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.     

The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

Beliefs About Psychological Services (BAPS): development and psychometric properties

A scale to measure attitudes towards seeking psychological help was developed (Beliefs About Psychological Services [BAPS]) and evaluated. This scale was based on items gathered from students, colleagues, and the authors when asked about common positive and negative attitudes toward psychologists and their services. Items were also based on the Fischer and Turner (1970 Fischer, EH and Turner, JLeB. 1970. Orientations to seeking professional help: Development and research utility of an attitude scale. Journal of Consulting and Clinical Psychology, 35: 79–90. [Crossref], [PubMed], [Web of Science ®] [Google Scholar]) Attitudes Toward Seeking Professional Psychological Services (ATSPPH) measure. Three studies are reported describing the construction and evaluation of the psychometric properties of the BAPS. The BAPS is an 18-item measure consisting of three subscales: Intent, Stigma Tolerance, and Expertness. Support was found for the reliability and validity of the measure.     

A qualitative exploration into how the use of prayer in counselling and psychotherapy might be ethically problematic

Aim: This research article contributes to the debate on the value and limitation of the use of spiritual strategies, like prayer, in counselling (Foskett & Lynch, 2001) by disseminating the insights that were gained from a qualitative study of mainstream counsellors whose work includes prayer. Method: Participants were 19 British Association for Counselling and Psychotherapy (BACP)‐accredited and Churches Ministerial Counselling Service (CMCS)‐approved counsellors who use prayer in their practice. They were interviewed, and the data were analysed using Interpretative Phenomenological Analysis. Results: The data reveal that counsellors who use prayer are aware that ethical problems may be encountered: if prayer changes the way that the counsellor is perceived; when using prayer with issues of psychopathology; if the counsellor uses prayer to impose faith on a client; when being professionally held to account; if prayer is used for avoidance or as a defence; if prayer is used to enhance the counsellor's power; if prayer is not part of the client's agenda; if prayer is used routinely; if prayer cannot be challenged; if there is a cultural pressure to pray; and if the prayer method is not matched to the client – but that their concern over potential ethical issues is not of sufficient strength to override their therapeutic use of prayer if facilitated with due care.     

The long‐term effects of counselling: The process and mechanisms that contribute to ongoing change from a user perspective

Aims: This qualitative study aimed to expand the limited evidence base about the long‐term effects of psychological therapies.Method: We conducted in‐depth interviews with 15 people, 1–3 years after primary care counselling, to investigate whether they could identify enduring benefits and the mechanisms that brought about and maintained them. From their narratives, we developed a model of the change process of counselling and mechanisms that were perceived as essential to produce lasting benefit. The model conceptualised movement through distinct phases: engagement; exploration of internal and external worlds; consolidation and negotiated ending. Results: Mechanisms integral to sustained impact were: the active engagement of people during and between sessions to work toward their own solutions; and acquisition through the change process of skills which could be further built on after the counselling ended. These enabled ongoing, dynamic change in the way people conducted their lives and relationships. Conclusion: A key concept in securing long‐term benefit was co‐production, both during counselling and in taking ownership of and using the ‘box of skills’ acquired. Support of the model was reinforced through comparison with the experience of three interviewees who reported no long‐term benefit.     

An evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in‐depth evaluation process with a greater number of health‐related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within‐group comparisons to assess any improvements in scores at six‐month follow‐up from baseline. Fifty‐six participants completed wide‐ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well‐being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow‐up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.     

Discourse analysis: Rich pickings for counsellors and therapists

Aim: It is only relatively recently that discourse analysis has begun to rise to prominence in the fields of counselling and psychotherapy. This paper briefly explains ways of understanding discourse analysis, discussing what the approach can offer counselling research and practice. Approach: An initial categorisation of recent discourse analysis studies is offered, to demonstrate diverse ways in which this type of research can address issues relevant to counselling practice. The five categories proposed range from the examination of language use in therapy to analyses that focus on the social structures, meanings and power relations related to therapy. Implications: The paper demonstrates that through the critical analysis of counselling sessions, research interviews, written texts and other materials, discourse analysis can provide insight into ways in which counselling operates as a social practice, and so help counsellors to contextualise their work within broader social structures and processes.     

Working with differences: Issues for research and counselling practice

This paper considers our experience within a group researching domestic violence in minoritised groups and the implications for counselling practice. Issues of race, gender and power were significant within the research team. These issues are intrinsic to minoritised women's experiences of service responses and are also a powerful, yet often unexplored, dynamic in counselling practice. We reflect on issues of ‘outsiders’ and ‘insiders’ in terms of the research process and findings, and the impact and influence of these power roles on counselling practice. We acknowledge that it is only by retrospectively engaging with each other and our differences that we have been able to explore our parallel processes and consider their implications for counselling practice.     

Exploring the relationship between secondary traumatic stress,professional identity and career factors for counsellors

This study used a correlational research design to explore the relationship between secondary traumatic stress, counsellor professional identity and career factors, including work setting and amount of counselling experience, among counsellor practitioners. A sample of 1,218 counsellors completed an online survey including the Secondary Traumatic Stress Scale (STSS), Professional Identity Scale in Counseling and career factors. Career factors included context of work environments including years of experience, licence status, type of practice and work setting. Multiple regression analysis with forward selection demonstrated that, out of all the variables, professional identity emerged as the best predictor of secondary traumatic stress. One-way ANOVA showed significant group differences in the level of counsellors' secondary traumatic stress based on work setting, level of experience, type of practice and gender. Discussion explores how career and personal factors impact counsellor experiences of professional identity and secondary trauma in mental health settings.