Counselling in primary care: a randomised controlled trial

A randomised controlled trial of the effectiveness of counselling (In-House Counselled (IHC) group) compared to routine advice from General Practitioners (Routine Treatment (RT) group) was conducted with three practices and a total of 188 patients in East Sussex. Changes in interpersonal problems using the 32 item Inventory of Interpersonal Problems, symptoms of psychological distress using the Symptom Index and self esteem using Repertory Grids were compared between groups at four months and after a further four month follow-up. A questionnaire monitoring patient service satisfaction was given to those who had received In-House counselling. The number of counselling sessions, early withdrawals and refusers was also monitored. In order to facilitate interprofessional communication, the three counsellors and a GP representative from each practice met monthly for an Action Learning group, led by an external facilitator to provide a forum to discuss working practices. The group met six times for two and a half hours. An audit of the participants' medical notes was carried out at the end of the study to establish any changes in subsequent use of medical services and prescribing patterns. The results show that patients within both groups improved considerably, in line with similar studies. The IHC group was significantly less likely to be referred out to mental health services. However, there was no statistical difference between the groups on any of the measures or in changes in subsequent service use or prescribing patterns. This may have been a result of Action Learning Group producing more psychologically minded GPs. Patients in the IHC group were overwhelmingly in favour of counselling and stated that it had helped them with a variety of psychological problems.