A journey through the “rational mind” and the “paradoxical logic of the unconscious”: Implications for treatment guidelines

Current political and economic trends in psychology push for an evidence-based practice whereby interventions are chosen on the basis of relevant research findings. Although valuable and effective, the efficacy and the ecological validity of evidence-based interventions has often been questioned, as it can be argued that the complexity of human experience cannot be captured by the restraints of clinical trials only (Larner, 2004). In addition, the dangers of pressurising psychology services to strictly adhere to manualised guidelines means that specialist’s skills might be obscured. This paper and the case-study presented in it positions itself in the midst of this debate by highlighting how clinical intuition and an idiosyncratic formulation based on psychodyamic principles was integrated and enriched Cognitive Behavioural Therapy (CBT) research based practice. In addition, this paper also highlights how these fluid specialist skills are crucial to the vitality of the field and to the identity of counselling psychologists. This calls for a wider definition of what constitutes “evidence base” when working with such complex presentations as human beings.