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Janet Low, MA PhD, is a clinical associate with CFAR and a member of the London Society of the New Lacanian School
eIpnosis is edited, maintained and © Denis Postle 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007
The Impossible Dream: Evidence Based Psychological Therapy, Science, and the NHS
Janet Low 12 October, 2007.

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Evidence Based Practice is a policy maker's dream, a wish of what science would be: totally free from human contamination, utterly beyond question, and absolutely clean. Over the last decade there has been a huge rise in the use of this phrase 'evidence based this or that'. It can be heard more and more in the University and NHS systems, and especially amongst those who want to please policy makers. In some corridors it has taken on a very special meaning indeed: it is a shibboleth, a magic word - it has a hypnotic effect. How is it possible that this little phrase - evidence based practice - has become so prolific in the UK today? And why are otherwise thoughtful and careful people responding to it in a medieval way?

It really is time to subject this process to a critical and urgent analysis. A major new conference entitled 'Psychological therapies in the NHS: science, practice, and policy', sets itself the task of examining the challenge of evidence based practice for the psychotherapy professions'. Hurrah! (you might think) At last! People who know about the suffering human subject and the place of knowledge in society are going to bring things down to earth. Dream on. This conference, planned for the end of November is already caught up in an underlying process that pushes the very essence of science and psychotherapy out of the picture.

Without a genuine attempt to understand the way that political and managerial discourses have already organised the conference, we won't stand a chance to understand why its scientific aims are in fact already foreclosed.

Freud's historic meeting with Einstein is invoked on the cover of the programme. These two great men each has claim to fame because he figured out something that had enormous explanatory power. This is not evidence based thinking. This is theory based thinking where evidence knows its place, and where people stake their name and claim responsibility for their work.

Behind the great intentions of the conference blurb there is a kind of hidden structure. Words like science, debate, thought-provoking, are stuck onto its façade but people will have to work very hard if they are to achieve anything approaching a scientific debate in what is in effect a showcase for minds already made up.

Each day of the conference opens with what looks like a question: are they scientific questions? Hardly. Are they even questions? I don't think so - each one is provided with an answer already. Look at the opening programme. Friday morning's question is: Whose ideas will change our mental health? The answer is provided: Professor Lord Richard Layard. Saturday morning's question: What is the future for state funded psychotherapy service? Answer: Professor Lord Richard Layard.

Richard Layard was on BBC Radio 4 recently (10 October) hot on the heels of the Secretary of State for Health. Where science might once have distinguished itself with a concern for the base of its truth, we here have simply politics and economics. There was talk of 'ground breaking' 'state of the art' psychological therapies. There was a promise to cure half of all those currently suffering anxiety and depression. But in fact what were they speaking of? A prescription of CBT.

What has become of this country? Why do we succumb to such nonsense? Who are the great thinkers prepared to put their name on this brave new claim? The radio presenter raised the question of knowledge and asked how a short training course was going to achieve the miracle. Layard was ready with an answer, which reveals his underlying cynicism. First he diminished the problem: he said this was only about depression and anxiety. This was less than a minute after he had quoted the Lancet to argue that mental illness was more debilitating and more serious than angina, diabetes, and arthritis. Second he conjured up a large number of people already experienced in dealing with mental illness who could easily be switched into the new service - nurses were the people he named. Third he said the magic words: add one year of training in "Evidence Based Therapies" to some kind of experience, and hey presto - a cure for debilitating mental illness.


If this conference were serious about its scientific aims then it would ensure that politics and economics knew their place, and it would build channels to ensure that real ideas were at the heart of its work, not reduced to window dressing.

But, the centralised political climate has diverted the scientific aim. Look at the structure of the conference programme: it is management strategy for delivering prejudged conclusions. For example, Stream C seminars on both Friday and Saturday are titled Towards Best Practice: how to design stepped care pathways. That's not science, it managerial control.

Management strategies have their place of course, and certainly need effort and ingenuity to get them off the ground. But why slip them in under the name of science? It takes up the place of critical thinking, it excludes the reality of the work, and it obliterates the truth about mental suffering.

I'd say we were facing the most serious ethical and political question of our time - are we going to allow politics to pretend that it is science? Just to keep our jobs? We need to snap out of this pseudo scientific dream where words and phrases float freely and economics and politics slip in undercover of Einstein and Freud. We have to wake up to reality and get on with some real work: analyse this clean scientific dream for a start.

Behind the marketing hype of this conference there are many difficult and complex questions. But the structure and profile of the conference make it impossible for such questions to be sustained. I'm not talking about evil conniving men in suits, but about the ways that censorship works unconsciously, and especially about the way that power and economics can hypnotise you. This high profile conference will strengthen the economic version of truth. It will reinforce the taboo against speaking another kind truth, the one that we know from our work.

Time to wake up and stop dreaming, time to get active and analysing. Or be prepared for a nightmare and impossible work indeed.