven’t all approaches stringently tested their efficacy with these issues? Are they not important enough? Or is it that testing for ‘particular problems’ goes against some kind of approach ethic, e.g. ‘CBT can do “that sort of thing” but we [insert approach of choice] don’t.’ As for ‘tested them yet’, why not? Many approaches have been around for far longer than CBT, is it credible to continue to believe the hackneyed ‘we/it/people can’t be tested that way’ arguments? The dodo bird effect says all have won and so all must get prizes but the approaches not tested have, for whatever reasons, not even been in the race, so how can they claim the ‘prize’ of equivalence with those that have?
  
  Facts are neither friendly nor unfriendly they are just facts. The facts regarding relative efficacy of all therapies, or even just the ‘mainstream’, are simple. There is no evidence suggesting that all therapies or the mainstream ones are equally as effective for specific problems, or are equally as effective in any ‘general’ sense. Factually, equivalence and the dodo bird effect exist only for those who were in the race in the first place and this is limited to very few.
  
  It is a fact, and it would be naïve to suggest it is one that does not link to the equivalence ‘debate’, that CBT is the fact-based ‘industry standard’ for the treatment of depression and many other ‘particular psychological problems’.
  If you just plain disagree or you want to say that all therapies are equally as effective or, and be honest, you want to claim your approach/way of working is at least as effective, then go ahead and do it – I for one would welcome an informed debate. However, if you are going to say that there are facts that provide evidence for your claim/s then make sure they are facts and not fictions.

• Andy Flint, Counsellor