The importance of research in counselling and psychotherapy
Questions regarding the effects of counselling and psychotherapy (therapy) are important and such questions range from the general to the particular. For example, to know how the effects of therapy generally compare with those of medication can guide national policy-makers as to whether to invest in medication or psychological therapies for people with psychological problems. The emergence of the Improving Access to Psychological Therapies programme would not have occurred without sound research as to the effectiveness of therapy as compared to medication. Similarly, on a more specific level research can tell us which types of therapy are most effective for particular types of client (e.g. children/ older people) or types of problem (e.g. anxiety/depression). This helps therapeutic services adapt themselves to meet the needs of local populations. The types of research investigating the effects of therapy are often divided into 2 categories: efficacy research which studies therapy under strictly controlled experimental conditions, comparing the difference between control and intervention groups, and effectiveness research which investigates therapy in routine settings using pre- and post- measures, but without a control group.
Efficacy research is often referred to as Evidence-based Practice (EBP) and effectiveness research as Practice-based Evidence (PBE), the similarity of the two phrases denoting a complementary relationship. EBP tends to ask does it work? Whereas PBE asks does it work in routine practice? Both of these are important and related questions. The importance of research can be seen from a number of viewpoints. Firstly, as professionals we have a responsibility to expand the frontiers of knowledge in our field. Secondly, it is arguably unethical to offer therapy to clients where no evidence of effectiveness exists; to do so would be to waste their time or even put them at risk. Thirdly, we live in an era where the commissioning of therapy, particularly in the NHS, is guided by clinical guidelines which are derived from research evidence and so if we want our therapeutic interventions to be commissioned we must provide evidence of their effectiveness.
Cognitive Behavioural Therapy (CBT) currently has the largest body of research evidence as to its effectiveness and in many ways other approaches such as Humanistic and Psychodynamic are playing "catch up". In this sense research is not only a scientific and an ethical endeavour, it is a political one which has at its root the desire to promote therapeutic plurality and choice of interventions for clients.
Types of Study
Randomised controlled trials (RCTs): A study in which people are allocated at random to either an intervention or control/comparison group. The effects of the intervention are determined by comparing the outcomes of both groups.
Systematic Reviews: Systematic reviews aggregate the findings of similar types of study addressing the same type of question, thus providing robust findings based on large amounts of data. Systematic reviews of RCTs, often known as meta-analyses are viewed as the most reliable type of evidence on which to base clinical and policy decisions.
Practice-based research: Studies which use pre- and post- measures (such as CORE) to study the effects of an intervention in a particular cohort of clients, without the use of a control group. Some types of case study and qualitative research can also fit within this category.