The relative effectiveness of different forms of counselling and therapy for depression
This touches a nerve for many people. I include some references.
I wholeheartedly support the principle of evidence based practice and the need for cost effectiveness in the NHS. However, counselling is not just a medical intervention, and this is one good reason for the ongoing place of private counselling. It relates to well being and wider aspects of life. It is also recognised that there are 'multiple pathways of change' (Cooper and McLeod, 2007) and that there are many ways to help distressed people with problems and issues. Even in the field of depression, the guidance notes published by the National Institue for Health and Clincal Excellence (NICE) (see new guidance notes CG90 and CG91) recommend a number of treatments and recognise that the care provided needs to be 'person-centred'. They refer to various forms of CBT, a form of brief therapy called 'Interpersonal therapy', mindfulness-based cognitive therapy, psychodyamic therapy and various kinds of group therapy and self help groups.
It is widely accepted that no established form of counselling or therapy is superior to any other in terms of outcomes (e.g. Barkham, 2003), although certain types may be more suitable in specific circumstances and some focus more on quantative outcome research than others. A range of factors enter into the process, chief among which is the relationship between the client and counsellor (Cooper, 2008). In the field of depression, no reputable large scale study has ever found a significant difference between the effectiveness of the main therapies (see for example a recent meta-study by Hill and Jenkins (2008)).
Barkham, M. (2003). Qualitative Research on Interventions. In R. Wolfe, W. Dryden & S. Strawbridge, Handbook of Counselling Psychology, pp. 25-73
Cooper, M. (2008). Essential research findings in counselling and prychotherapy. London: Sage
Cooper, M. & McLeod, J. (2007). A pluralistic framework for counselling and psychotherapy: Implications for research. Counselling and Psychotherapy Research, 7 (3), 135-143
Hill, A. & Jenkins, P. (2007). Counselling in primary care: The evidence base. Healthcare Counselling and Psychotherapy Journal, 8 (2), 15-18