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A naturalistic longitudinal evaluation of counselling in primary care

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Abstract

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.

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... These are most frequently tested against routine primary care and cover a wide range of target problems, including anxiety and depression, generic psychological problems, postnatal depression, psychosomatic disorders and chronic fatigue. There were nine studies which measured outcomes before and after the intervention (pre and post counselling studies) (Baker et al., 2002;Booth, Cushway, & Newnes, 1997;Evans, Connell, Barkham, Mashral, & Mellor-Clark, 2003;Gordon & Graham, 1996;Kates, Crustolo, Farrar, & Nikolaou, 2002;Mellor-Clark, Connell, Barkham, & Cummins, 2001;Murray, Sharp, Quigley, & McKenzie, 2000;Nettleton et al., 2000;Newton, 2002). All studies were conducted in the UK, apart from that of Kates et al. (2002), which is Canadian. ...
... Survey ' User perspectives USA Non-specific generic counselling Depression Evans et al. (2003) To evaluate a service with reference to the ethnicity of service users using CORE data Pre post '' Effectiveness UK Non-specific generic counselling Non-specific, generic psychological problems Gordon & Graham (1996) To evaluate outcomes of short-term and long-term effects of a brief counselling intervention in primary care Counselling in primary care 211 strate that as a brief, 6-to 10-session intervention, between 60% and 80% of patients achieve reliable and clinically significant improvements (Evans et al., 2003;Gordon & Graham, 1996;Kates et al., 2002;Mellor-Clarke et al., 2001). The long-term effects of counselling are more equivocal, with evidence from a systematic review (Bower & Rowland, 2006) and an RCT (Murray et al., 2003) finding a lack of effect in the long term (up to two years), but two pre and post studies finding a positive effect over the long term (Baker et al., 2002;Gordon & Graham, 1996). When compared against CBT, counselling was shown to be as effective with typical heterogeneous primary care populations, in one systematic review and two clinical trials. ...
... One systematic review (Bower & Rowland, 2006) also suggested that counselling may be as effective as medication. A pre and post counselling study demonstrated that counselling and medication in combination is more effective than either intervention offered as a single treatment (Baker et al., 2002). In terms of individual versus group counselling, there was a lack of studies, but one clinical trial suggested that individual counselling may be more effective than counselling delivered in groups in the treatment of postnatal depression (Milgrom et al., 2005). ...
Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care.Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services.
... The WHO (1978) asserts that, as the foundation to the health and social well-being of people in every country, governments have a responsibility to provide equitable access to PHC that is available to people in their own communities and is based on principles of public participation, health promotion, accessible skills and technology, as well as intersectoral cooperation between health and social service disciplines. There is good evidence that access to PHC services positively impacts the mental and physical health of individuals and populations (Agency for Healthcare Research and Quality, 2004;Baker, Allen, Gibson, Newth, & Barker., 2002;Shi et al., 2004;Starfield, Shi, & Macinko, 2005). In U.S. studies, researchers have found that communities in which there is access to PHC centers have higher documented rates of preventative health services, such as Pap smears, immunizations, and prenatal care, and report better population health outcomes than communities without such access (Agency for Healthcare Research and Quality, 2004;O'Malley, Forrest, Politzer, Wulu, & Shi, 2005;Regan, Schempf, & Politzer, 2003). ...
... Furthermore, both unmet need for and fit of primary medical services in a PHC system, such as those provided by a family doctor, general practice physician, or nurse practitioner, have been associated with early detection of illness and disease, resulting in better mental and physical health outcomes (Bindman, Grumbach, Osmond, Vranzian, & Stewart, 1996;Shi, 1994;Shi et al., 2004;Vogel & Ackerman, 1998). Moreover, patients who access mental health services in PHC settings, such as those provided by counselors, social workers, psychologists, and psychiatric nurses, without the requirement of a referral, report significant improvements in depressive symptoms, anxiety, self-esteem, and quality of life over time (Baker et al., 2002;Greasley & Small, 2005;Nettleton et al., 2000). Few Canadian researchers, however, have examined the impact of either unmet need or fit of PHC services on the mental and physical health of Canadians, including women who have experienced IPV. ...
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Primary health care (PHC) can improve the health of women who have experienced intimate partner violence (IPV), yet, access to, and fit of PHC services may be shaped by income and racialization. We examined whether income and racialization were associated with differences in PHC service use, unmet need, fit with needs, and mental and physical health in a sample of 286 women who had separated from an abusive partner. Mothers, unemployed women and those with lower incomes used more PHC services and reported poorer fit of services. Poorer fit of services was related to poorer mental and physical health.
... Data were collected by questionnaire designed by researcher and by unstructured interview was taken by researcher. Qualitative method was used for data analysis [6]. ...
... he longer term impact of counselling, investigating two linked questions: Are there any enduring benefits of counselling from a user perspective? What mechanisms bring about those benefits and maintain them? Several studies have examined long-term impact of counselling using different criteria and measures of outcome, but findings are inconsistent. Baker et al. (2002), using standardised patient outcome tools (Bedford and Foulds Delusion-Symptom-States Inventory (DSSI); Rosenberg-Self Esteem Scale; Watson and Marks Life Impairment Scale), found sustained improvement at two years. Gordon and Wedge (1998) , employing the Hospital Anxiety and Depression Scale (HADS) and a questionnaire on client percept ...
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... Psychologists were asked to define the problem type of participating patients by completing a diagnostic information sheet based on DSM III-R (Baker et al., 2002). This procedure has been used in previous research and was embedded in the clinical service (Baker, Allen, Gibson Newth and Baker, 1998). ...
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... Sometimes a questionnaire was described in part but not published and further enquires drew a blank, such as the modified Rosenberg Self Esteem Scale [16], and the Personal Concerns and Goals Assessment [17,18]. Questionnaires could be broadly categorised as follows, although there was some overlap between categories: satisfaction with/orientation of life [19-22]; coping with/adjustment to illness [23-27]; quality of life [28-34], Self-efficacy [21,35-39]; self-concept [15,22]; spiritual wellbeing [18,40,41]. ...
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