Evidence-based practice and the need for paradigmatic pluralism in cognitive behavioural psychotherapy

The scientist-practitioner model, which is based on positivistic methodological assumptions, is influential in the development, training and practice of cognitive behavioural psychotherapists. As the emergence of 'Nurse Cognitive Behavioural Therapist' training in the early 1970s in Britain, many of those trained have been mental health nurses and with the emergence of the Increased Access to Psychological Therapies agenda many more are likely to undergo training. Despite some acceptance of its relevance, the scientist-practitioner model is subject of criticism on the grounds of its achievability and contemporary relevance, and its exclusion of other modalities of counselling and psychotherapy without an, as yet, disseminated evidence base. In line with key policy-related work, the empirical and political issues inscribed within the scientist-practitioner model have direct implications for the educational preparation and ongoing professional development of cognitive behavioural practitioners. Specifically, in this polemical paper it is argued that there is a moral and educational need for 'senior' practitioners to question the philosophy of science assumptions underpinning the overwhelming dominance of the quantitative-experimental approach in cognitive behavioural psychotherapy. Such a critically evaluative and pluralistic stance would arguably distinguish senior practitioners in terms of them being able to make broad rather than narrow appraisals of the evidence base for their practice. A recognition of the relevance of paradigmatic and epistemological pluralism in cognitive behavioural work would, it is argued, confer considerable advantages on our practice communities and clients. A range of emerging implications for cognitive behavioural education, practice and relational ethics are described and discussed.