BMJ  2004;329:514 (28 August), doi:10.1136/bmj.329.7464.514

Letter

Future of psychotherapy in the NHS

Control groups play important part

The first 150 words of the full text of this article appear below.

EDITOR—In discussing the future of psychotherapy, Goldbeck-Wood and Fonagy comment on the difficulties in providing meaningful evidence about efficacy.¹ However, they do not explain that the specific problem is about the adequacy of control groups.²

Comparison of active with control treatment in psychotherapy cannot be conducted double blind as subjects inevitably know to which group they have been allocated. Drug trials may seem to have an advantage over psychotherapy trials in claims for scientific legitimacy because they can be conducted double blind by using placebo drugs. However, the degree of bias remaining in apparently double blind trials should not be underestimated.^{3 4}

Goldbeck-Wood and Fonagy may have focused too much on evidence as factual without acknowledging the importance of interpretation and have therefore not spelt out the role of ideology in assessing efficacy. Evaluation of psychotherapy is controversial. Psychotherapy may be in conflict with biomedical psychiatry in its conceptualisation . . . [Full text of this article]

Carrobreck, Norfolk and Waveney Mental Health Partnership NHS Trust, Hellesdon Hospital, Norwich NR6 5BE dbdouble@dbdouble.co.uk

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