Evidence-based therapy, and why it matters

An evidence-based therapy is one that has been put to the test. It has been taken into controlled trials, used with people dealing with what you are dealing with, and measured against a real comparison — usually the best alternative available at the time, and often against another established therapy rather than against nothing at all. The results are published, other researchers repeat the work, and approaches that do not hold up are set aside.

What that buys you is not a guarantee, but it is a great deal better than a starting guess. Across the difficulties these therapies were built for — anxiety, depression, trauma, insomnia, the patterns that keep repeating in relationships — trials consistently find that most people improve over a course of treatment, that a meaningful proportion recover altogether, and that the gains tend to hold after the sessions stop. It usually happens over weeks and months rather than years. Those are findings about groups of people rather than promises about any one of them, but they are the reason a practitioner working this way can tell you what they intend to do, why they have chosen it for your situation, and roughly when you should expect to notice a difference.

It is also not a substitute for the relationship between you and the person sitting opposite. Decades of research suggest that relationship is the single strongest predictor of whether therapy helps anyone. A tested method in the hands of someone you cannot talk to is not worth much. The two work together.

Cognitive behavioural therapy, acceptance and commitment therapy, EMDR, schema therapy, dialectical behaviour therapy, short-term psychodynamic therapy, emotionally focused therapy, the Gottman method and CBT for insomnia all sit in that category, each with its own body of trials behind it and its own set of difficulties it suits. We explain every one of them in plain language in our guide to types of therapy, including what the evidence supports each one for.

Plenty does. Some approaches have never been tested against the difficulty they are marketed for. Some have been tested and have not been shown to help. Some are drawn from a genuine tradition but applied to problems the tradition was never about.

This is not the same as saying the people offering them are untrained or acting in bad faith. Many are neither. But there is no requirement on anyone practising outside the regulated professions to use a tested method, to explain the evidence for what they are proposing, or to stop when it is not working — and there is no register you can search to find out what training they actually hold.

Some people find real value in approaches with a thin evidence base, and that is their business rather than ours. The point is that you should know which of the two you are choosing, and at the moment most websites make that impossible to tell.

There is a useful shortcut. Therapy that attracts a Medicare rebate under the Better Access initiative has to be drawn from a defined list of approved interventions. A practitioner cannot bill Medicare for whatever approach they happen to prefer, and the requirement is the same whichever eligible profession they come from. That list is narrower than the full range of therapies with good evidence behind them — couple and family work, for one, sits outside the scheme entirely — so treat it as a floor rather than a complete picture. As a floor it is a good one.

Both psychologists, who are registered with the Psychology Board of Australia through AHPRA, and Accredited Mental Health Social Workers, credentialled by the Australian Association of Social Workers, are eligible to provide it. Both complete extensive training in those interventions, work within their scope of competence, carry professional indemnity insurance, do continuing professional development every year and answer to a regulator if something goes wrong. Counselling and psychotherapy, by contrast, are not government-regulated in Australia and do not attract a rebate.

So Medicare eligibility is a reasonable proxy for two things at once: a tested method, and somebody accountable for how it is used. Everyone who practises at OneBodyMind meets both.

Any practitioner, anywhere, should be able to answer these without hesitation, and how they answer tells you a good deal:

• What approach do you intend to use with me, and why that one for what I am dealing with?
• What does the evidence say about it for what I am dealing with?
• Roughly how many sessions before we should expect to see a change?
• How will we know if it is not working?
• What are your qualifications, and where can I check them?

On the last of those: every psychologist in Australia appears on AHPRA's public register, which is free and takes about thirty seconds to search — it shows registration status, endorsements and any conditions on their practice. Accredited Mental Health Social Workers can be checked through the AASW. You are welcome to look up anyone here before you book, and each practitioner profile sets out their qualifications and the approaches they work with.

Between practitioners who all work from tested methods, the choice is less about credentials than about fit: whether they work with what you are dealing with, whether the practical details suit you, and whether you can imagine talking to them. That last one is not a soft consideration — it is the thing the research keeps pointing at.

Read a couple of profiles and start with whoever you would find it easiest to begin with. If the first person is not the right fit, that is ordinary rather than a failure. Say so, and ask to be pointed elsewhere — including away from here, if somewhere else suits you better.