Medicine, Health Care and Philosophy

, Volume 12, Issue 1, pp 67–75 | Cite as

Psychotherapy and distributive justice: a Rawlsian analysis

  • Stephen Wilmot
Scientific Contribution


In this paper I outline an approach to the distribution of resources between psychotherapy modalities in the context of the UK’s health care system, using recent discussions of Cognitive Behavioural Psychotherapy as a way of highlighting resourcing issues. My main goal is to offer an approach that is just, and that accommodates the diversity of different schools of psychotherapy. In order to do this I draw extensively on the theories of Justice and of Political Liberalism developed by the late John Rawls, and adapt these to the particular requirements of psychotherapy resourcing. I explore some of the implications of this particular analysis, and consider how the principles of Rawlsian justice might translate into ground rules for deliberation and decision-making.


Cognitive Behavioural Psychotherapy Comprehensive doctrines of the good Dialectical inquiry Distributive justice Interpretivism Overlapping consensus Political Liberalism Positivism Schools of Psychotherapy 


  1. Aldridge, S., and J. Pollard. 2005. Interim report to Department of health on Initial Mapping Project for Psychotherapy and Counselling. London: BACP. available on Accessed 7 June 2007.
  2. Arthur, A. 2001. Personality, epistemology and psychotherapists choice of theoretical model: A review and analysis. European Journal of Psychotherapy Counselling and Health 4 (1): 45–64.CrossRefGoogle Scholar
  3. Bateman, A., and P. Fonagy. 2000. Effectiveness of psychotherapeutic treatment of personality disorder. The British Journal of Psychiatry 177 (2): 138–143.PubMedCrossRefGoogle Scholar
  4. Beauchamp, T., and C. Childress. 2001. Principles of biomedical ethics, 5th edn. New York, NY: Oxford University Press.Google Scholar
  5. Beck, A., A. Rush, B. Shaw, and G. Emery. 1979. Cognitive therapy of depression. New York, NY: Guilford.Google Scholar
  6. Berniker, E., and D. McNabb. 2006. Dialectical inquiry: A structured qualitative research method. Qualitative Report 11 (4): 643–664.Google Scholar
  7. Brechin, A., and M. Sidell. 2000. Ways of knowing. In Using evidence in health and social care. ed. R. Gomm and C. Davies, 3–25. London: Sage.Google Scholar
  8. Brockner, J., and P. Siegel. 1996. Understanding the interaction between procedural and distributive justice: the role of trust. In Trust in organizations, ed. R. Kramer and T. Tyler. New York, NY: Sage.Google Scholar
  9. Butler, J. 1999. The ethics of health care rationing. London: Cassell.Google Scholar
  10. Churchman, C.W. 1971. The design of inquiring systems. New York, NY: Basic Books.Google Scholar
  11. Feltham, C. 1999. Against and beyond core theoretical models. In Controversies in psychotherapy and counseling, ed. C. Feltham, 182–193. London: Sage.Google Scholar
  12. Freud, S. 2005. Mourning and melancholia. In On murder, mourning and melancholia, ed. S. Freud, 201–218. London: Penguin.Google Scholar
  13. Garb, H. 1997. Race bias, social class bias and gender bias in clinical judgement. Clinical Psychology: Science and Practice 4 (2): 99–120.CrossRefGoogle Scholar
  14. Gelder, M., R. Mayou, and J. Geddes. 2002. Psychiatry. Oxford: Oxford University Press.Google Scholar
  15. Grant, A., J. Mills, R. Mulhern, and N. Short. 2004. Cognitive behavioural therapy in mental health care. London: Sage.Google Scholar
  16. Grove, W., and P. Meehl. 1996. Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy and Law 2 (2): 293–323.CrossRefGoogle Scholar
  17. Heath, G. 2002. Philosophy and psychotherapy: Conflict or co-operation? International Journal of Psychotherapy 7 (1): 13–51.CrossRefGoogle Scholar
  18. Holmes, J. 1999. Psychotherapy as essential health care. In Controversies in psychotherapy and counseling, ed. C. Feltham, 278–286. London: Sage.Google Scholar
  19. James, O. 2006. Sanity’s shining light. Guardian 19th December. Available on,,1974953,00.html. Accessed 12 July 2007.
  20. Layard, R. 2005. Therapy for all on the NHS. Sainsbury Centre Inaugural Lecture, September 2005. Available on Accessed 25 July 2007.
  21. Leichsenring, F., and E. Leibing. 2003. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry 160 (7): 1223–1232.PubMedCrossRefGoogle Scholar
  22. Linklater, A., and R. Harland. 2006. After Freud. Prospect June: 36–41.Google Scholar
  23. Malhotra, Y. 2000. Knowledge management and virtual organisations. Hershey, PA: IGP.Google Scholar
  24. McGinn, L., and J. Young. 1996. Schema-focused therapy. In Frontiers of cognitive therapy. ed. P. Salkovskis, 182–207. New York, NY: Guilford Press.Google Scholar
  25. McGinnis, S. 2006. Not all is CBT. Therapy Today April: 23.Google Scholar
  26. Nuttall, J. 2002. Imperatives and perspective in psychotherapy integration. International Journal of Psychotherapy 7 (3): 249–264.CrossRefGoogle Scholar
  27. National Collaborating Centre for Mental Health. 2004. Depression: Management of depression in primary and secondary care. National Clinical Practice Guideline Number 23. London: National Institute for Clinical Excellence.Google Scholar
  28. O’Connor, J. 2003. Homelessness and the problem of containment. European Journal of Counselling, Psychotherapy and Health 6 (2): 111–128.CrossRefGoogle Scholar
  29. O’Connor, J. 2005. Between the street and the consulting room. European Journal of Counselling, Psychotherapy and Health 7 (4): 217–234.CrossRefGoogle Scholar
  30. Polkinghorne, D. 2001. Managed care programs: What do clinicians need? In Critical issues in psychotherapy, ed. B. Slife, R. Williams, and S. Barlow, 121–140. Thousand Oaks, CA: Sage.Google Scholar
  31. Rawls, J. 1971. A theory of Justice. Cambridge, Mass: Harvard University Press.Google Scholar
  32. Rawls, J. 1993. Political liberalism. New York, NY: University of Columbia Press.Google Scholar
  33. Roth, T. 2006. Applying evidence-based practice. Therapy Today June: 14–17.Google Scholar
  34. Roth, T., and P. Fonagy. 2005. What works for whom? A critical review of psychotherapy research. New York, NY: Guilford Press.Google Scholar
  35. Ryle, A., and I. Kerr. 2002. Introducing cognitive analytic therapy: Principles and practice. Chichester: Wiley.Google Scholar
  36. Spong, S., and H. Hollanders. 2003. Cognitive therapy and social power. Counselling and Psychotherapy Research 3 (3): 216–222.CrossRefGoogle Scholar
  37. Wampold, B. 2001. The great psychotherapy debate: Models, methods and findings. Hillsdale, NJ: Erlbaum.Google Scholar
  38. Wilkinson, H. 2002. The power and danger of pluralism in psychotherapy (Editorial). International Journal of Psychotherapy 7 (1): 5–12.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.University of British ColumbiaVancouverCanada

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