The effective ones are as good as drugs

Some people who are troubled seek referral to a counsellor or psychotherapist. “It helps me to get things in perspective,” they say, “It really works.”1 Are such “treatments” specific—that is, do they produce improvement faster than could be expected from natural recovery or from talking through problems with a supportive friend? Judging by advertisements in the local press, a wide range of therapies is now on offer, from plain psychotherapy to exotic varieties like “astrological archetypal counselling.” While people can spend their own money on whatever they wish, just what psychotherapeutic procedures should responsible doctors prescribe for their troubled patients, once they have made the appropriate diagnosis?

Cochrane popularised the use of the randomised placebo controlled trial as the preferred means of deciding which treatments were specifically effective for which disorders, and governments and other funders of health care now require data from a series of such trials before deciding which new drugs they will license and subsidise. Searching the mental health literature, and setting a threshold for effectiveness, our group has recently completed reviewing those disorders in which a specific psychotherapy exceeded that threshold, and …