ABSTRACT
This chapter aims to review both the frequently discussed "objective" factors in evidence-based practice as well as the more subjective factors facing psychotherapists engaged in this debate. It focuses on the current literature about evidence-based practice and attempts to include attention to the impact of this organizational discourse on the profession of psychotherapy and its practices, and on psychotherapists themselves. While health service documents outline the usefulness of a hierarchy of evidence with the randomized controlled trial as the "gold standard" when thinking at a populations level, the psychotherapist has a different focus. Alternative methodologies suggested include that mainstay of psychoanalytic and psychotherapeutic research—case study methodologies. In some respects these have a clear place in official evidence-based practice as a manifestation of innovative practice and case-study evaluation. P. Fonagy's point is important as it again notes the chasm that can occur between academic research and clinical practice.
