Counselling in primary care: a systematic review of the evidence

Abstract

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care.

Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services.

Keywords:

• counselling
• primary care
• systematic review

Acknowledgements

This report was produced as a result of collaboration between two research centres at the University of Salford, Institute of Health and Social Care Research: Salford Centre for Social Work Research and Salford Centre for Nursing, Midwifery and Collaborative Research. The authors would like to thank colleagues in these research centres for their assistance with this study.

We would especially like to thank Claire Hulme for her contribution to the economic issues section of the project report, Paula Ormandy and Janelle Yorke who reviewed articles for inclusion in the review, and Matthew Newton who provided clerical support. Many thanks, too, to Peter Bower of the University of Manchester, BACP for funding the project and the BACP research team for their support and guidance.