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James Norris’s paper, ‘(Overcoming) attacks on thinking: the importance of psychoanalytic thinking in surviving systemic fragmentation of the public mental health sector’ (Norris, 2025), describes and analyses two major policy shifts – the implementation of the Increasing Access to Psychological Therapies (IAPT) programme and the Health and Social Care Act – and what he describes as the ‘various barriers to effective treatment that they have created’. He proposes that psychoanalytic psychotherapists are ‘well-placed to support multidisciplinary colleagues’ to overcome the ‘feelings of hopelessness, anxiety and impotence’ which he suggests follow on from these policies. While broadly in agreement with many of Norris’s arguments and concerns, I shall, in this short contribution, focus on his citing of ‘research’, ‘evidence’ and ‘outcomes’ on both sides of the argument. In so doing, I shall briefly consider the implications of an economic argument for psychological therapy; sketch some key developments in researching psychoanalytic psychotherapy in the last 25 years; and note the strengths – but also the missed opportunities – of producing a workforce of child psychotherapists with research skills in recent years.
In his final discussion, Norris describes ‘a great need to better represent ourselves as “evidence-based”’ therapists’ and to ‘engage in … service-level transformation as thoughtfully as can be’, including with outcome monitoring. He is indeed not the only person to have called recently for child psychotherapy to engage with empirical research (cf. for example, Edginton, 2024). Yet there is little in his paper to inspire us to do so other than, at best, an uneasy pragmatism; it largely condemns evidenced-based practice, empirical research and the use of outcome measures.
In his discussion of the ‘medical model of care pathways’, Norris seems to conflate a number of ideas: that of a reliance on medical diagnosis; the growing trend for young people to adopt an