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It is good of David Veale to acknowledge that lack of evidence for the effectiveness of non-CBT therapies is not the same thing as evidence of their ineffectiveness (therapy today, February 2008)
On the topic of evidence...
It is good of David Veale to acknowledge that lack of evidence for the effectiveness of non-CBT therapies is not the same thing as evidence of their ineffectiveness (therapy today, February 2008). But I dispute the idea that there is such a lack. We are all ‘empirically grounded’ – the notion that non-CBT therapies simply pluck their technique out of the air is ridiculous. The issue is about what constitutes empirical evidence.
There are several layers to this. Firstly, David Veale assumes that the arbiters of evidential status should be ‘scientists’. Why? Secondly, even within the range of scientifically acceptable research – which I do not believe is the only relevant sort of evidence about therapy and counselling – CBT’s position is nowhere near as good as Dr Veale makes out. Thanks to Denis Postle (at www.iapt-cbt.info), there are links to 60 papers and articles, nearly all scientifically oriented, which question the effectiveness of CBT, support the effectiveness of other therapies, or cast doubt on the models of effectiveness which are used.
A third key issue is the therapeutic relationship, which Dr Veale tries to dismiss by asserting that ‘most scientists’ (nuclear physicists? electrical engineers?) ‘are not convinced … is a sufficient variable for change’. However, there is very wide agreement that it is a major influence; and RCTs, which aim to standardise both treatment and symptoms, specifically try to eliminate the effect of the relationship. Little wonder that therapies that centre their approach upon this relationship do less well in randomised trials. It is astonishing they perform as well as they do.
The importance of this is that the Government has invested heavily in CBT – not in leading-edge CBT, but in CBT-on-the-cheap. The Government’s rhetoric of ‘choice’, which Dr Veale endorses, camouflages the fact that IAPT will not offer choice of modality or choice of practitioner (after all, it is technique that is supposed to matter). How many therapists would accept such a proposition if seeking therapy themselves? But few of us will ever be in that situation; we have the money to buy choice.
CG Jung once said that ‘behind every fanaticism lurks a secret doubt’. Is it conceivable that CBT practitioners doubt whether, given a proper choice and a level playing field, enough people would choose CBT over relationship-based therapies? Nick Totton
Nick Totton
