The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

Counselling in primary care and the new NHS

A detailed overview of the changes in the structures of the new NHS in England, Scotland and Wales is presented, looking at the effect these changes will have on counsellors working in primary care. New structures for the provision of counselling in primary care and their implementation are explored. Supervision of counsellors in primary care is addressed and how supervision might fit into a managed counselling service. The requirements of clinical governance are discussed, as is the necessity of appropriate audit and evaluation data to inform service and individual development.     

Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.     

Counselling psychology in primary health care: A review

This paper reviews the development of counselling psychology within the field of primary health care. Issues discussed include liaison between counselling psychologists and other professionals, evaluation of treatment in primary care, family therapy in general practice and general practitioners’ skills in counselling. The need for training and evaluation of counselling are discussed and suggestions are made for further research.     

Counselling in primary care: a review of the practice evidence

This paper describes the level of mental health problems that are encountered in primary health care. The limitations of using randomised control trials (RCTs) in evaluating effectiveness of psychological therapies in primary health care are described. Although the RCT may be useful in evaluating interventions in highly controlled situations, its use in evaluating clinically representative service delivery research is limited. A three-stage model of psychological therapies research is described to show that distinct stages require different methodologies in order to evaluate them, and this model is used to structure the review. The literature on research carried out in more naturalistic circumstances is then reviewed. Evaluating psychological interventions in this way shows there is considerable evidence that psychological therapies are effective in a number of ways in a primary care setting. The naturalistic studies that are more typical of clinical practice support the use of psychological interventions. The theme of the grey literature is almost entirely positive from the point-of-view of patients and GPs alike. However, there is considerable diversity in the sophistication of the methodology of the latter studies. Some were comprehensive evaluations, while others were more akin to audit. A major shortcoming is that few described their qualitative methodology. This said, the themes arising from the reports are very consistent and, had they been supported by a more robust qualitative methodology, would have added even more support, financially and clinically, for the arguments for counselling provision in primary health care. The level of referred clients' distress, measured by a variety of measures, was shown to be moderate to severe and similar to the level of patients referred to Community Mental Health Teams (CMHTs). When they were measured, there was a considerable reduction in subsequent psychiatric symptoms.     

Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Counselling in primary care: past, present and future

The rapid growth of counselling in primary care has happened unofficially and almost by stealth over recent years until it has established a niche within many primary health care teams. If it is to survive following the latest reform of the NHS, it has some serious challenges to face. These challenges are to the very nature of counselling and involve the need to establish the professional identity of the counsellor in primary care. The current bias towards the regulation of health professionals also impinges upon counsellors in this domain, along with the need for their effective management and harmonisation of services within the health service. Evidence for the effectiveness of counselling is a pressing concern in a realm where the random control trial has reigned supreme. Whether or not counselling in primary care is subsumed into other health care professionals' roles is a matter for much speculation. Perhaps counselling will become 'medicalised' or perhaps it will develop further and continue to offer a different perspective on health and healing and remain in place to further enrich the services offered in primary care.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.     

Deconstructing 'brainwashing' within cults as an aid to counselling psychologists

With the approach of the new millennium there was increased activity within many of the new cultic movements. Many of these organizations promise a future paradise on earth, and can be identified as millenarian cults. Others predicted the end of the world with the focus for this event being the new millennium, the beginning of which is mutable, some claiming it for the year 2000 others the year 2001. The date for the end of the world can by quite idiosyncratic. It was, for instance, believed by the Movement for the Restoration of the Twelve Commandments to be due in March 2000, when over 1000 members of this particular Ugandan cult lost their lives, many through strangulation. The death toll was a stark demonstration of what appears to be some form of extreme control exercised within such groups. It has been estimated that there are between 500 and 800 different cults active in the United Kingdom with membership ranging from under ten people to thousands. This activity indicates that counselling psychologists need to be aware of the problem of the psychological damage with which some members or ex-members of cults continue to present and of the techniques of control practised within the cult and the effect that these techniques have on members. These types of techniques and the resultant negative psychological consequences are the focus of this paper. This paper aims to begin to educate counselling psychologists in the techniques used within cults which effect social control. It intends to equip counselling psychologists to work with a group of clients, that they will meet on an increasing basis as the new millennium, whatever date is allocated to it, approaches and passes. That is if heaven on earth or the earth's destruction does not materialize.     

