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.

Clients' experience of therapy and its outcomes in ‘good’ and ‘poor’ outcome psychological therapy in a primary care setting: An exploratory study

“…We chose a primary care setting for soliciting participants because it is quite representative of the diversity of issues for which counselling is considered a good option of support. Furthermore, while it is recognised that counselling in primary care settings is worth studying, and the number of studies in this area are growing, the studies primarily focus on the effectiveness of therapy measured by outcomes measured by quantitative means (Brettle, Hill, & Jenkins, 2008) without accounting for the extent to which this corresponds with the clients’ experience in their own words.…”

Evidence for the Management of Adolescent Depression

“…70 No meta-analyses of brief counseling treatments exist for adolescent populations, but meta-analyses of adult studies indicate that brief counseling interventions, including 6 to 8 sessions of cognitive behavior therapy (CBT) and problem-solving therapy, and 3 to 7 sessions of nonspecific psychotherapy in primary care are effective depression treatments. [71][72][73] There is no definitive brief counseling protocol for youth, although problem solving and psychoeducation have been identified as key components. 74,75 No meta-analyses of problem-solving interventions with youth were identified, but such work in adults indicates problem-solving interventions led to greater decreases in depression and hopelessness scores compared with controls 76 and had equivalent or stronger effects than other therapies.…”

“…• Guideline 34,35,[47][48][49][50] • Meta-analysis/systematic review [71][72][73][76][77][78]83,84 • RCT 70,75,[79][80][81][82][85][86][87] • Quasi/nonexperimental 74 QI 5: Treatment initiation (antidepressant medication or psychotherapy).…”

Evidence Based Practice: An Opportunity?

“…One of the problems is that there are few descriptions of librarians engaging in different roles within the literature. I am guilty of this myself, having engaged in systematic reviews outside the library (e.g., Brettle, Hill, & Jenkins, 2008;Dugdill, Brettle, Hulme, McCluskey, & Long, 2008), I did not describe my role, which in both cases involved leading the systematic review itself as well as critically appraising the health literature; pretty active and outside the comfort zone of health libraries! For me, engaging in evidence based activities inside library and information practice gave me the confidence and skills to branch outside my familiar domain, and then on to new roles and opportunities.…”