BackgroundCognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned.MethodA secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session.ResultsCounselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3–10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4–12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT.ConclusionsOutcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1370-7) contains supplementary material, which is available to authorized users.

Background There is a growing body of data to show that participation in school‐based counselling is associated with significant reductions in psychological distress. However, this cannot be taken as evidence that school‐based counselling is effective, as improvements may have happened without the intervention. Aims The purpose of this study was to develop a method of estimating the amount of ‘natural’ change that might be expected in young people who would attend school‐based counselling, such that the effects of the intervention over and above this amount could be identified. Method Young Person's CORE (YP‐CORE) scores from 74 participants allocated to waiting list control conditions in four pilot trials of school‐based counselling in the UK were re‐analysed using regression models, and a formula was found for estimating the outcomes for young people were they not to receive counselling. This was termed their Estimated Non‐intervention Outcome (ENO), and could then be compared against the young person's Actual Outcome (AO), to give an estimated intervention effect (EIE). Results The formula for the ENO was 4.17 + 0.64 × baseline score. Using this, we calculated a mean EIE for 256 young people in a cohort evaluation study of school‐based counselling, which showed that the counselling was associated with large and significantly greater change than would be expected without the intervention (Cohen's d = 0.91). Discussion The method presented in this paper is a simple means for improving the accuracy of estimations of treatment effectiveness, helping to adjust for changes due to spontaneous recovery and other non‐treatment effects.

Background Women's centres are community‐based third sector organisations providing gender‐specific services to vulnerable females, including offenders and those at risk of offending. Mental health is a particular need within this population; however, there is limited knowledge of the type(s) and availability of mental health interventions within women's centres. Aims To explore the provision of mental health interventions within women's centres, providing an overview of services and the extent to which they evaluate interventions offered. Method A 32‐item online survey was developed, and 48 services across England and Wales were invited to participate. Data collected were exported from the survey host website and analysed descriptively. Results Thirty‐four services took part in the survey. Over two‐thirds provided psychological interventions, with counselling being the most frequently offered type of therapy. Clients presented to services with a range of issues, including mental health problems, personality disorder and self‐harm. Thirteen services undertook evaluations of interventions; data gathered were used for a variety of purposes, including improving interventions and justifying service provision. Conclusions This exploratory study provides information about current mental health provision in women's centres and the range of needs experienced by clients. We need to increase our knowledge and understanding of provision within these services, develop a standardised approach to client data collection and management, and create a robust package of valid and reliable outcome measures for use across services. This will augment routine evaluation of the effectiveness and cost‐effectiveness of these services in meeting the health, well‐being and offending needs of female clients.