Many patients in primary care suffer from mental health and psychosocial problems. These problems often involve feelings of sadness, nerves or stress. Many of these problems may be due to personal and social problems or reactions to life events such as physical illness or unemployment.
‘Counselling’ is a recognised psychological therapy that is often provided to such patients. In the United Kingdom, counsellors have often been employed to deliver psychological therapy to patients in primary care settings. Providing counselling alongside other treatments such as cognitive behaviour therapy means that patients have greater choice, and that alternatives can be found for patients who either do not benefit from standard treatments or who do not find them acceptable.
However, recent clinical guidelines in the United Kingdom have highlighted the lack of evidence for counselling compared to other treatments such as cognitive behaviour therapy, and have not been able to clearly recommend the use of counselling in primary care.
In this review we found nine studies involving counselling in primary care for 1384 participants. There were some problems with the methods in some studies. The evidence suggested that counselling is better than usual general practitioner care in improving mental health outcomes in the short term, although the advantages are modest. People who receive counselling in primary care from a trained counsellor are more likely to feel better immediately after treatment and be more satisfied than those who receive care from their general practitioner. However, in the long term, counselling does not seem to be any better than GP care. Although some types of healthcare utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. There is very limited evidence comparing counselling with other psychological therapies (2 studies with 272 participants) or with antidepressant medication (1 study with 83 participants).