The big issue: Bridging the gap
Therapy Today, March 2025

I often ask myself how I would react if my GP relied on a medical textbook from the 1950s to diagnose a current health issue. Yet this is the standard service many of us are offering our clients, informed by theory and thinking that hasn’t changed for decades. Although as a profession we have made significant progress over the past three decades in developing an evidence base for what we do, a number of key academics are concerned that many courses lack a curriculum informed by contemporary therapy research, and the majority of practitioners view research as separate, secondary and often unrelated to their therapeutic work with clients.¹

We know from the introduction of NHS Talking Therapies (formerly IAPT) in 2008 that without research some modalities will face redundancy. Models need their counsellors to champion expertise and experience through published research, to protect them from being overlooked and undervalued. Evidence is not just beneficial to us as a profession – it is essential for credibility and financial investment. Within IAPT, the substantial body of research proving the efficacy and cost-effectiveness of CBT led to NHS decision makers rapidly replacing existing counselling approaches with CBT in GP surgeries. The absence of comparable research for other modalities initially left them marginalised in the NHS, showcasing the critical importance of robust evidence to maintain relevance and support in the field.

As therapists we operate on a ‘mix of practical, personal, procedural, cultural, moral, ethical and theoretical knowledge’, says John McLeod, Emeritus Professor of Counselling at Abertay University. And while research can speak from and to these different ways of knowing, it often falls outside the awareness of many therapists. 

A growing number of key stakeholders think our ambivalent relationship with research has to change for our profession to achieve its full potential. ‘It would be a huge benefit to counsellors and psychotherapists if we could reach a point where looking at research as part of thinking about a practice dilemma or simply developing as a practitioner is as natural and commonplace as making use of supervision,’ says Clare Symons, BACP’s Head of Research. 

So how did we in the UK come to develop a therapy tradition where older research and theories are referenced without fully considering their relevance to today’s world? Why are we, as researcher Alan Kazdin put it, ‘letting knowledge from practice drip through the holes of a colander’?² I spoke to academics and practitioners to explore the extent of the research-practice gap and the reasons behind it – and perhaps more importantly whether it matters. 

Therapy Today, March 2025

Traditions 

I started with Mick Cooper, Professor of Counselling Psychology at the University of Roehampton, one of the co-authors of two recent papers published in BACP’s Counselling and Psychotherapy Research journal, which called on our profession to take research more seriously.^1,3 He is also currently in the process of updating his bestselling book, Essential Research Findings in Counselling and Psychotherapy: the facts are friendly (Sage), written to demystify research for working practitioners and explain its relevance to their practice. ‘A lot of the issues stem from where the therapy traditions come from the UK. In the US psychotherapy is grounded in psychology, whereas in the UK counselling comes from a more pastoral tradition,’ he says. ‘Practitioners are often more interested in the reflexive components of practice than in research. Research knowledge is not seen as playing as much of an important role as areas such as theory or personal experience.’ 

Our profession’s many modalities mean that what research there has been has been siloed, with individual modalities in the quest for legitimacy striving to build their own evidence bases, resulting in fragmented research limiting cross-disciplinary growth and the collective advancement of the therapy field.⁴ ‘Psychotherapy is so complex, and there’s not enough therapy researchers. If we take the number of therapy researchers there are, they’re divided up into individual modalities,’ says McLeod. ‘A group of researchers will mainly just talk to their colleagues in that world, and read articles published within that specific professional community. There are maybe 2,000 active therapy researchers in the world at the moment, and by the time you divide them down into these groups there’s not a sufficient critical mass of researchers to pursue research questions. For example, the development of COVID-19 vaccines was built on both co-operative and competitive work across a global network of research teams and labs. The complexity of the questions that counselling and psychotherapy researchers are trying to answer is not matched by the available person-power within the research community. To move things forward, particularly in an era of scarce resources, it would be better to have a more co-ordinated approach.’ 

Academic, researcher and author Sofie Bager-Charleson agrees on the need for collaboration: ‘If we can have at least consensus that we can discuss, compare and critique in a listening way, I think we’ll start to find that link in a process and what’s going on here.’ 

Clare Symons

Curiosity

The landscape has begun to change in recent years, says Symons. ‘There is very clear, high-quality evidence that counselling and psychotherapy are effective at alleviating people’s distress. We have considerable evidence about different aspects of therapy such as the quality of the relationship or how the therapist works that contribute to a positive outcome, and which can therefore inform practice.’ 

As well as this, considerably more therapists have had at least some exposure to research and, according to Symons, ‘there has been an explosion in people going on to do doctoral research’. 

