Few terms carry as much weight in contemporary psychotherapy as evidence-based practice. It appears on training courses, clinic websites and treatment programmes, often as a shorthand for quality, credibility and professionalism. (Indeed, we use it often at the Laurel Centre!) For prospective clients, it offers reassurance that the help they are seeking is grounded in something more substantial than personal opinion or therapeutic trends. For clinicians, it signals a commitment to working in ways that are informed by research rather than relying on tradition or intuition.
Yet despite its widespread use, the phrase itself is rarely examined. In fact, the more frequently it appears, the more important it becomes to ask what we actually mean when we use it. When a therapist or organisation describes their work as evidence-based, what exactly are they communicating? Are they saying that there is research supporting their approach? Or that they have personally witnessed positive outcomes in their clients? If so, how many? Are they referring to standardised outcome measures that demonstrate effectiveness? Or are they simply using a phrase that has become synonymous with “good therapy”?
These questions are important ones to ask because if a term can mean everything, it risks meaning very little.
What evidence-based practice originally meant
Part of the confusion arises because people often use evidence-based practice differently from its original meaning. The concept originated in medicine and later spread to psychology and other healthcare professions. Its founders never intended therapists to follow the latest research papers uncritically. Nor did they place research above all other forms of knowledge.
Instead, they defined evidence-based practice as the integration of three elements:
The best available research evidenceClinical expertiseThe values, preferences, and circumstances of the individual clientResearch formed one pillar of this framework, but it was never the only one. Clinicians also relied on professional expertise and careful judgement. They then applied both in ways that reflected each client’s unique needs, values, and circumstances.
It is surprisingly common to hear evidence-based practice discussed as though it were synonymous with research-based practice. Yet research findings alone cannot tell us what will be most helpful for the individual sitting in front of us. Studies can tell us what tends to work for groups of people in particular conditions, but they cannot fully account for the complexity of a person’s history, relationships, culture, motivation, strengths or vulnerabilities. The role of the clinician is to integrate the available evidence with their expertise and the client’s circumstances, rather than simply applying research findings in a mechanical way.
The reality is that therapy is rarely as straightforward as the phrase “evidence-based” sometimes implies.
When evidence becomes a marketing term
One of the reasons this discussion feels increasingly important is that evidence-based practice has become a powerful marketing tool. There is nothing inherently wrong with this. Clients deserve to know that the therapy they invest in draws on credible knowledge and professional standards. However, the phrase can sometimes create an impression of certainty that is difficult to justify.
When a clinic advertises an evidence-based approach, we should ask what evidence supports that claim. Does it draw on randomised controlled trials? Perhaps it relies on outcome data collected within the service or years of clinical experience. Alternatively, it may simply cite research conducted during the model’s development. These claims describe very different forms of evidence, yet clinics often present them under the same label.
Imagine two therapists. One follows a model that has been extensively studied in academic research but has never measured outcomes with their own clients. The other has collected years of outcome data demonstrating positive change among the people they work with, but practises in an area where the published research literature remains relatively limited. Which practitioner is more evidence-based? The answer is not immediately obvious, and that ambiguity highlights why the conversation is more complicated than it first appears.
The difference between evidence-based practice and practice-based evidence
In recent years there has been growing interest in the concept of practice-based evidence. Whereas evidence-based practice typically begins with research and asks how it can inform clinical work, practice-based evidence starts with clinical work and asks what it can teach us about effectiveness.
This often involves collecting outcome measures, monitoring progress, gathering client feedback and examining patterns across large numbers of cases. Rather than assuming that an intervention works because research suggests it should, practice-based evidence seeks to establish whether it is actually helping the clients who attend a particular service.
There is something refreshingly pragmatic about this approach. After all, the realities of clinical practice are far messier than the conditions under which research studies are conducted. Clients rarely present with a single neatly defined problem. They bring multiple difficulties, complex histories and competing priorities. They miss sessions, encounter life crises, experience setbacks and often arrive with challenges that would exclude them from tightly controlled research trials.
