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Psychotherapy research has made significant progress in providing strong evidence for process and outcome in favour of specific approaches. However, after many years of research and advanced methodologies, we are still unsure about why psychotherapy works, and how and to what degree these findings can be applied in everyday practice (Kazdin, 2009). Evidence-based approaches do not appear to be effective for everyone, and the mechanisms of change are still investigated with diverse findings. Randomised controlled trials (RCT) and meta-analyses inform policy and guidelines followed by the likes of the National Institute for Health and Care Excellence (NICE). Illustrating this, NICE Guidelines for the treatment of Depression state that “well-defined” depression can be treated with CBT based on its proven efficacy, however “it is not effective for everyone”(NICE, 2009). Clinicians need evidence-based recommendations to inform their work with clients. It is notable though that evidence-based practice is based on nomothetic, quantitative approaches of inquiry but what is actually demanded from practitioners is to apply these theories in an idiographic context and adjust to the needs of the individual who seeks help (Persons, 2008).

One cannot reduce psychotherapy to specific factors and cannot reduce the person to a specific list of symptoms. Added to that, each psychotherapeutic encounter is unique, in terms of transference and real relationship factors. Rigid diagnosis criteria are challenged and culturally sensitive, social models of diagnosis are encouraged in the literature, which question the constant pursuit of functionality, fulfilment …