Counselling loses face in NHS review

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The Independent Online
Counselling, the therapy offered to thousands of people undergoing divorce, bereavement and redundancy, is useless when practised on its own, a survey by a government health research body has concluded.

Britain's fastest growing talking therapy, counselling has been dubbed the "new religion". Demand has boomed in response to a growing belief that providing a listening ear can relieve emotional stress and prevent depression and other mental illness. The number of organisations offering training for counsellors has risen from 76 in 1990 to 545 in 1997, and the number of trained counsellors is estimated to run into tens of thousands.

The controversial report, by the NHS Centre for Reviews and Dissemination, says the technique "has not been shown to produce sustained benefit in a variety of groups at risk". The finding was immediately challenged by the British Association of Counsellors who said it was "unduly negative".

The two main types of counselling are "person-centred", focussing on practical problems, and "psychodynamic", which involves a psychotherapeutic examination of the client's life.

About 60 per cent of GP practices employ a counsellor, with the Government paying more than two thirds of their salaries. The British Association of Counsellors' directory of counsellors in private practice lists 2,500 names, up from 800 in 1988, and the association's membership tops 15,000.

The NHS Centre for Reviews and Dissemination, based at the University of York, was set up with more than pounds 1m of government funding to assess new treatments. It says in its latest bulletin on promoting mental health, based on a survey of research literature, that the growth in counselling cannot be justified. In bereavement, postnatal depression and support for carers, trials showed counselling by itself had no effect. "More attention needs to be given to the content and effectiveness of specific forms of counselling and the skills of counsellors before this approach is extended too widely," it says.

Mary Turner Bootle, editor of the bulletin, said: "Counselling is burgeoning ... We are not saying it is a total waste of time but the evidence for its effectiveness is not there. There is an awful lot that could be done to prevent people getting depressed but offering counselling on its own is like applying a sticking plaster without disinfecting the wound."

Although the report looked only at mainstream counselling, she said the same principles were likely to apply to specialist forms such as marital and careers counselling.

The NHS Centre is independent of the Government but its findings have influenced policy. Earlier this year a bulletin which highlighted the ineffectiveness of prostate cancer screening was followed by a government circular instructing health authorities not to set up screening programmes.

Yesterday, the Department of Health said that family doctors were best placed to judge whether counselling could help, but added: "Health authorities and GPs may now want to look again at their primary care priorities in the wake of this useful review."

The British Association of Counsellors said it had introduced tougher requirements to ensure that members were better trained and more reliable. Lack of regulation means anyone can give themselves the title of counsellor and set up practice. A spokeswoman said: "The report does seem unduly negative and it does not reflect our experience. We are talking about people's feelings which are impossible to measure."

Penny Spearman, a counsellor at the Westminster Pastoral Foundation, said professional rivalry had led to a "subtle discrediting" of counselling by social workers and psychologists jealous of its popularity. But Dr Frank Furedi, a sociologist at the University of Kent, and author of The Culture of Fear, an investigation of public attitudes to risk, said counselling was "one of the biggest cons" of modern life.

"[Counselling] has become a cultural response to every disaster," he said.

Case history

Anne went to a counsellor to help her overcome her phobia of dentists, writes Jeremy Laurance. The treatment was successful - she is now able to sit in a dentist's chair without being overwhelmed by panic - but it has left her with a bigger problem than it solved.

"The dentist who had been attempting to treat me suggested I get therapy. I contacted one of the professional associations, they recommended a local person and I went to see him. He was a counsellor who practised hypnotherapy and he asked full questions about my history and then regressed me to babyhood."

After three sessions the counsellor concluded that Anne's phobia stemmed from the fact that she had been abused at the age of two.

Anne said: "I went to pieces. I came home and I was in hysterics."

Over the next weeks Anne remained confused and upset. "It didn't trigger anything. The memory did not expand in the way you would expect if it were real."

She concluded she had been misdiagnosed and mistreated, and complained to the British Association of Counsellors with whom her therapist was registered. Later she heard he had been struck off after complaints from other clients.