As therapists we are well suited to being researchers, says Bager-Charleson, because we are ‘so, so curious, and well experienced in stepping in and out of people’s meaning-making process’. Our core therapeutic skills – empathy, humility and the ability to build rapport – also form an essential foundation for engaging in research. 

Bager-Charleson is Chair of the Therapists as Research-informed Practitioners (TRP) research group at Metanoia Institute, formed to demystify research for therapists, both empowering them to engage with existing published research and emphasising that not all research needs to follow a strictly scientific, statistical model. ‘We often talk about research in terms of outcomes and monitoring clients’ progress, which obviously are really important, but I think there is a way that we can research and put the lived experience out there in the public space in an embodied, emotional, intuitive, relational therapeutic way,’ she says. ‘I’m talking about not compromising what we believe as therapists, by being able to speak in different ways about what we do, in putting our practice into the context of society, which I think is the missing link. By moving out of the closed room which is so typical of the therapeutic position of confidentiality, we can put out the findings and the knowledge that are gained from lived experience. I think it’s a more indirect benefit in that it will give the profession the credibility that it deserves without making it into some tickbox exercise.’ 

Cooper agrees that many therapists embrace research because they possess ‘a hunger for finding out an answer to their curiosities and questions’. It was such a hunger that motivated Nick Campion, an integrative psychotherapist, to independently undertake research into the relationship between clients’ sexual practices and their early relational deficits (see pages 34-37 of this issue for his article on his research, ‘Repair through the erotic’).⁵ The process of research invited him to ‘read more widely and in greater depth. It challenged my thinking and the things I thought I knew, enabling me to understand the theory more deeply and what the theory looks like in practice.’ Campion’s research gave him more than he had anticipated. ‘It helped me to keep my mind and ears open, to not assume, and to be OK with uncertainty. It was personally and professionally a really enriching experience.’ 

Research provides a way for ‘burning questions’ arising from practice to be addressed, provoking new ideas for further research, says Nollaig Frost, Adjunct Professor at University College Cork. ‘It provides practitioners with enhanced awareness of their own practice, and opportunities to consider that of others.’ 

It was my own burning questions and hunger to more deeply understand my personal experiences that drew me to my current PhD research. Navigating the challenges of being a psychotherapist in private practice while independently engaging in and publishing my research⁶ sparked my curiosity to learn from others in similar situations. 

For person-centred psychotherapist Tatiana Davis the process of her research into the interaction between client imagery and unconditional positive self-regard brought this very much into focus.⁷ ‘It’s a collaborative task,’ she says. ‘You’re still owning the research but there’s a negotiation and a relationship going on. Even though it’s a scientific response, it is a very creative process. There is a huge amount of emotional practice surrounding research.’ 

Integrating more right hemispherealigned research could address these issues, suggests Iain McGilchrist in The Matter with Things: our brains, our delusions, and the unmaking of the world (Perspectiva). Practice-based evidence that gathers insights from real-world therapy emphasises context and variability reflecting the art of therapy. But it’s a tricky balance to get right – while it’s true that the scientific knowledge of therapy holds little value without the wisdom derived from the art of practice, Bager-Charleson reminds us that ‘we may have focused too much on the art at the expense of the science, rather than seeing that it’s both’. 

Sofie Bager-Charleson

Decolonisation 

As well as encouraging personal development there is increased awareness of the key role of research in making our profession more inclusive and accessible to those from marginalised communities. BACP’s current research strategy highlights the importance of involving individuals with lived experience as essential partners in the research process, and the 2025 BACP Research Conference will also centre on collaboration, with a focus on integrating diverse perspectives and fostering co-construction in practice and research. 

Research is also crucial to the process of decolonising therapy, which underscores the significance of embracing diverse world views and challenging the dominance of Eurocentric models. By ‘muddying the waters’ and challenging conventional research methodologies, we can dismantle perceived legitimacy and dominant narratives, paving the way for the decolonisation of therapy research.⁸ 

According to Dwight Turner, Senior Lecturer at the University of Brighton, it’s essential that we find more ways to hear ‘the voices of those groups that have not had space to speak about their experiences before, and for that then to be heard within an academic or professional context’. 

Turner advocates that therapistresearchers should shift away from qualitative methods that merely mimic quantitative research as these approaches contribute to the colonisation of ideas, perspectives and voices. Embracing research methodologies such as narrative inquiry or autoethnography, he says, can ‘bring something different to the table that I think the wider research community can benefit from’. He further invites us to ‘stop being so afraid of our ideas, our research, our perspectives, as not being seen as academic enough’. 

