Rethinking “Evidence-Based” Therapy: What Are We Really Measuring?

What if “evidence-based therapy” doesn’t mean what we think it means?

The phrase “evidence-based therapy” has become a powerful buzzword in mental health—synonymous with scientific rigour and best practice. But according to psychologist Jonathan Shedler, much of what passes as “evidence-based” today tells a narrower story than we might assume.

In his 2018 paper, Where Is the Evidence for “Evidence-Based” Therapy?, Shedler argues that the term has been co-opted to promote short-term, manualised treatments—especially CBT—while sidelining the rich diversity of relational and insight-oriented approaches. The link to the article can be found here: 

Where Is the Evidence for EBT’s?

He revisits landmark studies like the NIMH Depression Trial, often cited as proof of CBT’s success. In truth, the study found no meaningful advantage for CBT over placebo, with only 24% of clients recovering and staying well. Later research shows similar results. Benefits tend to fade within months, and the majority of clients seek further treatment.

Even more concerning are research biases:

• Carefully selected participants who don’t reflect real-world clients.
• Sham control groups designed to make CBT look better.
• Unpublished negative results that exaggerate apparent success by as much as 75%.

When legitimate therapies are compared fairly, CBT performs no better than psychodynamic, humanistic, or integrative approaches. The APA itself now recognises that all bona fide therapies can be effective when delivered with skill, care, and relational attunement.

For Shedler, true evidence-based practice means integrating three elements: research, clinical expertise, and clients’ values and preferences—not simply following a manual.

Reflection Prompt for evidence-based therapy discussions:

How do we stay evidence-informed while remaining true to the art and humanity of counselling?

Perhaps the best “evidence” is what unfolds before us every day—the subtle, enduring shifts that can’t always be captured in data, but are deeply real in the lives of our clients.

I’d love to hear your thoughts. How do you balance scientific rigour with relational depth in your own practice?

Reply to this email or share your reflections on our next supervision call.

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Marc de Bruin is an ACA Level 4 counsellor, clinical supervisor (for both PACFA and ACA), university tutor, and former barrister-solicitor with over 20 years’ experience in counselling, supervision, and professional development. He is the founder of Counselling Supervision and Simplifying Life.