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.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

A five‐year evaluation of the effectiveness of person‐centred counselling in routine clinical practice in primary care

Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person‐centred counselling, the Core Outcome Measure (CORE‐OM) was administered at referral and at the beginning and end of therapy. A pre‐post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person‐centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.     

A follow‐up study of the long‐term effects of counselling in a primary care counselling psychology service

Despite much recent work examining the short‐term effect of counselling in primary healthcare settings, to date relatively little research has examined the effectiveness of such treatment programmes over the longer term. In this study, 58 participants underwent brief, time‐limited integrative counselling sessions, with symptoms being measured using the CORE‐OM immediately before, immediately after, and 30 months after counselling. It was found that in addition to participants reporting significantly lower levels of psychological distress immediately post‐counselling, a further significant improvement at 30‐month follow‐up was also apparent, indicating that the benefit from counselling was maintained. In addition to this reduction in symptoms post‐counselling, a significant reduction in GP visits was also detected in the 12 months following counselling when compared with the 12 months prior to counselling, indicating a lower reliance on the primary healthcare team after counselling.     

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.     

Evaluating the outcome of counselling in primary care using a goal attainment scale

This study evaluates the outcome of counselling in primary care. The method replicates part of a previous study in the same setting and finds similar results. Outcome was assessed by clients using a goal attainment scale. A high rate of goal attainment was reported. A content analysis system was used to categorize goals, a high level of inter-rater reliability was found. The majority of goals were those aspiring to some 'change' in the clients' lives. This study found that these goals were predominately expressed in positive rather than negative terms. Limitations of the study include the lack of data on the clients who chose not to participate. Recommendations for future research are to include the opinions of these clients.     

Evaluating the effectiveness of counselling in primary care: Taking a fresh look

One criticism voiced by counsellors and psychotherapists is that research does not reflect either the culture or values of therapy. Researchers, on the other hand, accuse practitioners of not attending to their findings, and the implication is made that the latter engage in treatment processes that are ill‐informed. These polarised understandings give rise to the situation where the client — and his or her development — fall into the practice‐research gap. In more recent studies of counselling in primary care, an attempt has been made to offer new perspectives for interpreting and understanding findings, and the relative value — and limitations — of different research questions and methods. They provide just a few examples of how practitioner‐researchers in the future may ask more precise questions, yet reflect on their findings from a broader set of viewpoints.     

Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care

In an earlier paper (Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326–335) an approach to treatment delivery was examined in which the duration and frequency of the appointments was scheduled by patients. Results of this approach were encouraging but the generalizability of the results was constrained because only one clinician trialed the approach and no standardized assessment measures were used. In the present study there are two clinicians involved and the Depression Anxiety Stress Scale (DASS) was used. The approach was introduced at one GP practice and monitored over a six-month period. Results suggest that this approach might be an effective way of promoting patient access to, and involvement in, service delivery as well as reducing waiting times.     

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.     

Counselling the community: The contribution of counselling psychologists to the development of primary care

The primary care groups (PCGs) newly introduced to the National Health Service require general practitioners and primary care teams to improve the health of their communities by addressing the health needs of their population, promoting the health of that population and working with other organizations to deliver effective and appropriate care. Community-oriented primary care (COPC) is an internationally tested model for primary health care development which is now being employed within the UK. This paper outlines the COPC model, and demonstrates how the skills and knowledge base of counselling psychologists and primary care counselling can contribute to a community-oriented primary care approach.     

Meeting the challenges of the new NHS for counselling in primary care: a service manager perspective

This paper addresses the challenge of meeting the requirements of the new NHS in primary care, whilst at the same time protecting conditions for counselling as a creative rather than a mechanical process. In managed teams this tension has to be held without the benefit of a long professional history of change and adaptation. The profession of counselling and psychotherapy in primary care has to rapidly find its place within the new structure and take on board new expectations for a profession that has traditionally enjoyed a high level of clinical autonomy.     

Applied pluralism in the evaluation of employee counselling

The method and major findings of a complex, 'pluralist' evaluation, which investigated the effectiveness of the counselling provision of an employee support and counselling service in a local authority education department over 22 months, are outlined. Reference is made to the underlying philosophical approach of integrated pluralist evaluation, which may represent a significant step forward from the accepted methods of triangulation. In addition to achieving predicted high satisfaction rates from clients, counsellors and clients both indicated significant improvements in all measures used. These were maintained at follow-up which took place at intervals from 1 to 18 months after counselling had ended. Reduction in absenteeism post-counselling suggested the possibility of very substantial revenue savings. Responses also indicated the acute, and often chronic, need for employee counselling provision in the education system.     

