Counselling — Why not? A qualitative study of people's accounts of not taking up counselling appointments

The aim of this research was to explore the reasons behind people's decision not to take up a counselling referral. A qualitative study was carried out, using semi-structured interviews and written responses. The investigation was based in NHS primary care counselling services in a GP practice in the North of England. People who had been referred for counselling by their GP, but did not attend any counselling appointments, were interviewed or invited to submit written comments. Many people talked about the courage it took to ask for help. The referral itself was sometimes therapeutic as it legitimised their distress. The GP's response affected people's decisions. Waiting time and what happened during waiting was important. Some people had their own resources, which they used actively, seeking other sources of help; others were more passive, their lives changed around them. Other factors that contributed to non-engagement were being referred in a crisis; lack of knowledge about counselling and mental distress; and concern about stigma and its impact on work. Perceived waiting time was the most significant factor for participants in this study, but most people had a combination of reasons for not engaging. Support from the GP, information about the service and being given a realistic expectation of waiting times, may help people feel better able to access counselling services.

Key words:

• counselling
• non-attendance
• primary care
• referral
• waiting time