Mental Health


Lesson 1

You may have personal experience of counselling, either as someone who has received it or as someone who has offered it in a professional capacity; or you may know people in these roles. Counselling is the most widely available of the talking therapies.

It is, for example, available in many workplaces, for students at university and at some GP surgeries. Counsellors have a variety of backgrounds, including psychology, social work and nursing, and there are numerous courses offering training in counselling.

The essence of counselling is that it is a relatively low-cost, 'low-tech' and low-risk intervention, (compared with medication, for example), but it is not risk-free.

It works through the counsellor encouraging a focused discussion around specific problems, crises, life events or conflicts in order to facilitate understanding of them and to develop ways to tackle or manage them.

As stated earlier, counselling is much sought-after as an alternative (or as an adjunct) to more traditional mental health interventions such as medication. Many service users/survivors, however, report waiting for six months or more for the chance to talk to a counsellor (Waddell, 2002).

Despite the demand and the inevitable waiting lists, counselling is not completely free from risk or controversy. This is partly because it is a relatively unregulated activity and its practitioners may work without supervision.

How effective is counselling?

The National Primary Care Research and Development Centre (King et al, 2001) undertook a randomised controlled trial of counselling in primary care for people who had a diagnosis of depression. Each person received counselling or CBT or GP care.

The measured outcomes were the self-reported signs of improvement from participants, and the costs of providing each therapeutic approach to the primary care service.

The key findings were:

Compared with GP care, counselling and CBT are cost-effective methods of reducing depressive symptoms for the first four months.

Over a longer period, the overall costs of care were similar for all the approaches.

Participants reported a higher level of satisfaction when involved in the talking therapies.

Other mental health service users/survivors are also a resource. Self-help and mutual help can take place through working together in groups to talk through problems, share experiences and support one another's strategies for action and change.


Co-counselling, where two people work together to provide their own counselling, can also be helpful, as Jim Read describes below.


Jim Read describes how he discovered re-evaluation counselling (from which co-counselling is derived) and how it helped him.

I joined the class a week late, so I was the new boy. We met in a small North London flat. It wasn't like walking into any group of strangers. The teacher was especially warm and friendly. I remember the atmosphere better than the content.

I felt welcome. At one point we paired off to take turns listening to each other. My listening partner herd my hand and looked really interested in what I was saying. I liked offering something back by listening to her.

Cycling home from the class, I got a puncture. I had to push my bike several miles. I didn't care. It was a mild autumn night and I had a lot to think about. I didn't know quite what I had found but I knew it was what I was looking for.

It was 25 years ago that I went to my first Re-evaluation Counselling (RC) class. It became the driving force of my life. It is a set of ideas and practices, and a network of people that make a great deal of sense to me.

Using RC helped me through the difficult times as I found my way in the world after several years as a psychiatric patient. It has helped me gradually create a life that I wanted and eventually enjoy experiences that were beyond my wildest dreams.

It hasn't been particularly easy. RC doesn't solve your problems for you. It does give you the tools to solve your problems. Then it is up to you. To make the changes I want. I've spent countless hours taking turns to listen with a co-counselling partner. Sometimes progress has been frustratingly slow - and sometimes alarmingly fast. It has been worth it. The break with the mental health system has been decisive.

The central activity for people who do RC is the co-counselling session. Two people take it in turns to be counsellor and client. The aim of the session is for the client to discharge as much as possible and to see more clearly the differences between hurtful experiences of the past, the reality of the present and the possibilities for the future.

The exchange of roles, alone, makes RC different from other forms of counselling, or therapy. Instead of one person being the expert and the other, the needy client, both have the same understanding of what they are trying to achieve. A co-counselling session is a collaborative effort, with both people thinking about one of them and then the other.

Another difference is that an RCer can have sessions with as many others as they wish. This means their opportunity to progress is not restricted by the inevitable limitations of one person who is chosen as their counsellor.

Also, we are able to start co-counselling as soon as we begin a class. The usual difficulties in obtaining counselling melt away. There are no waiting lists or restrictions on how many sessions you have.

(Read, 2002, pp. 1, 3)


King, M., Ward, E., Lloyd, M., Sibbald, B. and Bower, P. (2001) Executive Summary 20: Randomised Controlled Trial of Non-Directive Counselling, Cognitive Behaviour Therapy and Usual General Practitioner Care in the Management of Depression and Mixed Anxiety and Depression in Primary Care, Manchester, NPCRDC.

Read, J. (2002) 'Re-evaluation counselling: a radical alternative to psychiatry', paper presented to The Big Alternative Conference, 'Something Inside So Strong', London, 3 October.

Waddell, H. (2002) 'The drugs don't work', Community Care, 19-25 September, p. 26.