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Lesley Murdin's paper poses important questions regarding the future of psychotherapy that no clinician can afford to ignore. There is increasing pressure from both outside the profession and, to a certain extent, from within, to accommodate psychotherapy to the model of a service industry. Therapy becomes an intervention to be locally applied, like a drug, with exactly those features that regulators require of pharmaceuticals: that active ingredients be specified, that the outcomes and benefits be clearly defined and that the time period for delivery of these effects be precise. As Lesley Murdin points out, the framework here is ‘evidence-based research’ (EBR), a slogan that has become almost deafening in those fields that we could call the contemporary pseudo-sciences.
Many psychotherapists feel that they must defend the legitimacy of their profession and have accepted the EBR framework as a gold standard. It is identified with a - sometimes the - scientific approach, with little critique of its practises and conceptual merits. RCTs become the given form in which enquiry is cast, despite the fact that they are totally inappropriate for psychotherapies, for one simple reason: it is not possible to randomize transference. Any model of psychotherapy which recognizes transference will acknowledge that transference is not a variable that can be switched on or off at will, but a basic substructure of all human relationships. Whether it is noisy or discreet, it lays the foundations for all transfers of interest, energy, attachment or belief.
It is interesting to note here how EBR has grown out of the disciplines which are least sure of their scientific credentials: medicine and psychology. Until quite recently, historians of the field argued that medicine was not a science since, apart from the theory of infection, it had no theories aside