Tracking trends: A longitudinal look at internship placements in counselling psychology in the United States

Efforts to track trends in internship placements across time serve the field of counselling psychology in a number of ways. But this research is qualified by its reliance upon a single source of data: the Council of Counseling Psychology Training Program (CCPTP) annual survey. This paper provides a review of the concerns related to this over-reliance, and addresses these concerns by supplementing this data source with the comprehensive data collected by the Association of Psychology and Post-doctoral Internship Centers (APPIC). Findings provide a longitudinal look at the supply and demand issue concerning internship placements, track the nature of pre-doctoral internship placements across a 30-year period of time, and generally support the validity of the CCPTP data by documenting their close correspondence to recent APPIC data.     

CORE-OM mental health norms of students attending university counselling services benchmarked against an age-matched primary care sample

Whilst concern has been expressed at the increasing severity of the mental health of students, there has been very little research on this growing population outside of small, single institution studies. The aims of this paper are to provide CORE Outcome Measure (CORE-OM) norms for the psychological health of students across multiple sites receiving university counselling, and benchmark these against an age-matched sample of people receiving treatment in NHS primary care settings. Results indicate that students using university counselling services show severity levels only marginally lower than young people presenting in primary care, with the differences being at a functional/relationship rather than a symptomatic level and with levels of risk to self being similar. This suggests that university counselling services deliver a service to people who closely resemble NHS primary care clients in terms of severity and risk to self.     

The complexities of undertaking counselling evaluation in the workplace

There is a long-standing debate over whether evaluation is an art or a science (Barker et al.: Research Methods in Clinical and Counselling Psychology, Chichester, John Wiley?&?Sons, 1994). The “science” camp argues for scientific rigour in methodology, whilst the “art” camp maintains that evaluation should be tailored to the specific circumstances under evaluation. The compromise proposed by Barker, Pistrang,?&?Elliot (1994 Barker, C, Pistrang, N and Elliot, R. 1994. Research methods in clinical and counselling psychology, Chichester: John Wiley?&?Sons.  [Google Scholar]) suggests that evaluation should be as systematic as possible within the practical and organizational constraints inherent in service settings. The aim of this paper is to present a review of the literature on evaluation and workplace counselling. The paper initially reviews the literature in the counselling/psychotherapy field, and then explores studies on employee assistance programmes. The themes that are explored are the relationship between research and practices; the interactions with stakeholders in the field; the use of control groups and the economic side of counselling.     

Babbling development as seen in canonical babbling ratios: A naturalistic evaluation of all-day recordings

Canonical babbling (CB) is critical in forming foundations for speech. Research has shown that the emergence of CB precedes first words, predicts language outcomes, and is delayed in infants with several communicative disorders. We seek a naturalistic portrayal of CB development, using all-day home recordings to evaluate the influences of age, language, and social circumstances on infant CB production. Thus we address the nature of very early language foundations and how they can be modulated. This is the first study to evaluate possible interactions of language and social circumstance in the development of babbling. We examined the effects of age (6 and 11 months), language/culture (English and Chinese), and social circumstances (during infant-directed speech [IDS], during infant overhearing of adult-directed speech [ADS], or when infants were alone) on canonical babbling ratios (CBR = canonical syllables/total syllables). The results showed a three-way interaction of infant age by infant language/culture by social circumstance. The complexity of the results forces us to recognize that a variety of factors can interact in the development of foundations for language, and that both the infant vocal response to the language/culture environment and the language/culture environment of the infant may change across age.     

A call for a pluralist epistemological understanding in the assessment and evaluation of counselling

The authors outline and posit the futility of the 'paradigm war' between reductionistic/positivistic and phenomenological/naturalistic philosophies within counselling evaluation, pointing out that the notion of such competition is itself based on positivist thinking. They trace attempts at creating a 'truce' in the war based on strict demarcation of territory. They conclude that in the longer term more might be gained by accepting the veracity of both philosophies and creating a pluralist model which will be more fully equipped to evaluate the human process of counselling.