Anxiety and depression are common mental disorders found in general practice. There has been an increasing number of counsellors attached to general practice over the past ten years, despite there being little evidence on effectiveness. Many studies have suffered from serious methodological weaknesses. This prospective, randomised controlled trial compares nondirective counselling with routine general practitioner care in assisting people with emotional problems. Fourteen general practices were recruited. Counselling sessions ranged from 1 to 12 sessions over 12 weeks. Most patients suffered from depression due to relationship or family problems. Self-report questionnaires on psychological, social, economic and patient satisfaction outcomes were used at baseline interview and at the three and nine months follow-up interviews. The sample consisted of 136 consenting general practice attenders, mean age 39 years old. Most of the sample were female (81%) and predominately Caucasian (92%). Seventy patients were randomised to the counsellor and 66 patients to the general practitioner. Patients in both groups improved significantly over time, but there were no significant differences on the psychological and social outcome measures between a nondirective counselling intervention and routine general practitioner care. However patients who scored as cases on the Beck Depression Inventory, were younger and from manual classes improved to a greater extent by seeing a counsellor compared to seeing the general practitioner. Patients were also more satisfied and felt less troubled after seeing a counsellor. In terms of cost, counselling was less cost- effective than routine general practitioner care immediately post-treatment, but became cost-effective on direct costs only after nine months. This study indicates that non-directive counselling is as efficacious as routine general practice treatment. The findings on cost effectiveness were equivocal. Patients were more satisfied with seeing a counsellor compared to a doctor. Further research is needed to assess which particular patients could benefit from counselling and whether counselling becomes cost-effective long-term
