Press Release

Counselling works!

A new study to be summarised in the BMJ on 2 December shows that the most effective help for the treatment of depression lasting less than a year is counselling.

This is true whether you opt for the 'friendly-supportive' Counselling of the traditional variety or consult a behavioural psychologist who uses 'Cognitive Therapy'.

It is more effective over four months than is consulting your GP and obtaining anti-depressants.

While long-term drug treatment is also effective, counselling helped patients more quickly and was of most benefit to those whose depressions were of less than six months' duration.

It overturns the popular misconception among a minority of doctors that counselling is ineffective.

It gives backup to the majority of doctors who offer counselling as part of their practice. Between 1992-1998, the percentage of GP surgeries offering counselling rose from 31-51% ("Counselling in Primary Care in the Context of the NHS Quality Agenda", a BACP Report, October 2000, available for £8 p&p included from BACP, 1 Regent Place, Rugby CV21 2PJ).

It chimes with the fact that problems of a psychosocial nature now comprise the second largest presenting symptom-cluster in primary care (BACP Report, above). * Technically, this new study by Dr M King of The Royal Free Hospital and University College London and colleagues is "a randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care".

In plainer English this means it is of the highest quality of research that you can get.

This report proves what we always knew but have never been able to demonstrate that - counselling works for ordinary people - and it's affordable by the NHS.

It blows out of the water populist critics who suggest that counselling may sometimes be "counter-productive"

It chimes with what we know about patient preference - a 1996 MORI poll showed that 86% of patients would rather see a counsellor than take tranquillisers or anti-depressants.

It also chimes with the fact that counselling has far less stigma attached to it than psychiatric assessment or becoming pill-dependent.

It demonstrates that well-organised, targeted and appropriate counselling interventions are an effective use of resources, both clinically and in cash terms.

It will persuade more doctors that counselling for depression is now the treatment of choice.

In summary, this report enables GPs to feel confident that sending a patient to a counsellor is an effective treatment model - it works, it's cost-effective and the patients prefer it.

Further information from Phillip Hodson 020 7794 2838

Technical information

This is perhaps the most rigorous study of counselling yet completed. Certainly, it is the most rigorous study of short term (12 weeks) counselling in primary care. It focussed specifically on those suffering depression or depression with anxiety. It compared non-directive counselling (person-centred therapy - PCT) and cognitive-behavioural therapy (CBT - in this instance provided by clinical psychologists) with routine GP care.

The findings indicate that both forms of counselling are equal to routine GP care in the long term in terms of benefits to patients and in terms of cost.

In the short term (4 months) both CBT and PCT are significantly more effective than routine GP care - i.e. counselling helps people more quickly than routine GP care.

The additional costs of providing counselling were offset by patients going to see their GP less often (i.e. reduced GP consultation rates) and needing fewer drugs (i.e. reduced psychotropic medication). The costs per session were £24 for PCT and £42 for CBT provided in this way by clinical psychologists.

As the study notes, the factors that should determine choice of treatment for depression and for depression with anxiety include:

1. Patient preference
2. Physician/practitioner preference
3. Availability of services In the light of this it is significant that PCT received substantially higher patient satisfaction than either routine GP care or CBT in this study. Also a recent Mori poll indicated >80% of people would prefer counselling to drug treatments for depression Furthermore, counselling may be more acceptable because it bears less stigma than other interventions. Counsellors in primary care are also typically more accessible than clinical psychology services because of shorter waiting lists.

Encouraging though this study is counselling, it is probably an under estimation of the advantages of both types of counselling because some of the patients who were supposed to be receiving only routine GP care were referred to some kind of psychological therapy.

The study is has its faults. It included 464 clients which may not have been enough to distinguish the cost factors precisely. Furthermore, the study itself cost nearly £500,000. At >£1000 per client it exemplifies how expensive this type of research can be. BACP and others (e.g. the Scottish Office Dept of Health) considers it important that this type of randomised controlled trial be supplemented with other forms of more naturalistic evidence.

Where more naturalistic methods have been used the effect of counselling has been found to be 4 or even 5 times higher than that reported in most randomised controlled studies.

Further research information from Stephen Goss 01506 511565