Introduction

Abstract

It is becoming increasingly clear that causal models of understanding mental distress, involving assumed faulty mechanisms and processes in the mind or brain, do not yield results consistent with evidence-based medicine. After decades of biological research we have learned much about the brain but little that is relevant about the whys and wherefores of mental distress. In psychotherapy no clear pattern of superiority for any one treatment has emerged. What emerges is that the placebo effect, the quality of the relationship between therapist and patient, and other non-specific factors are what are important. The theories held by the therapist may be important to her but are of little relevance to the effectiveness of the treatment. Similarly in cognitive-behaviour therapy (CBT): most of its specific features can be dispensed with, without adversely effecting outcome (Editorial, 2012; Bracken et al., 2012; Linden, 2013 pp. 166–7).