‘CBT or Not CBT’, is that really the question? Re-considering the evidence base – the contribution of process research

As practitioners in both the National Health Serivce (NHS) and private practice Counselling Psychologists will be aware the National Institute for Clinical Excellence (NICE) has published guidelines for the psychological treatment of the main psychiatric disorders (Depression, Anxiety, Eating Disorders, Obsessive Compulsive Disorder, OCD, Post-Traumatic Stress Disorder, and Schizophrenia). NICE identifies evidencebased psychological treatments for each disorder and can, therefore, claim to identify criteria for ‘best practice’ (NICE, 2008). Based on the highest graded evidence base of Randomised Controlled Trials, (RCTs), they suggest that Cognitive Behavioural Therapy (CBT) or specialist models of CBT should be the treatment of choice. As a result of this, and wider political interest in mental health, Lord Layard (2006) published proposals that attempt to implement NICE recommendations. Although this has significant implications for the NHS, it is also increasingly relevant for private practice as insurance providers, for example, begin to identify evidence-based treatment for their clients. Treatment decisions, therefore, may become less focused on clinical assessment by the clinician and more about the request of the purchaser, e.g. private health insurance. This article discusses some of the main criticisms of the NICE guidelines, and proposes that better foundations for an ‘evidence base’ in psychotherapeutic interventions are provided by process and relational studies.