The evidence remains weak for the long-term effectiveness of counselling in primary care


General practices in the UK sometimes offer counselling to people with mental health or psychosocial problems. This is an alternative to standard GP care or the conventional treatments such as cognitive behaviour therapy or antidepressants.

However, recent guidelines have not been able to recommend the use of counselling because the evidence-base remains weak in comparison to other therapies.

This new systematic review from the Cochrane Depression, Anxiety and Neurosis Group set out to assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care.

The reviewers conducted the usual comprehensive literature search, looking for randomised controlled trials of counselling for mental health and psychosocial problems in primary care. They retrieved 9 trials involving a total of 1,384 participants.

Here’s what they found:

  • Counselling had significantly greater mental health outcomes when compared with usual care in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials)
  • Counselling was no better then usual care in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials)
  • Counselling was no better then usual care in terms of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials)
  • Levels of satisfaction with counselling were high
  • There was some evidence that the overall costs of counselling and usual care were similar
  • There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions.

The reviewers concluded:

Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.

Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD001025. DOI: 10.1002/14651858.CD001025.pub3.

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