broadcast: Wed, 22 Mar 2000 18:00
from: Institute of Psychiatry / Maudsley Debates
03 Does counselling screw you up?

3rd Maudsley Debate

Does counselling screw you up?

This house believes that there should be no more counselling until it is proved to be safe and effective.

Speakers

Report / Review / Analysis

author: Kwame McKenzie

On March 22, the Wolfson Lecture Theatre was once more full and overflowing for the Maudsley debate. Over 300 people turned out and proved eloquently that the monthly series has quickly established itself as a must attend event - there was standing room only for late-comers. This latest debate - "This house believes that there should be no more counselling until it is proved safe and effective." brought together a counsellor, a psychiatrist, a researcher and an agony aunt for a lively and sometimes heated discussion of the subject.

Professor Simon Wessely, the psychiatrist amongst the four panellists, got the debate off to a blistering start. He told the audience that there were forms of psychotherapy that had been proved safe and effective but that counselling was not one of them. Not only was there no evidence to show that counselling worked but there was evidence that, after counselling in the wake of traumatic incidents, there were actually more people who subsequently developed mental health problems. He quipped that the best thing that a counsellor could do in the event of a major disaster was to sit at home and watch it on TV.

Gladeana McMahon, a Fellow of the British Association of Counsellors and a counsellor herself for 23 years then spoke against the motion and in support of counselling. She explained that counselling was a relatively young speciality and was developing all the time. It was as effective as many medical interventions and accreditation was improving its quality. She agreed that there was a need for more research but held that the existence of a few rogue counsellors does not mean that counselling should not be available to people who wanted it.

On Simon Wessely’s side opposing counselling was The Sunday Mirror’s and the Independent’s agony aunt Virginia Ironside. She spoke about her experiences of counselling and psychotherapy over many years. In her opinion cognitive and cognitive behavioural therapy had been effective but she thought that much of the other counselling she had experienced was not. Virginia Ironside commented on a number of issues in her wide-ranging attack on the process of counselling including: the 50 minute hour. You pay for an hour of counselling but you only ever get 50 minutes and dependence she complained and was quick to add that with clients representing a counsellor’s income there may be a perverse incentive to keep you in counselling.

The final contribution from the panel came from Adrian Hemming a researcher from the University of Sussex who supported counselling. He has carried out two scientific trials of counselling in primary care and believes that it is safe and effective when performed by those who have been properly trained. He spoke about his results and the positive attitude that GPs had towards counsellors but acknowledged that it was difficult to set up reliable trials.

Then, finally, the audience had their say. Not surprisingly, many counsellors in the audience were upset by Virginia Ironside’s negative portrayal of them. However, a current user of mental health services came to their defence by emphasising that users wanted people who would listen to them. If doctors did not have time then there would have to be counsellors. But does counselling work? Controversy surrounded the use by counsellors of cognitive and cognitive-behavioural therapy, two treatments which most professionals acknowledge are effective. Some claimed that because practitioners use elements of these treatments counselling, too, must be effective. But others thought that both therapies would only succeed if properly administered by highly trained professionals. It was one of the psychiatrists in the audience who stood up for counselling again. He highlighted a ’need for counselling’, which he had perceived while working with many counsellors over the years, including those at Relate, the marriage guidance charity. In his experience the public wanted counselling and found it helpful. Finally debate turned to the issue of what would happen in counselling were not available with claims that it would still occur but would not be as well "regulated".

In the end the motion that there should be no more counselling until it is proved safe and effective was defeated. However, while only 19 people supported it versus a majority of 94 against in the beginning, the number of counselling sceptics had risen to 43 versus a majority of 103 against the motion after the debate.

The views expressed in this article are those of the author and do not necessarily reflect those of their colleagues or the views of the Institute of Psychiatry, King’s College London.