Patients unlikely to benefit

The following groups of patients are not likely to benefit from counselling therapy 1 (i.e. relative contraindications):

• psychotic patients

• patients who have had an unrewarding experience with psychiatrists and other psychotherapists

• people who are antagonistic to the notion of a psychosocial diagnosis, subsequently found to be organic

• patients with little awareness or language to express emotional difficulty

• patients who do not believe doctors can treat psychosocial problems

• patients who are dependent on contact with the doctor and are willing to do almost anything to maintain the relationship

• patients with a vested interest in remaining unwell who are therefore resistant to change, e.g. patients with work-related disabilities awaiting legal settlement

• patients with chronic psychosomatic tendencies who are willing to do almost anything to maintain the relationship

• those in an intractable life situation who are unable or unwilling to change

• patients who are unwilling to examine and work on painful or uncomfortable areas of their life

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