Bager-Charleson says that when it started, therapy was ‘a unique sort of middle-class, white kind of relationship. There’s something about research looking into so many different lived experiences, we can really show that groups in the past have been regarded as insane or in need of repair because of prejudice in society. That’s many different groups, starting with women with “neurosis” and “hysteria” but with increased attention to sociocultural, (dis-)ability, neurodiversity, gender and sexual identity aspects and injustices in the field of mental health. Research that focuses on different experiences can make our society and our world a better place, where people actually have fewer mental health issues because they’re not being mislabelled by other people.’ 

Peter Blundell, Senior Lecturer on the MA in Counselling and Psychotherapy Practice at Liverpool John Moores University, agrees that research is vital for understanding the experiences of marginalised groups and communities and their experiences of therapy: ‘I think that’s something that’s been almost absent in past research, but that’s shifting now.’ He advocates for the establishment of research-practice groups where practitioners collaboratively engage with academic materials – such as articles, studies or book chapters – to explore emerging themes and consider their implications for practice. This approach promotes the active integration of research findings into therapeutic work, fostering a stronger connection between research and practice. ‘We need to be aware of whether we are just looking at all the research from our own modality and positionality, or are we looking at research from those with marginalised voices and their experiences of therapy? We will be able to learn something about how we practise by looking at the other research that’s out there,’ he says. 

While there is currently a growth in research studies helping to amplify the voices of marginalised groups, much more remains to be done. BACP has started to tackle this absence by offering members access to training and resources, please see the EDI page for more information, and topic-specific virtual issues of the BACP journal Counselling and Psychotherapy Research (CPR). However, it is unclear whether counsellors are actively engaging with these initiatives, and what needs to be done to encourage wider awareness and engagement. 

Dwight Turner

Barriers 

When we talk about therapy we treat it as one discipline and yet it’s not – therapy is a multifaceted, multi-focused endeavour, not merely a mechanical application of techniques. It is a profound relational process that requires creativity, flexibility and sensitivity to the unique contexts of each person. The mysterious nature of therapy is still often celebrated, and I have lost track of the number of times I have been told that the therapeutic relationship cannot be researched. 

Thankfully these days are largely behind us, but therapy research does become problematic when the science of therapy is not considered in the context of its art, leaving us homeless as a research discipline. Bager-Charleson says that ‘puts us in a sort of mystery box, and maybe that’s where people want us to be’. 

This enigmatic quality can make it challenging to quantify therapeutic outcomes or fully capture the richness of the therapeutic relationship. McLeod says we need an ‘open dialogue in the profession about focused research aims’. The recent CPR commentary coauthored by McLeod, Cooper and Kate Smith points out that many students embark on their training journeys with a deep curiosity and a readiness to learn, only to feel disappointed by the limited focus on research and inquiry in their curriculum: ‘Rather than a curriculum that weaves research findings directly into practice, model selection and treatment approaches, they encounter an education largely centred on established frameworks with minimal emphasis on ongoing inquiry.’³ This gap can leave students with unanswered questions about how their practice fits within the evolving landscape of mental health research. 

Practitioners who do pursue research tend to be driven by their personal curiosities rather than a collective focus on addressing the pressing needs of the field. For Cooper, the resulting assortment of research projects is a challenge, identifying that ‘we need to work together, to generate compelling, good case knowledge around particular topic areas’. 

Mick Cooper

One such success story is the Effectiveness and Cost-effectiveness Trial of Humanistic Counselling in Schools (ETHOS) study, a long-term collaboration between BACP, several universities and other training providers and charities, with funding from the Economic and Social Research Council. Raising in excess of £800k with a research team of around 40 academics and therapists working with 18 schools and more than 300 young people, the project spanned over three years. It took about 10 years of preparative work to get funding, says project lead Cooper, ‘looking at particular topic areas, and talking to policy makers, then doing pilots, producing, testing, attempting and failing, and keeping going’. 

The independent research landscape and smaller projects face significant barriers to funding as well as ethical considerations and limited access to research publications. Client confidentiality, awareness of potential harm and informed consent are essential but they can restrict the depth and types of studies therapists can conduct. From my own PhD research findings, many therapists also highlighted the significant lack of funding as a barrier to practitioner research. 

BACP has published research guidelines for independent review panels for independent researchers,⁹ although the experiences of therapists who have utilised independent review panels remain largely unexamined in published research. Few independent researchers reach the review stage simply because, as Blundell says, ‘Often there is literally a paywall. Practitioners who are not within universities can’t access research to look at. And some journals are now asking for fees for publication – practitioners are paying them because they’re desperate to have their research out there.’ 

Debs Mendham

As editor of the open access European Journal for Qualitative Research in Psychotherapy, Frost identifies editorial teams serving as ‘essential gateways to the insights and practices of others by publishing high-quality research, made possible by therapist-researchers who conduct and submit their work’. CPR, BACP’s own dedicated research journal, is free to access for all members, and every member also has access to the EBSCO publishing databases. 

