Nancy Rowland

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.

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

Abstract 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 relation...

Psychotherapy professionals in the UK: Expansion and experiment

The workforce providing psychological therapies in the UK has traditionally been divided according to where they work, sharp boundaries between professional associations and adherents of different treatment models, and allegiances to other professions. There are signs of a more unified (and larger) psychotherapy profession emerging as a result of government initiatives that, directly or indirectly, have the potential to reduce each of these divisions. The paper summarises recent initiatives in service delivery, training standards, evidence-based practice and professional regulation that are working to reshape the workforce responsible for providing psychological therapies in the UK, especially within publicly funded services.

School counselling in Wales: Recommendations for good practice

Aims: This paper presents the context, methodologies and findings of a research project commissioned by the Welsh Assembly Government to evaluate school counselling and services available to children and young people in the UK and to make recommendations for future service development in Wales. Method: The study adopted three research methods: desk research (a literature review), a quantitative survey, and qualitative fieldwork. The survey included a sample of primary and secondary schools in Wales, as well as local authorities. Fieldwork included interviews with teachers, counsellors, parents, and children. Findings: Evidence-based recommendations for counselling service provision in schools in Wales were developed, which now inform the Welsh Assembly Governments (WAG) National Strategy for counselling in schools in Wales (2008).