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.     

Analysis of An Intervention to Reduce or Prevent Secondary Conditions for People with Spinal Cord Injuries

People with acute spinal cord injuries (SCI) are at risk for developing secondary conditions such as pressure sores, urinary tract infections, pain, weight gain and deconditioning, and depression. This study analyzed the effectiveness of an Internet assessment and feedback tool in determining secondary condition risk for this population based on individual responses to a knowledge and behavioral questionnaire. Seventy-one people with newly-diagnosed SCI who were treated at one of five Model Spinal Cord Injury Systems Centers were randomly assigned to either an experimental condition in which they received computerized feedback and one-on-one consultations based on their online questionnaire answers, or to a control condition in which they received no feedback until the study's completion. One year after the initial assessment, the online questionnaire was re-administered to all participants as a post-test. Three times between the pre- and post-test assessments researchers telephoned participants to administer phone surveys probing secondary condition development. Results indicate there were significant differences among race groups and between complete and incomplete injury status for pressure sore occurrence. This study represents a new era of interactive technology in health promotion that can serve as a basis for future research to decrease secondary condition risk for people with SCI.     

What You Know When You Know an Answer to a Question

A significant argument for the claim that knowing‐wh is knowing‐that, implicit in much of the literature, including Stanley and Williamson (2001), is spelt out and challenged. The argument includes the assumption that a subject's state of knowing‐wh is constituted by their involvement in a relation with an answer to a question. And it involves the assumption that answers to questions are propositions or facts. One of Lawrence Powers’ counterexamples to the conjunction of these two assumptions is developed, responses to it are rebutted, and the possibility of rejecting the second rather than the first of these assumptions is explored briefly.     

Getting Closer to the Action: Using the Virtual Enactment Method to Understand Burglary

In this article we describe a new method, the Virtual Enactment Method (VEM), to enhance offender recall and motivation to disclose information by having burglars reflect on their experience while committing a crime in a simulated virtual environment. Participants, a sample of 61 incarcerated burglars, ‘thought aloud’ whilst undertaking a virtual burglary. Following the ‘virtual’ burglary, emerging themes were expanded upon in an interview. We show that the simulated environment effectively reinstates the criminogenic event, increases engagement, enhances recall, and encourages participants to talk more openly about their experiences, skills and knowledge.