On reviewing this book, I had two things in mind. First, what's new in the material presented? And second, is the material presented likely to be effective in helping change my clinical practice?

Some chapters were particularly impressive. The chapter on political milestones gave a very good overview of the evolution of a quality agenda in mental health. Other chapters in the early part of the book seemed full of ‘ management speak’ and did not sustain my interest. The chapter entitled ‘In defence of NHS Psychotherapy’ by Phil Richardson and Peter Hobson was published previously in Psychoanalytic Psychotherapy. It presents a good case for the services provided at the Tavistock. There is little evidence of Tavistock NHS psychotherapy wishing to learn from current research so that clinical practice may be improved, and the planning, organisation and delivery of psychological therapy services made more effective. Chapter seven emphasises that ‘it is no longer a disorder that is being treated but a person’. Phil Richardson here presents a good overview of evidence-based practice and the psychodynamic psychotherapies. However, this chapter seems rather discouraging and dispiriting for an individual attempting to base practice on evidence. Such an individual might well wish for guidance on a range of solutions, rather than just reading about the complexities and problems inherent in much evidence-based practice.

In their useful overview of the audit cycle, McPherson and Richardson recognise that the most difficult part of the audit cycle is in implementing change. I believe the attempts to distinguish between audit and research in chapters nine and ten create confusion and are not helpful. In the later chapters, complexities and problems are raised in the choice of outcome measures. The writers do not write as if the measures have been incorporated into the everyday evaluation of Tavistock Clinical Services. The examples given come from services outside the Tavistock Clinic, such as the Brandon Centre. I was disappointed that health service users seemed to be mentioned as a two-page afterthought in chapter fifteen. Clinical effectiveness in psychotherapy and mental health services might be greatly increased by the thoughtful involvement of health service users in the planning, organisation, development and delivery of psychological therapy services at the Tavistock and elsewhere.

I hope the next book on clinical effectiveness will be more forward-looking and will present a clearer vision of how things can move on in evaluating the psychological therapies, and with the Tavistock Clinic at the forefront of developments.