Some problems cannot be resolved by just “getting it all out of your system”, reports Nigel Hawkes.

COUNSELLING, the 1990s remedy for life’s problems, is ineffective when used on its own to help those at risk of depression or other mental illness.

The conclusion, reached by the NHS Centre for Reviews and Dissemination at the University of York, will come as unwelcome news to the growing army of counsellors, now believed to run into tens of thousands.

No disaster is complete until those involved have been offered counselling, a technique which involves sharing worries by talking them through. The bereaved, the unemployed, the divorced and children from disadvantaged backgrounds are all considered to be at high risk of suffering long-term damage unless it can be averted by counselling.

But the study by the York centre concludes that “counselling by itself has not been shown to produce sustained benefit in a variety of groups at risk”. Among women who have had a miscarriage, for example, none of the three trials into the effectiveness of counselling showed a sustained effect.

The same was true of bereavement counselling. The report says it showed no effect on quality of life, satisfaction or frustration levels in people close to deceased cancer patients, and no difference in depression among spouses of people who had committed suicide.

“There has been a rapid growth in the employment of counsellors, particularly within primary care”, the report concludes. “However, there is little evidence that generic counselling, provided by itself, is particularly effective. More attention needs to be given to the content and effectiveness of specific forms of counselling and the skills of counsellors before this approach is extended too widely.”

The York centre was set up with government money to provide independent advice on different treatments. It does so by reviewing the literature, not by conducting its own research. In this case, it has reviewed all the available studies of the effectiveness of various forms of counselling in helping people with mental health problems.

Mary Turner-Boutle, editor of the bulletin in which the findings appeared, said yesterday: “There is a great shortage of research evidence in this field, but what there is fails to show that counselling in general is effective. But we did find that specific sorts of counselling, in particular cognitive behavioural therapy, can have good results.”

A spokesman for the British Association for Counselling said that she thought the conclusions were rather sweeping: “We have never claimed that counselling by itself is a panacea for everybody,” she said. “But we find that GPs are extremely satisfied by the effectiveness of counselling used in conjunction with other treatments, such as drugs for example.” The association’s directory of counsellors in private practice lists 2,500 names, up from 800 in 1988.

About 60 per cent of GP surgeries now employ counsellors, with two thirds of their salaries paid by the NHS. Nobody knows how many counsellors there are, but membership of the association is more than 15,000. Many counsellors have set themselves up with little or no qualifications, and competence varies widely.

“This is a terribly difficult area in which to conduct research,” the association spokesman said. “Often only the patients and the counsellor know what has gone on, and patients are usually reluctant to talk about it. Are they happier? Can they cope better?”

Ms Turner-Boutle says: “This is such a burgeoning field, with such a proliferation of counsellors, that it is important to try to measure how successful it is. We are not saying that counselling is useless, but that there is no evidence to demonstrate that it is effective.”

Reprinted from the Times, August 19 1997

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