Over the past two decades, millions of people have sought help through psychological therapy. For many, therapy has been life-changing. For others, it has been disappointing. Some leave feeling understood, hopeful, and emotionally stronger. Others complete treatment feeling little different than when they started. This raises an important question: How do we know whether a mental health treatment is actually working? For men, this question matters because many delay seeking help until they are struggling significantly. If they finally reach out, they deserve treatments that are genuinely effective, not simply treatments that appear successful on paper.

What Is IAPT?

In England, one of the largest mental health programmes is called Improving Access to Psychological Therapies (IAPT). Launched in 2008, its aim was straightforward: To make evidence-based psychological therapies, particularly Cognitive Behavioural Therapy (CBT), available to far more people experiencing depression and anxiety. Since its introduction, millions of patients have received treatment, making it one of the largest publicly funded psychological therapy programmes in the world.

Supporters point to improved access, shorter waiting times, and large numbers of people reporting reduced symptoms. But not everyone agrees that the programme’s reported success tells the full story.

Why Has IAPT Been Criticised?

Clinical psychologist Dr. Michael J. Scott argues that before celebrating IAPT’s reported recovery rates, we need to ask a simple scientific question: Are the results as good as they appear? His commentary does not claim that therapy is ineffective. Instead, it questions whether the evidence used to judge IAPT’s success is sufficiently rigorous.

What Does “Recovery” Actually Mean?

One of Scott’s biggest concerns involves the word recovery. When most people hear that someone has recovered from depression or anxiety, they imagine something quite specific. They assume the person no longer meets the criteria for that mental health disorder. In everyday language, recovery means the illness has genuinely resolved.

However, many large therapy services measure recovery differently. Instead of conducting detailed diagnostic interviews before and after treatment, they often rely on self-report questionnaires completed by patients. If a person’s questionnaire scores improve enough, they may be counted as “recovered.” Scott argues that these are not necessarily the same thing. Feeling better is important. But feeling better on a questionnaire does not automatically mean someone no longer has a diagnosable mental health condition.

Why Does Diagnosis Matter?

Imagine a man seeking help for trauma after military service. He may receive treatment labelled as trauma-focused therapy. But if nobody establishes whether he actually meets the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD), how can researchers confidently compare his treatment outcome with clinical trials conducted on patients who definitely had PTSD?

Scott argues that without careful diagnosis, meaningful comparisons become difficult. The people receiving treatment may not resemble those studied in scientific research.

Can Therapists Say They Delivered a Treatment Without Anyone Checking?

Another concern involves something psychologists call treatment fidelity. Treatment fidelity simply means asking: Did the therapist actually deliver the therapy they claimed to provide? In clinical research, sessions are often recorded and independently reviewed. Experts examine whether therapists followed the treatment protocol correctly.

Scott points out that large routine services rarely monitor treatment fidelity in this way. As a result, we cannot always know whether evidence-based therapies are being delivered consistently. Two therapists may both describe their work as CBT while practising very differently.

Why Is Independent Research So Important?

Scott also raises concerns about allegiance bias. This occurs when researchers evaluating a programme are closely connected to that programme. This does not necessarily mean the research is dishonest. Most scientists work with integrity.

However, decades of research have shown that studies conducted by people closely associated with a treatment often report more favourable outcomes than studies conducted independently. For this reason, science places great value on independent evaluation. Just as new medications are tested by researchers outside the pharmaceutical company whenever possible, Scott argues that large public mental health programmes should also undergo independent assessment.

Do People Who Drop Out Matter?

Yes, and this may be one of the most important issues. Many therapy programmes report outcomes primarily for people who complete treatment. At first glance, this seems reasonable. But imagine a gym advertising that 80% of its members became fit... while quietly excluding everyone who stopped attending after two weeks.

