A train journey of several hours gave me the opportunity to read the latest Therapy Today (July 2011) from cover to cover. I was impressed by the variety of what was on offer as well as the quality of the writing. Therapy Today is a widely read journal and it is therefore excellent that its producers are willing and able to print quick responses to important matters. In particular I refer here to the response by Andy Rogers, Jennifer Maidman and Richard House to Mick Cooper’s call for us to embrace RCTs as a means to gain ‘evidence’ for the usefulness of counselling and psychotherapy.

What a strange world we live in when there is a perceived need to demonstrate measurable ‘outcomes’ for such a basic human activity as listening and responding to each other when one of us is in distress. I also noted with interest that Julia Segal’s ‘audit’ of her own practice showed that some of the people who valued counselling the most, showed no improvement on what was being measured. In my past life as a nurse we were taught that ‘pain is what the patient says it is’. In other words, the individual patient’s experience is paramount, not the professionals’ opinion of what they should or should not be feeling. We would do well to listen more to clients and what they find helpful, irrespective of previously determined outcomes!

I totally agree with Rogers, Maidman and House’s concerns regarding RCTs as well as with the additional points made by Marc Storr in his letter on the same subject. Is it ethical, I wonder, to take a ‘pragmatic’ stance that runs counter to our values and philosophy? My fear is that to do so may cause us to lose sight of who we are as professionals as well as people. I see psychotherapy and counselling as involving a therapeutic use of self that requires us to be authentic. I fear that the kind of pragmatism Cooper advocates may lead to incongruence and tumble us onto a slippery slope.

Is it not time to stop our internecine rivalries and for all modalities to take a unified stance? After all, it has been widely demonstrated that the most important factors for client change are those relating to clients themselves, with the client-therapist relationship in second place.¹ The importance of the actual modality appears to matter far less than all this emphasis on RCTs seems to assume. Rather than trying to squeeze how we work into something we barely recognise in order to demonstrate its value, we should all speak up and explain to those involved with developing NICE guidelines etc that for most of what we do, RCTs are an inappropriate methodology, but that there are plenty of other ways to research counselling and psychotherapy.

This emphasis on RCTs is of course part of a modernist worldview, according to which everything is explainable. In other words it implies that certainty is possible. However, in this second decade of the 21st century we need to recognise that nothing in life is either certain or predictable. The sooner we realise this, the ‘safer’ we may actually be!

Dr Els van Ooijen
Psychotherapist, counsellor and supervisor, Nepenthe Consultancy

1. Wampold B. The great psychotherapy debate: models, methods and findings. Mahwah, NJ: Lawrence Erlbaum Associates; 2001.