How effective is workplace counselling? A review of the research literature

Abstract

The provision of counselling for work-related problems has expanded in recent years, as organisations have recognised the value of this approach to staff support. However, there has been relatively little research into the outcomes of workplace counselling, and no systematic reviews have been conducted into the effectiveness of counselling in this setting. This paper presents the results of a preliminary review of evidence in this area. 34 studies of the effectiveness of workplace counselling were identified, of which 16 were sufficiently well designed to be considered as comprising reliable findings. The results of these studies suggest that, in general, workplace counselling is effective for clients for a wide variety of type and severity of presenting problems, employed across a range of different organisational contexts. The paper includes discussion of methodological issues associated with this research, recommendations for further research, and implications for practice.

Full text

COUNSELLING AND PSYCHOTHERAPY RESEARCH, 2001, VOL 1, NO 3
184
Over the last twenty years, the provision of face-
to-face, confidential counselling for employees has
become one of the major ways in which both
public and private sector organisations have deliv-
ered staff support. A variety of models of work-
place counselling have evolved, ranging from
externally contracted Employee Assistance
Programmes (EAPs) provided by large commercial
firms able to offer not only therapeutic counselling
but also financial advice and telephone helplines,
to the in-house employment of staff counsellors
within occupational health or welfare depart-
ments. Workplace counselling has evolved into a
mature field of specialist counselling practice, with
its own professional bodies, training programmes,
books and journals. A comprehensive account of
the nature and development of workplace coun-
selling can be found in Carroll and Walton (1997)
and Oher (1999).
However, the expansion of workplace coun-
selling has not been matched by a parallel growth
in research into the effectiveness of this form of
intervention, or into the factors which contribute
to good or poor outcomes for clients. If research
knowledge is to inform practice in this area, it is
clearly necessary to arrive at a comprehensive
understanding of the state of current empirical
knowledge as a basis for planning further studies.
This paper seeks to contribute to this aim by pro-
viding a review of research into the effectiveness
of workplace counselling. The material presented
here is taken from a wider study, commissioned by
the British Association for Counselling and
Psychotherapy, into all areas of research into work-
place counselling (McLeod, 2001), including utili-
sation rates, attitudes to counselling provision, the
costs of counselling, referral networks, the process
of counselling, and the characteristics of counsel-
lors. The full report of the study incorporates sum-
maries of all 80 research investigations located
during this scoping exercise, and details may be
found towards the back of this issue of the journal.
Method
The review process was designed to achieve a
comprehensive and balanced appreciation of the
research that has been carried out in this field. A
number of procedures, outlined below, were
adopted to ensure that the review generated con-
clusions that were valid and reliable.
How effective is workplace counselling? A review of the
research literature
John McLeod and Julia McLeod
School of Social and Health Sciences, University of Abertay Dundee, 158 Marketgait, Dundee DD1 1NJ, Scotland.
E-mail: j.mcleod@tay.ac.uk
Counselling and Psychotherapy Research 1(3) (2001) 184-190
ISSN: 1473 3145
Published by the British Association for Counselling and Psychotherapy, 1 Regent Place, Rugby, CV21 2PJ, UK
The provision of counselling for work-related problems has expanded in recent years, as organisations
have recognised the value of this approach to staff support. However, there has been relatively little
research into the outcomes of workplace counselling, and no systematic reviews have been conducted
into the effectiveness of counselling in this setting. This paper presents the results of a preliminary review
of evidence in this area. 34 studies of the effectiveness of workplace counselling were identified, of
which 16 were sufficiently well designed to be considered as comprising reliable findings. The results
of these studies suggest that, in general, workplace counselling is effective for clients for a wide vari-
ety of type and severity of presenting problems, employed across a range of different organisational
contexts. The paper includes discussion of methodological issues associated with this research, recom-
mendations for further research, and implications for practice.
Key words: EAPs, outcome, workplace counselling

