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Read about the dangers of relying on short-term psychotherapy

The global shift to short-term treatment abandons patients who need more care

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Red brain embedded in a maze

Australian Experience

Patients suffered when Australia cut psychotherapy coverage.

These papers analyse the social and human cost of abandoning patients in severe distress

Anaf, Gil. 2002. “Ethics and evidence-based medicine.” Medical Journal of Australia 176 (20 May):507.

Anaf, G. 2002. “Patients suffer when policy measures success in numbers.” The Advertiser Adelaide, S. Aust. 03 July:18.

Anaf, G. 2004. “Quick-fix solution is costing lives.” The Advertiser Adelaide, S. Australia 13 Oct: 20.

Anaf, G. & Jewell P. 2007. “Medicare Item 319 after 10 years: a range of concerns.” Australasian Psychiatry 15. October 2007 Australasian Psychiatry 15(5):372-4 lDOI: 10.1080/10398560701452189

Alliance for Better Access 2014. Australia needs Better Access to psychological treatment: recovery takes time in mental health care. 10 appointments are not enough.​

Breen, L., and Darlaston-Jones, D. 2008. “Moving Beyond the Enduring Dominance of Positivism in Psychological Research: An Australian Perspective.” 43rd Australian Psychological Society Annual Conference.

Cumming Fia. "Wooldridge's Dr 747 up in the air: A case described by Federal Health Minister Michael Wooldridge as a "giant rip-off" of Medicare appears to have no basis in the organisation's records." Sun Herald; Sydney, N.S.W. [Sydney, N.S.W]07 Feb 1999: 15.

Halasz, G, R Borenstein, J Buchanan, JM Davis, D Grant, S Prager, B Pring, R Prytula (Eds). She Won’t be Right, Mate! The impact of managed care on Australian psychiatry and the Australian community. Melbourne: Psychiatrist Working Group, 1997.

Halasz, G, R Borenstein, J Buchanan, JM Davis, D Grant, S Prager, B Pring, R Prytula (Eds). 1999. She Still Won't Be Right, Mate!: Will managerialism destroy values based medicine? Your health care at risk! Melbourne, Australia:  Psychiatrists Working Group.

Harari, Edwin. 1994. “The attack on private practice: reformation or deformation?Australasian Psychiatry 2:5:213-215. DOI: 10.3109/10398569409079279


Jorm, Anthony F. 2011. “Australia’s Better Access Initiative: Do the Evaluation Data Support the Critics?” Australian & New Zealand Journal of Psychiatry 45, no. 9 (September 2011): 700–704.

Jorm, Anthony.  2024. "What if the Cochrane Collaboration was the subject of a Cochrane review? Beyond randomized controlled trials in the evaluation of complex psychosocial interventions,"
Mental Health & Prevention, Volume 33,

Leeder SR, Rychetnik L. 2001. Ethics and evidence-based medicine. Med J Aust. 2001 Aug 6;175(3):161-4. PMID: 11548084.

Mullings, Ben. Review of Dose response literature

------. 2015. Increase visits of psychological care.

------. 2020. Alliance for Better Access Blog.

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United Kingdom experience

In 2008, U.K. switched to centralized, short term psychotherapy to increase access. But the model has created sharp criticisms about the lack of appropriate care. Ontario is adopting this model, which motivates the funding cuts to existing care.

Atkinson, Paul. 2014. “Lies, Damned Lies, and IAPT Statistics.” Self & Society 42(1-2): 18-19. Full text request.

Binnie, James. 2015. “Do you want therapy with that? A critical account of working within IAPT,” Mental Health Review Journal, 20 (2):79-83.

Cooke, Anne and Jay Watts. 2016. “We're not surprised half our psychologist colleagues are depressed.The Guardian Wed 17 Feb 2016.

Dalal, Farhad. 2015. “Statistical Spin: Linguistic Obfuscation—The Art of Overselling the CBT Evidence Base.” The Journal of Psychological Therapies in Primary Care 4 (May): 1–25.

