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PROMOTING EMOTIONAL HEALTH AND CLEAR THINKING
Editorial: Volume 7, No. 3 — 2000
Being heard — but not helped
THERE is no good evidence whatever that counselling is effective, either clinically or in terms of cost. That was the dismaying finding of a major 1996 review of the efficacy and effectiveness of counselling in primary care in the UK. The researchers Freidli and King concluded that, despite the fact that patients like it, if health service resources are being directed into counselling, as increasingly they are, it should urgently be established which counselling methods – if any – work for which patients.
Now a team from the NHS Centre for Reviews and Dissemination at the University of York, led by Nancy Rowland and Christine Godfrey, has attempted to meet that challenge, at least in part. Their findings[1] are illuminating, if disheartening and frustrating. Rowland et al chose to review randomised controlled trials of counselling, the ‘gold standard’ method in evidence based healthcare but one which, in this case, as they acknowledge, has shortcomings. Outside clinical trials, few practitioners use a standardised form of therapy to treat standardised patients over a standard period of time. Nevertheless, the strengths of the method are perceived as outweighing the weaknesses.
The researchers assessed the results of trials which compared non-directive counselling (as defined by the British Association for Counselling, to avoid any non-uniformity of approach) with standard GP care. (Cognitive therapy, behaviour therapy and problem solving approaches were all excluded, meriting, according to the authors, separate review.) Although only four trials involving nearly 500 people met the criteria, the data were statistically significant when pooled and, according to the authors, “can be said with some certainty [to be] the best available reflection of the reality of general practice counselling in the UK today”.
So what are the effects of this reflective or active listening style of counselling, currently so common in GP surgeries? Pulling findings from the trials, it seems that patients referred to counsellors felt better understood and listened to and were more likely to declare themselves satisfied with their treatment but there was no actual difference in patients’ ways of coping with their difficulties or their knowledge of what needed to be changed in their lives. There was no difference in social adjustment between those who were counselled and those cared for just by GPs. Prescriptions of drugs for anxiety did not fall and, while prescriptions for antidepressants dropped significantly for some patients in some trials, for others there was no change at all.
The researchers conclude that, while there are no clear cost advantages to this sort of counselling, patients show “modest” improvements in symptom levels; and that there is “very tentative evidence” that counselled patients are more likely to recover than patients given GP care only, although they hurry to add that even this result needs more investigation.
This is a rather sorry, if not surprising, state of affairs. Research has shown that the more we access distressing or disturbing material from our present or past, the more we are likely to access it in the future. (Professor Ian Robertson discusses the basis for this in his interview with Joe Griffin which starts on page 24.) Active listening may enable people to tell and re-tell their stories in a way which is unlikely to have positive effects unless they are also helped to move on.
Of course highly skilled therapists can generate positive effects, whatever method they use. (The York researchers acknowledge that their findings cannot take account of degree of skill and expertise on the part of the counsellors.) But the methods which therapists are taught should enable all of them to develop a high degree of skill which is transferable into all counselling settings, as in the human givens approach.
So surely we need researchers not to look further at what is most commonly offered in GP practices today and which is delivering just a “modest” benefit at best; but to explore solution focused, skills based, problem solving approaches which, according to all research so far, help patients develop new, protective life skills and competencies as well as satisfaction at being heard.
The Editors
1 Counselling in primary care: a systematic review of the research evidence. British Journal of Guidance and Counselling (2000), 28, 2, 215–231.
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