These initiatives are a vital step forward but the barriers remain significant, says McLeod. ‘As independent practitioners it’s really hard,’ he says. ‘Even a simple thing like getting ethical approval for a project is hard, as is another really simple thing – getting access to research journals, many of which are still only available behind paywalls.’ 

Training 

A therapist’s initial experiences with research during their primary training predominately shape their engagement for their entire career. As Blundell says, it is ‘important for trainees to understand the links between research and practice because the ways that we practise do not just come out of thin air’. Tutors on therapy training courses tend to be (rightly) employed on the basis of their practice experience and/or teaching experience. This means some tutors are ‘a bit intimidated about research’, says Bager-Charleson. ‘There can be a tendency to construe research as detached and contradictory to the emotional, embodied, engaged knowledge – almost as though research is an enemy in the room.’ 

However, it’s unfair to say that trainers don’t recognise the importance of teaching students to analyse data and integrate findings to contribute to scientific knowledge. For many, such as Debs Mendham, Programme Leader of the BACP accredited degree course at Sherwood Psychotherapy Training Institute, research is key: ‘Everything we do with clients is research. As therapists we are researchers. From the moment we meet with a client for the first time we are constantly in a process of research. We need to keep refreshing our theories, asking ourselves do they still stand up in the society we have?’ 

As an unregulated profession, anyone can set up a therapy training course and choose their own curriculum, one of the challenges that the Scope of Practice and Education (SCoPEd) framework aims to address, by eventually standardising training and professional development across different levels of therapeutic practice. By emphasising clear competences and educational benchmarks, the hope is that SCoPEd will foster research skills among therapists by integrating research literacy and application into training curricula. However, SCoPEd is not without its critics and it remains to be seen whether this will be enough to generate the sea change needed – in their recent CPR commentary, McLeod, Cooper and Smith also recommend that BACP invests in an annual research-oriented conference for trainers and clinical supervisors, a journal dedicated to disseminating research and good practice in training and clinical supervision, and/or a training/clinical supervision research network to co-ordinate activities in these areas.³

Peter Blundell

Evidence 

Challenges aside, there is no doubt that therapy research has evolved significantly over the past 10 years, moving from early theoretical explorations and anecdotal practices to more robust, evidence-based methodologies. 

The findings have at times been unexpected and uncomfortable – as an example, Cooper points to Michael Barkham and colleagues’ BACP-funded 2023 study measuring the effectiveness of person-centred experiential therapy versus CBT in NHS IAPT services.¹⁰ The study indicated that while personcentred experiential therapy was equally effective at the six months mark, it became inferior to CBT at 12 months, raising difficult questions for many counsellors. Our challenge as a profession is to respond to these findings and ensure what we are offering is what clients want and need. 

Research over the years from Bruce Wampold and Zac Imel discussed in The Great Psychotherapy Debate: the evidence for what makes psychotherapy work (Routledge) has consistently shown that all empirically validated therapy modalities yield comparable outcomes. This confronts us with another uncomfortable truth – the effectiveness of therapy is more likely driven by the therapist’s personal qualities rather than the specific modality they use. 

McLeod has highlighted how feedback measures and routine outcome monitoring have been widely adopted in large therapy-provider organisations. However, the research evidence suggests that while feedback systems seem to be beneficial, in terms of client outcomes in some services and with some clients and therapists, they are less helpful in other contexts. To take advantage of the potential value of feedback systems, it would be useful to have more research into the dynamics of using client feedback, and more training for therapists and service managers to help them make sense of the complexity of the feedback process. 

Crossroads 

Counselling and psychotherapy stand at a crossroads – a research-averse culture may be undermining the potential for us as a profession to create meaningful change in the lives of individuals and communities.¹ While statistical significance alone does not guarantee genuine improvements in a client’s day-to-day wellbeing, neither do personal development and mastering reflexive practice skills alone guarantee effective practice. Whether therapists who fail to engage with contemporary research are exposing their clients to unintentional harm remains under-researched. 

However, while evidence-based practice is crucial for the future legitimacy of counselling and psychotherapy, there is no doubt that lived experience research brings life and meaning to this evidence. Our challenge now is to find a path that embraces the two, integrating diverse perspectives and pushing beyond traditional boundaries to create more inclusive and effective therapeutic and research practices. It is only through collaborative partnerships between training institutions, professional bodies, researchers and practitioners that we will be able to embrace the necessary scale of future projects. 

Counselling and Psychotherapy Research is free to access for all BACP members.

John McLeod