Grant, A et al. 2004. “A critique of evidence-based mental health and its relationship to cognitive behavioural psychotherapy.” In Grant A et al. Cognitive Behavioural Therapy in Mental Health Care. London, Sage Publications.

Grant, A. 2009. “Evidence-based practice and the need for paradigmatic pluralism in cognitive behavioural psychotherapy.” Journal of Psychiatric and Mental Health Nursing 16 (4): 368-375. DOI: 10.1111/j.1365-2850.2009. 01388.x

Jackson, Catherine, and Rosemary Rizq. 2019. The industrialisation of care: counselling, psychotherapy and the impact of IAPT. Monmouth, U.K.: PCCS Books, Ltd.


Johnsen Tom J. and Oddgeir Friborg. 2015. “The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis.” Psychological Bulletin. Advance online publication.

Marzouk, Philip K. 2019. “Has ‘IAPT’ eaten itself?” January 7. Mental Health Today.

Proctor, Gillian. 2015. “The NHS in 2015: still a scary possibility to come.” Healthcare Counselling and Psychotherapy Journal. October 15(4)


Saarni, S I and Gylling, H A.  2004. “Evidence based medicine guidelines: a solution to rationing or politics disguised as science?” J Med Ethics 30:171-175. doi: 10.1136/jme.2003.003145

So, M., Yamaguchi, S., Hashimoto, S. et al. Is computerised CBT really helpful for adult depression?-A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry 13, 113 (2013).

Thyer, B. A., Pignotti, M. 2011. “Evidence-based practices do not exist.Clinical Social Work Journal, 39 (4): 328-333.

Timimi, S. 2020. Chapter 7: Industrialised Psychotherapy Markets Western Folk Psychology (Part 1) in Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How You Can Escape Them. Available in serialised form on the Mad in America website.


Williams, C. H. J. 2015. “Improving Access to Psychological Therapies (IAPT) and treatment outcomes: Epistemological Assumptions and Controversies.” Journal of Psychiatric and Mental Health Nursing. 22: 344–351 DOI:10.1111/jpm.12181

yellow brain embedded in a maze

Swedish experience

Swedish second thoughts on funding shift to short-term psychotherapy

Bohman, G., Säll, E. M. E., & Ögren, M-L. 2015. “Ensidig satsning på KBT skadar svensk psykvård  [The one-sided focus on CBT is damaging Swedish mental health].” Svenska Dagbladet, Debatt: Psykoterapi [Debate: Psychotherapy], November 7th

nician's Digest

Lyford, Chris. 2015. Clinicians Digest: Has CBT Lost Its Mojo? Psychotherapy Networker November/December 2015. 


Miller, Scott D. 2015. “Swedish National Audit Office concludes: When all you have is CBT, mental health suffers.” November 10, 2015

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Canadian and American criticism of exclusive shift to short-term psychotherapy

Cuijpers, P., and I. A. Cristea. 2016. “How to Prove That Your Therapy Is Effective, Even When It Is Not: a Guideline.” Epidemiology and Psychiatric Sciences 25, no. 5 (2016): 428–35. doi:10.1017/S2045796015000864.

Goodman, D. 2015. The McDonaldization of psychotherapy: Processed foods, processed therapies, and economic class. Theory & Psychology, 26(1), 77-95. DOI: 10.1177/0959354315619708.

Gupta, Mona. 2014. Is evidence-based psychiatry ethical? Oxford: Oxford University Press.

Gupta, Mona. 2007. “Does evidence-based medicine apply to psychiatry?” Theor Med Bioeth. 28(2):103-20.

Littlewood, E., et al. 2015. "A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial." Health Technol Assess 19(101).


Mercuri M., Baigrie B.S. 2019 “What counts as evidence in an evidence‐based world?” J Eval Clin Pract. 1–3.

Shedler, Jonathan. 2011. “Science or Ideology?” American Psychologist 66 (2):152-154.

