Counselling - an Introduction

There are a number of different forms of counselling, some of which are used in specific circumstances. In all forms of counselling the relationship between counsellor and client is of great importance. In primary care, some patients with minor psychiatric disorders may be treated by practice counsellors.

Although the term counselling implies the giving of advice and guidance, in the past much of the counselling available used a client centred non-directive approach. In this approach the counsellor is passive and tends to rephrase and reflect what the client says. The effectiveness of counselling in primary care has been disputed but from existing evidence:

• In the primary care setting, non-directive counselling and cognitive-behaviour therapy have both been shown to be significantly more effective clinically than usual GP care in the short term.
• But there were no differences between these three treatments in either clinical outcomes or costs at 12-month follow-up.
• Compared with usual GP care, no differences in overall costs were observed. The additional costs associated with providing practice-based counselling were recouped due to savings in visits to primary care, psychotropic medication and other specialist mental health treatments.^1,2,3

• This is a structured and systematic approach to resolving problems that are linked to stressful circumstances.
• It is particularly suitable for patients whose life problems are adversely affecting or maintaining a disorder.
• It involves the patient identifying and listing problems and then considering what practical ways exist to solve or alleviate the problem. These solutions are tried and then reviewed.
• This method has been shown to be useful in treating mild mood disorders.

• This is similar to problem solving approaches but the focus is on the current state of interpersonal relationships in the home, work and elsewhere.
• Problems in relationships can be viewed under the headings of loss, interpersonal disputes, role transitions and interpersonal deficits.
• A problem solving approach is adopted to encourage the patient to try out alternative ways of coping.
• This has been effectively used for patients with minor mood disorders.

• In this technique there is more emphasis on past experience and unconscious processes as the mainspring of current behaviour.
• The patient's emotional reactions to the counsellor and situation are an indicator of the nature of problems in other relationships.
• This approach has not been as thoroughly evaluated as those above.

Counselling has been used in the following situations:

• Counselling to relieve acute distress
  • In this situation there is emphasis on emotional release and ways of coping with the immediate problem.
  • Where the method is non-directive, unstructured and involves the recall of distressing events it may be inappropriate for those surviving traumatic experience and may lead to worse outcomes than where the patient receives no counselling.
  • Cognitive methods may be of some help but timing is important.
• Counselling for late effects of trauma
  • As above, it is inappropriate to use non-directive and unstructured approaches since they may result in recreating the emotionality of the experience without offering ways to deal with it.
  • Cognitive and psychodynamic approaches may be more useful.
• Counselling for relationship problems
  • It may be helpful for a counsellor to encourage couples to talk constructively about their relationship so that they come to appreciate their thoughts and feelings for each other.
• Risk counselling
  • It may be helpful for those who may be facing the risk of developing a hereditary disease or acquiring a sexually transmitted disease to discuss with a counsellor the nature of the risks and the possible responses to the various outcomes.
• Grief counselling
  • Counselling in this situation focuses on giving information about the normal stages of grieving, working through the normal stages of grief and giving advice on coping without the deceased.