The demand for psychological therapies in Britain has never been greater,1 yet their claim on scientific legitimacy and therefore on public resources has never been under greater scrutiny.2^w1-w4 At a meeting held by the UK Council for Psychotherapy in November 2003 to address the future of psychotherapy in the NHS, the clearest messages were conflicting ones—that although the taxpaying public demands increased access to psychological therapies and the government espouses both patient choice and user centred services,1 the evidence on the efficacy and cost effectiveness of the many different psychotherapies is patchy. Randomised trials cover only a limited number of treatments, and many treatments remain unevaluated in relation to many conditions.3 Exclusion rates of 40-70% of presenting patients limit their generalisability to the treatment seeking population,4 and a dearth of long term data, data on quality of life, non experimental evidence, user perspectives, and evidence of the generalisability to NHS practice of studies carried out in other settings hampers rational purchasing decisions. Little is known about equity of access to therapy across socioeconomic or ethnic groups, and with neither a career structure nor a pay scale of its own, psychotherapy is not even formally recognised as an independent profession. The result is a lottery …