Developing practice and evidence for counselling in primary care: the agenda

Counselling in primary care has developed rapidly over the last few years and now appears to be a widespread provision. Yet ad hoc , unregulated development, coupled with radical changes within the National Health Service environment, presents an array of challenges to continued development. This paper reviews and summarises the contributions of all the authors to this special symposium, and in so doing attempts to set out a development agenda for both evidence and practice as a practical yield from the rich insights and experiences offered.     

Counselling strategies for bereaved people offered in primary care

The aim of this study was to identify strategies that general practice-based counsellors used when offering support to bereaved clients. Over the last decade, there has been a rapid growth in the provision of counselling services associated with British primary care services. A study was designed involving qualitative methods of data collection (semi-structured interviews) and analysis (a grounded theory approach). Counsellors were recruited from two cities in Southern Britain (Plymouth and Southampton). Twenty nine (76% response rate) counsellors agreed to participate (Southampton n = 15, Plymouth, n = 14). Semi-structured face-to-face audio-taped interviews elicited information about their perceptions of the appropriateness of general practitioner referrals, counselling strategies and models of bereavement. Analysis indicated that counsellors saw bereavement counselling within a broader agenda of work concerned with loss and relationship management. Many drew on eclectic approaches to bereavement counselling and specific strategies included: facilitating telling of the 'story' of the loss; engaging in active listening and valuing allowing people to talk; establishing a supportive relationship; and enabling the bereaved person to deal with unfinished business and to say 'goodbye'. Counsellors drew on implicit stage/phase models of grief that assumed levels of distress reduced over time. The value of these strategies requires more exploration.     

Counselling for women: The contribution of feminist theory and practice

Much of the literature on the theory and practice of counselling is gender-blind, the assumption being that the emotional worlds of women and men are the same. This view is challenged, the author reviewing the work of feminist theorists and practitioners. Central to this discourse is the argument that to understand the internal psychic structures of women, her concepts of se& we have to acknowledge the effect of external and oppressive structures on her psychological development. This can assist us in our understanding of how the therapeutic relationship might address women's needs and provide the ‘space’ for her to grow and change.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

Counselling, counselling skills and encouraging pupils to talk: Clarifying and addressing confusion

The context in which counselling approaches operate in schools is outlined. The issues that arise from the location of counselling skills and the practice of counselling in the framework of pastoral care and of personal and social education are discussed both from a historical perspective and in terms of the current educational climate. Ways in which counselling and counselling skills might be more appropriately and effectively used in schools are considered.     

Rational-Emotive therapy and its contribution to careers counselling

While rational-emotive therapy is an influential therapeutic system in the USA, it has not received much serious consideration in Britain. Moreover, RET theorists and practitioners have not paid attention to its application to careers counselling. To correct these two situations, RET theory and practice is briefly discussed, and Crites' three-stage process model is used to show how counsellors can apply RET methods to careers counselling. Case material is presented to illustrate such applications.     

Suicide assessment and evaluation strategies: a primer for counselling psychologists

Suicide is a recognized national health risk in many countries. In order to effectively intervene in suicidal crises, it is important for mental health professionals to understand facts about suicidal behaviour, procedures for assessing an individual's risk of self-harm, and the evaluation of the lethality of a client's suicidal gestures. With updated knowledge and proper training, counselling psychologists can play a vital role in suicide prevention. This paper summarizes for counselling psychologists current statistics about suicide, general and specific risk factors for suicidality, and assessment tools used to evaluate suicidal risk.     

HIV counselling in developing countries: the link from individual to community counselling for support and change

Counselling in developing countries can extend from individual to family and community, can be implemented as a means of facilitating changes or support, and in the community context can be used to measure as well as sustain behaviour change. Contrasts between developed and developing countries include the capacity of communities in developing countries to acknowledge loss and find hope. Community involvement in counselling, and capacity for confidential sharing, are building blocks for strategic participatory response to AIDS and HIV, that can link inclusive care to prevention by community-determined change in attitudes, behaviours and environment. The premise that there can be a positive link from the individual to the community through confidential sharing and that it can give rise to prevention through counselling the community is illustrated by reference to programme examples from Brazil, Sri Lanka, North-Eastern India, Zambia and Zimbabwe. Community hope exists through recognition of loss, inclusion of suffering people, and capacity and action for change. One transferable tool for community development is community counselling in relation to HIV and AIDS. A visible and expected outcome is increased community capacity to care and hope.