Therapy the doctor ordered

Nearly a third of GP practices offer patients counselling, but how effective is it?

COUNSELLING services at local doctors' surgeries may not be so good for patients' health, according to the author of a study on their effectiveness.

Ed Godber, a research fellow at Southampton University, has called for an urgent investigation into GP counselling services after examining the data.

His research for the Institute of Health Policy Studies at Southampton University was based on a national survey which found that 31 per cent of GP practices employed a counsellor and 62 per cent of the remainder said they would like to.

But Mr Godber warns that there is a dearth of evidence supporting either the cost-effectiveness or the patient benefits of practice-based counselling.

He is calling for more consistency in employment, training and supervision of counsellors and clear guidelines on their skills, accreditation and experience.

"Counselling is sometimes seen as a soft option that can't do any harm, but it can. People can give up other support like family and friends for the counsellor, and when counselling is withdrawn, they can be left in a bad state," he said. "My instinct is that it is a valuable service for many - there is a general feeling among GPs and patients that it is a very good thing - but we need to find out just how helpful it really is."

Drawbacks include the lack of a national accreditation system for counsellors and widespread uncertainty among GPs over what skills a practice counsellor should possess.

In one survey cited in his review, 20 per cent of GPs said they did not know what qualification their counsellor held. There is also some confusion among GPs over whether psychotherapy is the same as counselling.

"They often don't know the level of training of people practising the different techniques and a lot of counsellors are not supervised," said Mr Godber. "I have come across counsellors who only offer 30-minute sessions when the standard time is 50 minutes, so they cannot be offering that effective a service."

The situation is exacerbated by a scarcity of data on the effectiveness of different counselling techniques.

"Some counsellors lean toward psychotherapy, where you try to find solutions to something that happened in a person's past, while other clinics run the sort of counselling that promotes self-acceptance among its clients and where the counsellor has a role more as a listener. We don't know which method is more successful."

Most worryingly, counselling services in GP practices are open to abuse by overstretched doctors who may be tempted to "shove a patient the wrong way".

"This is a major snag," he said. "Some clinics have a huge range of case mixtures and counsellors get cases that really need psychiatric help. Some GPs push off their workload (on to the counsellor) because they don't like a particular patient."

One of the bonuses of a practice-based counselling service is that patients are rarely left waiting more than six weeks to see a therapist, which is a clear advantage over the traditional lengthy referral system to outside psychiatric services.

But Mr Godber fears there will be a tendency for help to be restricted to patients with short-term, life-transition problems.

"If there is a waiting list to see the practice counsellor, the pressure will be on to see people who don't need the service that badly and only require one or two sessions," said Mr Godber.