Behavioural and Cognitive Psychotherapy is a research journal published for “the leading organisation for CBT in the UK”. And the current issue’s Leading Article is about “the gold standards of psychosocial interventions”. Important stuff? Not really.
All that glisters is not gold,
Often have you heard that told
The Merchant of Venice, Act II scene vii
In 1976, when cognitive therapy was in its infancy, Aaron T. Beck described five standards for evaluating theories of psychopathology, together with five standards for evaluating systems of psychotherapy. (The theories are models of mental illness, and the systems are of therapeutic techniques.) So the idea of such standards is an established one.
In 2008, do King and Ollendick trace the ancestry of their standards by placing them in the context of earlier work? No. Do they refer to Beck’s standards? No. How, then, do they explain the background to their proposals? They don’t — their paper has no Background section at all, and their introduction starts with the words: “In recent years…” (with references looking back as far as 2002).
As this is a research journal, it’s important for readers to know what research methods were used. In principle that’s so that readers can apply the same methods and see whether they reach the same conclusions. In practice most readers do this in imagination, making a personal judgement about whether it is plausible for the methods described to have given the stated results.
Possible methods for selecting standards include polling many experts, and testing the proposed standards against historical outcomes. Were these the methods used? Something else, perhaps?
No one will ever know. The paper has no Method section at all. The very idea of research method is waved away:
…methodological rigour may have obscured our thinking…
Of the six numbered standards, 1. simply aggregates Beck’s first five into a single item. 2. and 5. match a couple more of Beck’s. 3. is effectively “miscellaneous”.
4. promotes manualized treatments (that is, where a highly skilled therapist is not required because every aspect of therapy is fully specified by a treatment manual). The authors acknowledge the extent of the debate about treatment manuals, but their discussion of the subject is lightweight. For example, they do not mention that using relatively unskilled therapists is simply cheaper.
6. promotes social acceptability, but confuses acceptability of the therapeutic method (which would rule out any new kind of therapy) with acceptability of the therapeutic outcome (“customer satisfaction”). It also contradicts 4., because making therapy acceptable to clients is probably a characteristic of skilled therapists as opposed to those who are just following a treatment manual.
7. is… Wait a minute! Weren’t there only six? Yes, well the seventh one doen’t get a number for some reason. Perhaps the reason is that it’s two separate things: case formulation and therapueutic alliance. Or perhaps the reason is that these are covered by 6. Or perhaps the reason is that it was tacked on afterwards as an excuse to reference some of the authors’ other work.
Papers like this one successfully bamboozle journal editors by using attractive words and phrases like “elegant” and “gold standard”. But research it isn’t. Anyone with access to a library can churn out stuff like this by whacking together a couple of pages of references into a rambling and essentially meaningless essay.
The effect of papers like this is to devalue all research in the minds of practising psychotherapists. Arguably, research is pretty devalued anyway for other reasons (for example, issues around funding and experimental design), but the job of journal editors is to protect their readers from badly conceptualized and badly written work. If they did that job better, fewer copies of Behavioural and Cognitive Psychotherapy would be discarded unread.