Inclusion/exclusion criteria
In compiling a review that addresses the issues
associated with the provision of counselling, as a
distinctive form of workplace stress/wellbeing
intervention, it is necessary to be as explicit as pos-
sible about what is to be considered as a study of
counselling. For the purpose of this review, coun-
selling was defined as:
(i)ii a form of intervention that is voluntarily chosen
by the client. For example, studies in which
employees are directed or required to partici-
pate in stress management groups are not con-
sidered as examples of counselling, even
though the intervention may be based on
counselling principles and theory;
(ii)ia form of help that is responsive to the individ-
ual needs of the client or group. Programmes
in which individuals or groups receive a pre-
determined schedule of exercises or classes
would be defined as educational or training
interventions, rather than counselling.
Counsellor responsiveness to the process and
needs of individual clients is viewed, through
this criterion, to be intrinsic to counselling;
(iii) an activity that is primarily intended to bring
about change in an area of psychological/
behavioural functioning (e.g. emotional, rela-
tionships, self-esteem, symptoms of depression
or anxiety, work functioning, substance
misuse, absence from work, etc.). Interventions
that are primarily focused on organisational
(e.g. team functioning) or physical health out-
comes (e.g. exercise, diet) have been excluded,
even though these interventions may have
important incidental effects on psychological
well-being.
Studies of the effectiveness of stress management,
critical incident debriefing intervention, meditation
and fitness/well-being are excluded by this defini-
tion. Studies of group counselling/psychotherapy
for work difficulties would have been included,
although in fact no such studies were located.
Interventions labelled as ‘psychotherapy’ were
included in the study, where they satisfied the cri-
teria listed above.
In order to compile a review that is in itself
accountable, and open to alternative and further
analyses of its constituent studies, only research
studies that have been published in publicly acces-
sible sources have been included. Internal organi-
sational reports which would not be made openly
available (e.g. for commercial reasons) have not
been included, since it is clear that such studies
could not satisfy criteria for external review.
The term workplace counselling has been inter-
preted to include any study in which the provision
of counselling/psychotherapy is linked to being an
employee, or to suffering from work-related psy-
chological problems. For example, studies of out-
patient psychotherapy in which work functioning
outcomes are measured have been considered to
be not sufficiently close to the world of work to be
included. The studies reviewed in this report there-
fore relate to counselling provided by in-house or
externally contracted counselling services, narrow
(substance misuse) or ‘broad-brush’ Employee
Assistance Programmes (EAPs) or special projects
in which therapy is made available for people with
work stress difficulties (for example, within a uni-
versity research clinic).
Search procedures
The literature search has encompassed as wide a
variety of materials as possible: published articles,
books and chapters and also unpublished or semi-
published items such as reports and dissertations.
The search considered articles from a range of dis-
ciplines: counselling, psychotherapy, psychology,
sociology, management studies and occupational
health. Search strategies included the use of online
databases, handsearching relevant journals, writ-
ing to potential informants, and enlisting assis-
tance through presentations at conferences. The
review has been intentionally pluralistic, incorpo-
rating qualitative as well as quantitative studies.
Categorisation of methodological
adequacy
There are significant practical and ethical problems
associated with research into the outcomes of
EAP/counselling services. These problems mean
that it is probably impossible to carry out a rigor-
ous, controlled study of workplace counselling
that reflects the conditions of everyday service pro-
vision. There is a trade-off between rigour and rel-
evance. One option is to set up an intervention for
the purpose of the investigation (e.g. the studies
by Barkham et al, 1999, Iwi et al, 1998 and
Reynolds, 1997) in a way that ensures that a stan-
dard model of counselling is delivered, a range of
measures is administered, and that all (or most)
clients complete questionnaires. This approach
provides evidence that may be rigorous, but fails
to reflect the conditions of everyday clinical prac-
tice. The other option is to carry out a naturalistic
study of workplace counselling under normal cir-
cumstances (e.g. studies by Cheeseman, 1996 and
Worrall, 1999), and to accept that only a limited
set of measures can be administered, and that
many clients will not complete questionnaires. This
approach provides evidence that captures the
‘messiness’ of everyday practice, but is lacking in
control and methodological rigour. In recognition
of these methodological difficulties and dilemmas,
it was decided to divide outcome studies into three
categories:
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Category 1. ‘Best evidence’. This category
includes studies that, although limited in some
ways, and capable of improvement, comprise plau-
sible attempts to arrive at a fair and balanced
assessment of the effectiveness of counselling in
this setting, using evidence that is reliable, objec-
tive, relevant and sensitive to the phenomenon
being investigated.
Category 2. ‘Supporting evidence’. This group
contains studies that provide useful findings, but
nevertheless have important methodological limi-
tations. For example, some of the studies within this
category rely solely on client satisfaction ratings.
Category 2 also includes outcome studies in which
pre- and post-counselling change measures have
been administered, but problems of missing data
(clients leaving the study) have not been adequately
addressed. The findings of the studies in Category
2 are vulnerable to alternative interpretation, and
must be interpreted with caution.
Category 3. ‘Authenticating evidence’. This cat-
egory comprises systematic descriptive studies of
the effectiveness of workplace counselling. These
studies can be regarded as providing authenticating
evidence, in that they offer qualitative accounts of
the meaning of outcomes for clients and organisa-
tions. It is important in establishing an evidence
base for practice to include systematic case studies,
both as means of documenting and exemplifying
outcome, and also for heuristic purposes. This cat-
egory does not include clinical case studies derived
only from counsellor/psychotherapist notes. To be
included, a study must involve the use of an inde-
pendent source of evidence (e.g. test data).
In each study, the magnititude of change attrib-
utable to counselling was summarised using a 5-
point scale. Because relevant data were not
provided in some studies, it is not possible to esti-
mate Effect Sizes (ES; a statistical indicator of mag-
nitude of change; see McLeod, 1994) in all cases.
Instead, studies were coded according to the fol-
lowing scale:
Significant positive effect. A study has been
coded in this fashion where the effect of coun-
selling, averaged across all measures used in the
study, was large (equivalent to ES >.75). In addition,
the majority of clients in the study must have
shifted to within the ‘normal’ range of functioning
following counselling.
Moderate positive effect. This category includes
studies reporting moderate levels of effectiveness
(equivalent to an effect size between .2 and .75), or
where more than 50 per cent of clients remain at a
higher than ‘normal’ level of distress at termination.
Where client satisfaction measures have been used,
more than 90 per cent of clients must have indi-
cated that they were satisfied with the service they
received.
Neutral effect. Studies reporting no significant
impact of counselling in terms of key outcome
measures, even if client satisfaction reports were
positive.
Studies reporting negative effects of counselling
would similarly have been coded as significant neg-
ative effect and moderate negative effect. However,
no studies reporting negative effects were found
All studies were read by two independent read-
ers, who categorised them in terms of method-
ological adequacy and overall outcome. Ratings
were compared, and discrepancies resolved
through discussion.
Results
The results of this review process are summarised in
Tables 1 to 3. Table 1 lists outcomes associated with
the most rigorous studies that were located. Table
2 includes studies which are valuable, but include
significant methodological limitations. Table 3 lists
descriptive case studies and qualitative studies.
HOW EFFECTIVE IS WORKPLACE COUNSELLING?
Table 1. Category 1 studies: the ‘best
evidence’ on the effectiveness of
workplace counselling
Significant positive effect
Barkham and Shapiro (1990); Barkham et al
(1999)
Cheeseman (1996)
Cooper et al (1990; Cooper and Sadri (1991)
Dickson and Roethlisberger (1966)
Finke et al (1996)
Firth-Cozens and Hardy (1992)
Firth and Shapiro (1986)
Reynolds (1997)
Shapiro et al (1990, 1994)
Sprang (1992)
Worrall (1999)
Moderate positive effect
Alker (2000)
Guppy and Marsden (1997)
Nadolski and Sandonato (1987)
Neutral effect
Iwi et al (1998)
Macdonald et al (1997)

