Conclusions

Counselling is an activity that takes place within a wide range of settings. This review of research into the effectiveness of counselling has not attempted to encompass all of these areas but has instead focused on the evidence provided by key research studies into counselling in primary care, student counselling, and workplace counselling. There are some general conclusions that can be drawn from this body of research. There is evidence that counselling can claim levels of effectiveness that are broadly equivalent to those associated with other, more intensively researched mental health interventions such as CBT, psychotherapy and drug treatment. Counselling appears to have a particularly significant short-term impact, with long-term benefits in situations such as student counselling, where an individual may have good personal resources but need assistance in overcoming a specific crisis or difficulty. Counselling is well received by clients, who actively choose it as a form of help and are overwhelmingly satisfied with the service they receive. The majority of people who enter counselling report levels of distress and psychological disability that are similar to those found in psychiatric patients. Counselling seems to be able to make a difference to clients within six to 10 sessions. The contextual nature of counselling is reflected in research that demonstrates benefits in relation to organisational and systemic outcomes such as use of health resources, sickness absence, and student retention.

This largely positive picture of the effectiveness of counselling needs to be balanced against the methodological limitations of the research that has been carried out. Essentially, randomised controlled trials tend to create a research framework that diminishes the distinctive features of counselling whereas naturalistic studies tend to result in substantial levels of participant attrition, leading to difficulties in the interpretation of findings. It is essential for researchers within this field to develop pluralist methodologies that combine high standards of causal inference alongside greater sensitivity to the shape of routine practice.

What are the implications of research for anyone seeking to establish a counselling service within a community, organisational or health-care setting? There are three main recommendations that can be made. First, anyone setting up a counselling service can be reasonably confident that it will be well received by users, will be cost neutral and that between 50 % and 70 % of clients will report that counselling has had a significant impact on their presenting problems. Second, it is important that the design of the service takes into account the context within which counselling will take place. Ideally, counsellors should have personal experience of the organisational culture of the setting within which counselling is offered, or specific training in relation to the client group, so that they possess an informed awareness of the 'fit' between clients and their social context. Third, it should be recognised that effective counselling is not a matter of competence in delivering a standard intervention package but instead relies on building relationships within which clients can say whatever they need to say and explore different ways of approaching problems. In this respect, counselling practice reflects, in a basic way, the substantial body of research that demonstrates that client outcomes are influenced to a much greater extent by relationship factors than they are by therapeutic approach or mastery of technique (Norcross, 2002).

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