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 relationships. Conclusion: A key concept in securing long-term benefit was co-production, both during counselling and in taking ownership of and using the ‘box of skills’ acquired. Support of the model was reinforced through comparison with the experience of three interviewees who reported no long-term benefit.

Keywords:

• Change
• counselling
• outcome
• long-term
• primary care
• user perspective

Acknowledgements

Thanks go to Cath Snape, Rachel Nutt, Lesley Jones and Krys Shelmerdine, also to the interviewees who gave their time so generously. The study was initially funded by a grant from The Yorkshire Primary Care Research Network (YReN) then by seed-corn funding from the British Association for Counselling and Psychotherapy (BACP).