It can be seen that, in the ‘best evidence’ category,
11 from 16 studies present a picture of workplace
counselling as highly effective. Only two studies in
this category (Macdonald et al, 1997; Iwi et al,
1998) found that a counselling intervention had a
neutral effect. In the ‘supporting evidence’ cate-
gory, 4 from 13 studies found workplace coun-
selling to be highly effective. No studies have
found workplace counselling to be harmful, or less
effective than other alternative interventions. In
addition, over 90 per cent of clients surveyed, in a
number of studies, report themselves to be satis-
fied with the counselling they have received.
Given the methodological difficulties associated
with research in this setting, it is important to
examine the possibility that more methodologically
rigorous studies may produce less favourable
results, compared with less rigorous naturalistic
studies which could be seen as providing a biased
and over-optimistic estimate of outcome. There is
no evidence that effect size is associated with
degree of rigour. For example, among the group of
most rigorous studies, Shapiro et al (1990, 1994)
reported the biggest effect sizes, while Iwi et al
(1998) reported the lowest. Overall, higher levels
of gain were found in the Category 1 (best evi-
dence) studies, compared with less rigorous
Category 2 and 3 studies.
The relatively small number of strong studies
makes it difficult to identify trends regarding the
factors associated with good outcomes in work-
place counselling. For example, in the Category 1
(best evidence) studies, there are examples of cog-
nitive-behavioural, psychodynamic, client-centred
and solution-focused approaches reporting signif-
icant positive outcomes. Similarly, there are excel-
lent outcomes reported from brief (3 session) and
moderate length (16 session) models of delivery,
and from internal, external and EAP models of
service provision. Much more research will be nec-
essary in order to establish the conditions under
which alternative counselling modalities may be
shown to be differentially effective.
The results of research into the effectiveness of
workplace counselling compare favourably with
outcome studies carried out in other settings, in
terms of the range of effect sizes reported (see
Lambert and Bergin, 1994). It is worth noting that,
unlike most controlled studies of counselling and
psychotherapy, many investigations of workplace
counselling and EAPs have been able to use not
only client self-report data (from questionnaire
measures) but have also been able to incorporate
‘objective’ measures of behavioural change, for
example sickness absence. In fact, some of the
most substantial changes have been recorded in
the area of behaviour change rather than self-
reported symptoms.
While there is strong evidence that workplace
counselling has a beneficial effect on psychologi-
cal symptoms and well-being, and on sickness
absence, there is inconsistent evidence regarding
the impact of counselling on work attitudes and
commitment. Although Alker (2000), Firth-Cozens
and Hardy (1992) and Firth and Shapiro (1986)
reported moderate gains in work attitudes in
clients, studies by Cooper and Sadri (1991) and
Guppy and Marsden (1997) did not replicate this
result. It seems likely that existing methods of
measuring work attitudes may not be sufficiently
sensitive to individual change, and that longer-
term follow-up periods may be necessary in order
to detect the influence of counselling on organi-
sation-level outcomes.
Some general themes emerged across the set of
studies reviewed. The vast majority (over 90 per
cent) of employees who make use of workplace
counselling described themselves to be highly sat-
isfied with the service they had received, would
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Table 2. Category 2 studies: ‘supporting
evidence’ on the effectiveness of
workplace counselling
Significant positive effect
Gam et al (1983)
Park (1992)
Royal College of Nursing (2000)
Sloboda et al (1993)
Moderate positive effect
Goss and Mearns (1997)
Highley-Marchington and Cooper (1998)
Lueger and Howard (1994)
McAllister (1993)
Mitchie (1996)
Rogers et al (1995)
Schmit and Stanard (1996)
Saroja et al (1999)
Vonachan et al (1954)
Table 3. Category 3 studies: ‘authenticating
evidence’ on the effectiveness of workplace
counselling
Significant positive effect
Bayer (1998)
Denzin (1995)
Parry et al (1986)
Moderate positive effect
Chandler et al (1988)
Key (1999)

