I was at a course the other day and someone piped up from the back:

‘In an ideal world everyone needs a counsellor, that they can talk to every week about their problems’.

I expect that quite a lot of people would agree with this statement, but not me.

Different psychotherapies (‘talking therapies’) are easily confused and I’m not talking about directed therapies such as cognitive behavioural therapy, family therapy or behavioural therapy.  These therapies are aimed at specific psychiatric conditions, are goal directed and administered by trained practitioners.  

Counselling on the other hand is difficult to define, and tends to be performed by those with limited training and aimed at people without strictly classifiable mental health problems.  As such it seriously encroaches on normal experience and the implication of the statement above is that people going about their everyday life need professional help to deal with common problems of everyday living.   

There is little evidence that counselling helps, and some evidence that it actually makes people worse.  There is a danger that attending a counsellor for a problem will introduce the expectation of experiencing distress and in some way validate it.  Some people regard simply attending counselling as a mentally healthy thing, but is airing your problems suitable for everyone, and could it be that people attend counselling as a proxy for real action?  Counselling is popular and this is given as justification for it continuing to be available, but what people want and what’s in their best interests is not always the same thing. 

An argument could be made that the counsellor is taking the place of the parish priest in these godless times.  With many of my patients I feel that what they really need is some good friends, who can offer support, sympathy and real world feedback.  Friends are also a lot cheaper.

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5 Responses to “Counselling”

  1. TheShrink says:

    Counselling (as a specific therapy, Nondirective Counselling) has a woeful evidence base for outcomes. Indeed, after widespread us in General Practice, research found that the effect of Nondirective Counselling was nil, or not measurable. So it’s not a great cure, then.

    But like any intervention it’s not without it’s side effects.

    Messing with someone’s mind is serious business and as such talking therapies should be seen in the same light as SSRIs or ECT. There are risks and benefits, but therapy for one and all sounds like madness! 8)

  2. Tim A says:

    Posted in ‘Torture’? Surely shome mishtake?

  3. Nutty says:

    I’ve had a variety of talking therapies ranging from Jungian psychotherapy to CBT. The most effective therapy I ever had was ten sessions of counselling (I think basically Rogerian) with a student at the local rape crisis project. It did what it said on the tin. It helped me to deal with something that I needed to talk to someone about. You can’t discuss the details of everything with your family and friends.

  4. The article that you point to refers to critical incident stress debriefing. It was thought to help people who have witnessed or experienced a highly traumatic event to process what had happened to them and reduce post-traumatic stress. However, it doesn’t work and seems to produce worse outcomes. I suspect this is because it denormalises the perfectly natural distress someone experiences after a trauma, leads them to worry their distress is “not normal”, negatively appraise it as a sign that they’re not coming and increase the risk of more chronic post-traumatic stress leading to post-traumatic stress disorder (PTSD).

    However, it does not refer to non-directive, person-centred counselling such as is often offered to people with no diagnosable mental health difficulties. I have no experience of this kind of counselling either personally or professionally, and know it only as a control therapy within RCTs of directive psychological therapies (e.g. CBT for depression) where it seems to do better than no treatment but not as well as active therapy. PTSD is a bit of an exception here, is it does seem to present some difficulties in this population. I’d be interested if you know of any other research suggesting other negative effects.

  5. Apologies, I meant to say “a sign they’re not coping” not not coming. Oopsie!

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