Marriage of inconvenience

This book is an attempt to redress the division between researchers and practitioners. Five psychodynamically-oriented therapists start by explaining their dissatisfaction with research; ten chapters follow in which leading researchers attempt to address these criticisms and to explain the relevance of their work. At times this leads to a defensive and irritable tone. On the one hand some researchers claim that clinicians fail to recognise the relevance of research simply because they have not read it; on the other some clinicians seem to be suggesting that generalisations about patients can never be made.

As Robert Elliot and Cheryl Morrow-Bradley comment in their contribution, this has echoes of a strained and troubled marriage in which "there is a history of mutual blame, discounting and self-justification". To what degree is accommodation possible between these two camps? In answering practitioners' concerns, researchers offer an excellent overview of much research. Although their programmes are unlikely to convince all therapists, they present a strong case against the proposition that their findings are trivial or merely confirm clinically-derived wisdoms. In particular, there are many examples of research which can be directly applied by therapists themselves, with the aim of enhancing individual practice.

These include such issues as the formation and maintenance of the therapeutic alliance, techniques for tracking the progress of therapy, for identifying significant events in sessions, for improving and clarifying formulations and for monitoring change. These concerns are all relevant to the task of carrying out therapy, and are good examples of the way in which quantitative and qualitative research methods can be converged. Most of the researchers seem keen to meet clinicians' concerns - perhaps too concerned, as though there is some embarrassment about quantitative studies.

In contrast, David Orlinksy presents a robust overview of process-outcome studies from a researcher's perspective. He offers a summary of "probabilistic" (and therefore highly generalised) statements about factors likely to influence the course and outcome of psychotherapy. Clinicians tend to view this area with most scepticism because by definition it can only speak to the average, rather than the particular patient. However, as Orlinsky and others note - psychotherapists do not practice in a vacuum. Increasingly, searching questions are asked about the efficacy and cost-effectiveness of psychological therapies.

This is the research to which Governments and managers are turning, and the future of publicly-funded psychological therapies is likely to depend on its findings. Although this, in itself, would not be a good reason for researchers and practitioners coming together, it is a powerful one. One hopes that the arguments outlined here will provide the basis for a more reasoned and sounder rapprochement between research and practice.

Anthony D. Roth is clinical tutor on the North Thames/University College London MSc in clinical psychology.