Scientifically, professionally, and ethically, evidence-based psychotherapy seems to be a well-balanced movement. Nonetheless, it has not yet succeeded in promoting the best treatment for every client, especially regarding diversity issues and societal stress factors that influence clients from minority groups. Evidence-based psychotherapy is mainly based on nosological systems of mental illness and the biomedical model rather than on social structuring of mental health problems. It combines many important parts of the picture but overlooks all the societal or contextual factors that influence mental health in every group of people, especially in groups of discriminated people. It is argued that this perspective promotes an individualistic view of mental health. There is a need for a different framework of evidence-based therapy that should include societal and contextual factors that influence the client and the therapy process. An extended view of evidence-based psychotherapy is proposed, which adds a “fourth dimension,” the “context of therapy,” to the definition of evidence-based psychotherapy along with the reorientation of research to more user-led and diversity-adapted practices. This article outlines a comprehensive framework of evidence-based psychotherapy that can work as a general guidance for researchers, health stakeholders, therapists, and training programs in psychotherapy.
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