For this reason, practice-based evidence has the potential to complement traditional research rather than compete with it. Research can help us identify promising approaches, while outcome data can help us understand whether those approaches are producing meaningful results in the real world.
Understanding evidence in CSBD and problematic pornography use
Perhaps the most important question is also one of the simplest: how do we know that our therapy works?
The answer will vary depending on the field, but within the treatment of Compulsive Sexual Behaviour Disorder (CSBD) and problematic pornography use (PPU), we argue that clinicians and researchers cannot measure effectiveness solely by reductions in unwanted sexual behaviours. Sustainable behavioural change is important, but so too are improvements in emotional wellbeing, relationships, self-regulation, shame, and overall quality of life.
This is where the conversation becomes more complex. Compared with conditions such as depression, anxiety or substance misuse, the evidence base for CSBD and PPU remains relatively young and continues to evolve. Research has expanded significantly in recent years, but there is still much that we do not know, and many important questions remain unanswered.
For clinicians, this creates an inevitable tension. On the one hand, there is a responsibility to ensure that treatment approaches are informed by the strongest available evidence. On the other hand, clients need support now rather than waiting for decades of additional research to accumulate. Specialist clinicians therefore often work in areas where the evidence is still emerging rather than fully established.
In this context, an overly simplistic understanding of evidence-based practice can become problematic. If we define evidence solely as published research, we risk overlooking valuable clinical knowledge and practical experience gained from working with thousands of clients. If we define evidence solely as our own observations, we risk becoming detached from the wider scientific literature and vulnerable to confirmation bias.
A more balanced approach involves drawing upon both. Research provides an essential foundation, but clinical expertise, client feedback and outcome evaluation help ensure that this knowledge remains relevant to the people seeking help today. Rather than viewing evidence-based practice and practice-based evidence as competing ideas, perhaps the real challenge is learning how to hold them in productive dialogue with one another.
How we think about evidence at the Laurel Centre
At the Laurel Centre, we have long believed that if we are going to make claims about the effectiveness of our work, we should be willing to examine those claims critically.
In 2020, our peer-reviewed research paper evaluating the outcomes of our Residential Course was published. Since then, we have continued to evaluate our group programmes, including both our Online Recovery Course and Residential, not simply to demonstrate effectiveness but to help us refine, improve and strengthen what we offer.
Participants complete outcome measures before treatment, three months after completing the programme, and then at six-month intervals thereafter. This allows us to explore not only whether change occurs, but whether it is sustained over time.
More recently, we have begun a wider practice evaluation project designed to examine outcomes across all areas of our clinical work. This includes individual therapy, group work and partner support services, allowing us to better understand the relative impact of different interventions and continue developing our practice in response to what we learn.
We do not see this process as a way of proving that we have found the “right” approach. Rather, we see it as part of an ongoing commitment to curiosity, accountability and learning.
Beyond the buzzword
Ultimately when it comes to evidence-based practice, the greatest danger may be that it becomes a label rather than a mindset. It is relatively easy to describe a service as evidence-based. It is far more demanding to engage in the ongoing process of evaluating outcomes, questioning assumptions, staying informed about emerging research and remaining open to the possibility that some of our beliefs may be incomplete or mistaken.
Perhaps this is where the conversation needs to move. Rather than asking whether a therapy is evidence-based, we might ask a series of more interesting questions. What kind of evidence supports it? How strong is that evidence? How do practitioners know it is working? What outcomes are they measuring? How do they respond when clients are not improving? And how willing are they to adapt their thinking when new information emerges?
These questions may not lend themselves to neat marketing slogans, but they arguably capture the spirit of evidence-based practice more accurately than the phrase itself. At its best, evidence-based practice is not a claim of certainty or a guarantee of effectiveness. It is a commitment to intellectual honesty, scientific curiosity and clinical humility. It is the recognition that good therapy requires us to hold research, experience and client feedback in continual dialogue, while remaining willing to revise our understanding when the evidence points us in a new direction.
Perhaps the most evidence-based position of all is not to claim that we already have the answers, but to remain committed to asking better questions.