The results would present only part of the story. Scott notes that many people referred to IAPT do not complete treatment. If large numbers leave early, evaluating only those who remain may create an overly optimistic picture of effectiveness. Researchers call this attrition bias. To understand how well a service performs in the real world, we must consider everyone who enters treatment, not only those who finish it.

Does This Mean Therapy Doesn’t Work?

No. This is an important distinction. Scott is not arguing that psychological therapy is ineffective. In fact, decades of research show that therapies such as Cognitive Behavioural Therapy (CBT), trauma-focused CBT, and other evidence-based approaches can significantly reduce symptoms for many people. His criticism is more specific.

He argues that we should not assume a large public programme achieves the same results as carefully controlled clinical trials unless high-quality evidence demonstrates that it does. The effectiveness of therapy and the effectiveness of a particular delivery system are two separate questions.

What Outcomes Actually Matter to Clients?

Scott suggests that symptom questionnaires are only one part of the picture. Most people seeking therapy want to know:

• Can I enjoy life again?
• Can I sleep peacefully?
• Can I return to work?
• Can I maintain healthy relationships?
• Can I cope without constant anxiety?
• Will these improvements last?

These real-world outcomes often matter more than a numerical score on a questionnaire. Long-term recovery, not simply short-term improvement, is the goal most clients hope to achieve.

What Can Men Learn From This?

Many men avoid therapy because they fear it will not help. Others assume that if therapy is offered through a government-funded service, its effectiveness must already be proven beyond doubt. The truth lies somewhere in between. Psychological therapy is supported by a substantial body of scientific evidence and has helped millions of people. However, like all areas of healthcare, the systems used to deliver that therapy should continue to be evaluated, improved, and held to high scientific standards.

For men, the lesson is not to become cynical about therapy but to become informed consumers of mental healthcare. It is reasonable to ask questions such as:

• What type of therapy am I receiving?
• Is this treatment recommended for my specific condition?
• How will we measure progress?
• What happens if this approach doesn’t help?
• Are there alternative evidence-based treatments?

Asking these questions is not scepticism, it is good healthcare.

What Is the Overall Message?

Dr. Michael Scott’s commentary reminds us that access to therapy and evidence of effectiveness are not the same thing. Expanding mental health services is an important public health achievement, but those services should also be evaluated using rigorous, independent scientific methods.

For men seeking support, this means recognising that therapy is neither a guaranteed cure nor something to dismiss outright. The best approach is to seek evidence-based care, remain actively involved in the therapeutic process, and expect mental health services to demonstrate meaningful improvements in the lives of the people they serve. Ultimately, good therapy should not only reduce symptoms on a questionnaire, it should help people build healthier, more fulfilling lives.

Does Therapy Work? Understanding Evidence-Based Mental Health Treatment

Choosing a therapist or psychological treatment can feel like a big decision, particularly if you have never had counselling before or have previously tried therapy without seeing the changes you hoped for.

Research suggests that psychological therapies can be effective for many mental health difficulties, including depression, anxiety and trauma. However, as this article explores, access to therapy, the quality of therapy and evidence of effectiveness are not necessarily the same thing.

For men considering counselling, it can be useful to ask questions about the type of therapy being offered, how progress will be measured and what happens if the initial approach is not helping. You do not have to simply accept treatment without understanding it.

At Male Minds Counselling in Reading, Berkshire, I work with boys and men experiencing difficulties including anxiety, depression, stress, panic, anger, relationship problems, low self-esteem, trauma, grief and emotional distress. My approach draws on CBT, humanistic and psychodynamic approaches, with therapy tailored to the individual rather than assuming that one approach will work for everyone.

Counselling is available in Reading and surrounding areas including Caversham, Woodley, Tilehurst, Earley, Lower Earley, Wokingham, Pangbourne, Henley-on-Thames, Newbury, Basingstoke and across Berkshire, as well as online across the UK.

If you are considering therapy and want to understand whether counselling could be appropriate for you, Male Minds Counselling offers a free 30-minute initial consultation.

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