Shedler, J. 2015. “Where is the Evidence for Evidence-Based Therapy?The Journal of Psychological Therapies in Primary Care 4 (May): 47–59 and in The Limbus Critical Psychotherapy Conference Challenging the Cognitive Behavioural Therapies: The Overselling of CBT's Evidence Base, Devon, England, November 1, 2014. Adapted in 2018 Psychiatr Clin N Am 41 (2018) 319–329

Shedler, J. 2017. “Selling Bad Therapy to Trauma Victims: Patients and therapists should ignore new guidelines for treating trauma.” Nov 19, 2017

Song, Wei-Yi 2019. “Don’t penalize people with severe mental illnessToronto Star July 8, 2019.

Tasca, G. A., Town, J. M., Abbass, A., & Clarke, J. 2018. “Will publicly funded psychotherapy in Canada be evidence based? A review of what makes psychotherapy work and a proposal.Canadian Psychology/Psychologie canadienne, 59 (4): 293-300.

Thyer, B.A., Pignotti, M. Evidence-Based Practices Do Not Exist. 2011. Clin Soc Work J 39, 328 (2011).

Vakoch, Douglas A., Strupp, Hans H. 2000. "The evolution of psychotherapy training: Reflections on manual‐based learning and future alternatives." Journal of Clinical Psychology 2000 56:3 pp, 309-318 DO: 10.1002/(SICI)1097-4679(200003)56:3<309::AID-JCLP7>3.0.CO;2-7 SN: 0021-9762

Weir, Doug. 2019. Long-term therapy is only one cog in a large wheel of services [reply to Cohn 2019]. Toronto Star July 29, 2019.

Westen D, Novotny CM, Thompson-Brenner H. 2004. The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials. Psychol Bull. 2004;130(4):631–63. [PubMed] [Google Scholar


Westen, DrewMorrison, Kate. 2001. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies, Journal of Consulting and Clinical Psychology 69:6 (Dec 2001): 875-899. DOI:10.1037/0022-006X.69.6.875

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Supporters of limiting care

Papers and news items supporting the 24 hour limit

Cohn, Martin Regg. “Mental health reform in Ontario is no easy matter,” Toronto Star July 24, 2019.


Kurdyak P, Stukel TA, Goldbloom D, Kopp A, Zagorski BM5, Mulsant BH. 2014. “Universal coverage without universal access: a study of psychiatrist supply and practice patterns in Ontario.” Open Med. 2014 Jul 15; 8 (3):e87-99. PMID:25426177


Kurdyak, P., Lesley Wiesenfeld, Sanjeev Sockalingam. 2016. “Choosing Wisely? Let’s Start with Working Wisely.” The Canadian Journal of Psychiatry 61(1) 25-28.


Health Quality Ontario. 2017. “Psychotherapy for major depressive disorder and generalized anxiety disorder: a health technology assessment.” Ontario Health Technology Assessment Series [Internet]. 2017 Nov;17(15):1-167. Available from:


Howard KI, Kopta SM, Krause MS, Orlinsky DE. 1986. “The dose-effect relationship in psychotherapy. Am Psychol. Feb 41(2):159-64. PMID: 3516036


Ministry of Health and Long-Term Care. 2019. MOHLTC Submission 2 In the Matter of a Board of Arbitration Established Pursuant to The Binding Arbitration Framework to Deal with a Dispute Between: Her Majesty The Crown In Right Of The Province Of Ontario (as represented by the Ministry of Health and Long Term Care) and The Ontario Medical Association.


Rudoler, David, Claire de Oliveira, Juveria Zaheer, and Paul Kurdyak. 2019. “Closed for Business? Using a Mixture Model to Explore the Supply of Psychiatric Care for New Patients.” The Canadian Journal of Psychiatry 64(8): 568-576.


Paris J., Goldbloom D, Kurdyak P. 2015. “Moving Out of the Office: Removing Barriers to Access to Psychiatrists.Can J Psychiatry. Sep 60 (9):403-6. PMC4574716


Strauss, Matt 2019. “Ontario's proposed cuts welcomed by critics of 'boutique psychiatrists' who over-treat wealthy patients.” National Post April 23, 2019.


Samuels, A and Veale, D. 2009. “Improving access to psychological therapies: For and against.” Psychodynamic Practice 15 (1): 41-56. ISSN 1475-3634.

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