COUNSELLING AND PSYCHOTHERAPY RESEARCH, 2001, VOL 1, NO 3
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use it again if necessary, and would recommend it
to colleagues. Those who made use of workplace
counselling typically reported high levels of psycho-
logical distress, equivalent to that found in outpa-
tient psychiatric populations. In the majority of
studies, post-counselling levels of work-related
symptoms and stress return to the ‘normal’ range
for more than 50 per cent of clients, and sickness
absence rates in clients were reduced by 25 to 50
per cent. Research findings consistently supported
the conclusion that significant benefits for clients
could be achieved in three to eight sessions of
counselling; only the most severely disturbed clients
appear to require long-term counselling help or
referral to specialist services. In addition, published
studies of the economic costs and benefits of work-
place counselling (not included in Tables1 to 3) have
reported that counselling/EAP provision at least
covers its costs, with some studies reporting sub-
stantial positive benefit:cost ratios (Ahn and
Karris,1989; Alexander Consulting Group, 1990;
Blaze-Temple and Howat, 1997; Bray et al, 1996;
Bruhnsen, 1989; Bruhnsen, 1989; Houts, 1991;
Klarreich et al, 1987; McClellan, 1989).
Discussion
Taken as a whole, the findings reported in the stud-
ies included in this review provide consistent evi-
dence for the effectiveness of workplace
counselling. However, it is also important to be
aware that there are significant methodological and
practical difficulties associated with research into
this field of psychotherapeutic practice. For exam-
ple, many researchers reported that both clients
and counsellor compliance with data collection had
been low. In addition, it is clear that a wide range
of different outcome measures and definitions have
been employed, making it difficult to compare the
results of different studies. Clearly, it would be
useful if future researchers in this area could agree
and adopt standardised approaches to measuring
psychological and organisational outcomes.
At present, research into the effectiveness of
workplace counselling has generated few implica-
tions for practice. The only policy and practice direc-
tive that is supportable by current research is that
counselling of some sort should be available to all:
the evidence confirms that provision of workplace
counselling is beneficial not only for individual serv-
ice users, but also for the organisations which
employ them. It would be desirable to be able to
use research evidence to address practical problems
such as: Which counselling approaches are most
appropriate in the workplace setting? Under what
conditions is it best to utilise in-house or external
models of service provision? Are there different
client needs (and counselling interventions) associ-
ated with gender, patterns of sickness absence or
job role? What impact does organisational culture
have on counselling utilisation and effectiveness?
The knowledge base which exists at the moment is
not extensive enough to answer any of these ques-
tions with confidence. Much more research is cer-
tainly necessary. Nevertheless, the studies which
have been reviewed here can be seen to provide the
next generation of researchers with a solid base of
methods and tools with which to begin to build
research-informed practice in this important thera-
peutic arena.
© John McLeod, Julia McLeod, 2001
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