There is evidence that the use of non-directive counselling techniques leads to more accurate diagnosis and therefore to more appropriate management and an improved outcome. 6 Jerome Frank wrote in 1967: 'The field of counselling and psychotherapy has for years presented the puzzling spectacle of unabating enthusiasm for forms of treatment where effectiveness could not be objectively demonstrated'. 7 Traux and Carkhuff 8 measured important aspects of the psychotherapeutic relationship and demonstrated what had long been recognised: the outcome was enhanced if practitioners had such qualities as accurate and sensitive awareness of the patient's feelings, deep concern for the patient's welfare (without attempting to dominate) and openness about their own reactions.
The essential feature of the patient-centred approach is that the counsellor is more like a facilitator; that is, by the asking of well-directed questions it is hoped that patients can realise their own solutions for their problems. 1 This encourages patients to attain understanding and personal growth themselves rather than just put their personal affairs in the hands of someone else. This does not mean to say that the facilitator is passive in the process of assessing the relative merit of various solutions produced by the patient. The doctor-centred approach is most applicable for patients who are so confused or distraught that their ability to reflect usefully is temporarily or permanently inaccessible. Here, taking a more active and authoritarian role may be just what is required. It is therefore important to be flexible and move between the two ends of the spectrum as needed.
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