Conclusions

Counselling is a major growth area within psychiatry. For the psychiatrist or other mental health professional, it can be difficult to make sense of the range of counselling models available; thus it is not surprising that the consumer is sometimes confused about the nature and advisability of counselling. Counselling has only recently been subject to the rigorous evaluation necessary to meet the standards of evidence-based practice. The most central aspects of counselling, the therapeutic relationship and qualitative nature of the work, can be difficult to evaluate using established research methodology. However, far more attention is being paid to evaluation, with the development of research paradigms suited to counselling. Systematic evaluation will eventually make it possible to identify, on the basis of clear evidence, the indications for specific models of counselling as well as their limitations.

The relationship between specific models of counselling and psychotherapy needs to be further clarified. Lack of clarity confuses the potential purchasers and consumers of services. Furthermore, there is a growing tension in some areas between counsellors and established mental health practitioners of psychological therapies, including psychiatrists and psychologists, who may feel threatened by the development of this new profession. These concerns may be justified if health service commissioners see counselling as a cheaper source of psychological treatments.

Counselling is a vital part of psychiatry for many reasons. Counsellors are equipped to offer a valuable service to those with mild to moderate mental health problems as well as social and relationship difficulties. It makes sense for interventions to be offered at an early stage of difficulties: whilst many problems do resolve on their own, patients welcome the support and understanding that counselling can offer, and it is valuable in hastening recovery from emotional distress. Counselling may be appropriate for some patients with serious mental illness, offered by psychiatric nurses, social workers, occupational therapists and workers in the voluntary sector. The expansion of counselling raises the issues of training, standards, ethics, and accountability, which need to be addressed further before the place of counselling can be fully consolidated and integrated within psychiatry.

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