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Introduction
We sought to replicate a comparison of the outcomes of cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic or psychoanalytic therapy (PDT) as delivered in routine primary-care mental health practice within the UK National Health Service (Stiles et al. 2006). CBT, PCT, and PDT are distinct approaches in terms of their usual repertoires of interventions and their assumptions about the nature and sources of psychopathology. Each encompasses a range of techniques and should be considered a family of treatments rather than a specific treatment protocol. Each is considered by its practitioners as widely applicable to the varied problems presented for psychotherapeutic treatment (Gabbard et al. 2005; Feltham & Horton, 2006).
There is strong evidence for the efficacy and effectiveness of CBT for a wide variety of disorders (Dobson, 1989; Clark et al. 1999; Ladouceur et al. 2000; Teasdale et al. 2000; Hollon et al. 2002; Hollon & Beck, 2004; Ma & Teasdale, 2004; Ehlers et al. 2005; Westbrook & Kirk, 2005; Whittal et al. 2005; Butler et al. 2006). Fewer studies have systematically examined outcomes of the other two approaches, but available evidence similarly supports the efficacy and effectiveness of at least some varieties of PCT (Greenberg & Watson, 1998; Ward et al. 2000; Elliott et al. 2004; Goldman et al. 2006) and PDT (Leichsenring, 2001; Leichsenring & Leibing, 2003; Leichsenring et al. 2004). Clinical trials comparing alternative approaches (Elkin et al. 1989; Shapiro et al. 1994; Barkham et al. 1996; Ward et al. 2000) and broadly based reviews (Wampold, 2001; Roth & Fonagy, 2004) have concluded that bone fide therapies that have been actively researched tend to be similarly effective. This is the equivalence paradox: many psychotherapies appear to have equivalently positive outcomes despite manifestly non-equivalent theories and techniques. The paradox is expressed by the Dodo verdict, 'Everybody has won, and all must have prizes' (Carroll, 1865/1946, p. 28; italics in original). This verdict has been quoted by psychotherapy researchers for more than 70 years, although debate about it continues (Rosenzweig, 1936; Luborsky et al. 1975; Stiles et al. 1986; Beutler, 1991; Norcross, 1995; Seligman, 1995; Hunsley & Di Giulio, 2002).
Despite such indications of equivalent outcomes across many treatments, the predominance of published research on CBT has given CBT a greater...