Formulating Research Questions that are Relevant to Psychotherapy

This paper argues that the National Institute for Health and Clinical Excellence (NICE) has created misleading recommendations and that their interpretation by the Improving Access to Psychological Therapies (IAPT) initiative is likely to inflict lasting damage on the operation and development of psychotherapy. I propose that the root of the problem lies in persevering with an inappropriate research question. Both the research question ‘which therapy works best’ and the research methodology to which it leads, the Randomised Controlled Trial (RCT), were transferred from medical treatments for clearly defined illnesses. I explore the consequences of this process, and propose a research question that is an example of a better fit to the purposes of psychotherapy. The implications of the therapeutic alliance, and of working in relation to the relational contexts in which the client lives their life, demonstrate the limitations of the reliance on RCTs. The approach taken by the IAPT initiative is shown to be based on a selective reading of NICE guidelines. Suggestions are made of strategies for research to improve the usefulness of psychological therapies.