Counseling Effectiveness

Counseling Effectiveness
-Shannon Sumrall, M.A., M.Ed., LPC, NCC
NLP, Hypnosis & Time Line Therapy™ Trainer

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In the counseling profession there is a great deal of discussion and debate about the effectiveness of counseling and psychotherapy. Examination and research of the literature yields a variety of approaches and explanations as to the effectiveness of helping. Research designs and methodologies are often criticized and their flaws pointed out and recommendations are given for improving the designs. The one constant that appears in all of this frenzy of research deliberation is that almost all of the literature and research concludes that counseling and psychotherapy are effective. The degree to which counseling has been shown to be effective varies greatly with the methodology being utilized but overall the success and satisfaction rates seems to consistently remain very good.

The effectiveness of counseling has been examined in several studies and has been shown to be generally effective. Examining the progress and outcome of clients undergoing therapy, it is apparent that while the majority of clients improve, a minority remain unchanged, and still others actually deteriorate (Lambert & Cattani-Thompson, 1996). Rowland et al (2000) have shown that counseled patients are significantly more likely to have recovered than non-counseled patients in analyses of data from patients who were followed up, (OR=0.54, 95% CI 0.31, 0.97) (Chi-square=1.22; DF=1). Client outcomes are most often determined by client variables such as chronicity, severity, motivation, defenses, acceptance of responsibility for change, and complexity of symptoms other than by counseling or individual counselor variables (Anderson & Lambert, 1995; Safran, Segal, Vallis, Shaw, & Samstag,1993).

Hemmings (2000) conducted a meta-analysis of client outcomes in the United Kingdom and out of 26 reports, 17 included a measure of client satisfaction. Hemmings' work demonstrated that the number of participants who rated counseling as helpful to very helpful ranged from 88% (Clwyd,1996) and 75% (Baker et al, 1998) down to 66% (Gordon, 1995). Hemmings examined the study of Kingston & Richmond (1997) where over half gave counseling the maximum rating for helpfulness and it was noted that the high ratings were not dependent on the counselor and there were not significant differences between practices. One study examined by Hemmings found levels of client satisfaction reported at 93% in East Kent (Bunker & Locke, 1998). The results of this study might be criticized for being self-reported and influenced by social approbation but this seems to be overcome by the large number of positive comments (Hemmings, 2000).

High success rates in counseling appear to consistently appear in meta-analysis of the literature. Lipsey & Wilson (1993) document a strong tendency, in their meta-analysis, of the positive effects of counseling above the placebo effect threshold. Smith, Glass, & Miller (1980) conducted a meta-analysis of 475 psychotherapy trials and reported that psychotherapy was effective; it was estimated to have an average effect size of 0.85 for all types of therapy, clients and outcomes. The majority of these trials occurred in education (56%) and hospital (12%) settings instead of a general practice setting (Smith, Glass, & Miller, 1980). These studies seem to indicate a high rate of success for counseling overall.

When examining specific treatment approaches and efficacy studies there seems to be some evidence of variability in success rates. Panic disorder treatment has been shown to be most successful when a cognitive-behavioral interventions are used (Barlow, Craske, Cerny, & Klosko, 1989; Michelson et at., 1990). Behavior therapies have demonstrated powerful and superior effects for specific problems in comparative studies (Emmelkamp, 1994). Behavioral techniques utilizing systematic exposure have been shown to be very effective and superior to other interventions when treating phobic disorders such as agoraphobia, simple phobias, and compulsions; however, in the case of social phobias, generalized anxiety disorders, or some combination of these exposure treatments are still effective but not as effective or uniquely effective (Emmelkamp, 1994). Such research has led to empirically supported treatments which are often put into a manual format for treatment. Manualized treatments have been developed for numerous conditions such as phobias, anxiety, personality disorders, depression, post-traumatic stress disorder, panic, borderline personality disorder, and substance abuse (Egan, 2002).

The vast majority of the research when examined as a whole seems to indicate very positive outcomes for counseling. Self-reported outcomes, follow-up studies, and efficacy studies all show a generalized trend that indicates a significant success rate for counseling and psychotherapy. There is still a great deal of research that needs to be conducted to determine specifics about determination of the optimal approaches and interventions to be utilized within the larger framework of successful counseling and psychotherapy. Ultimately, more qualitative measures need to be developed to compliment the over-reliance on quantitative measures that currently dominate the literature to refine the skills and outcomes of the helping relationship.

References

Anderson, E. M., & Lambert, M. J. (1995). Short-term dynamically oriented psychotherapy: A review and recta-analysis. Clinical Psychology Review, 9, 503-514.

Baker, R., Allen, H., Penn W., Daw, P. & Baker, E. (1998). The Dorset Primary Care Counselling Service research evaluation.

Barlow, D. H., Craske, M., Cerny, J. A., & Klosko, J. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20, 261-282.

Bunker, N. & Locke, M. (1998). South Kent Primary Care Counselling Service 1997-98. Report to South Kent Community NHS Trust.

Clwyd Fhsa (1996). Counselling in primary care: report on a one-year pilot project in the Scottish borders 1995-1996.

Egan, G. (2002). The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (7th edition). Pacific Grove, CA: Brooks/Cole.

Emmelkamp, P. M. G. (1994) Behavior therapy with adults. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 379-427). New York: Wiley.

Gordon, P.K. (1995). Evaluation of counselling in primary care.

Hemmings, A. (2000). Counselling in primary care: a review of the practice evidence. British Journal of Guidance & Counselling, 28(2), 234-254.

Kingston, M.A. & Richmond, R.G. (1997). Counselling in Primary Care Patient Survey 1997: aggregated findings.

Lambert, M. J. & Cattani-Thompson, K. (1996). Current findings regarding the effectiveness of counseling: Implications for practice. Journal of Counseling & Development, 74(6), 601-609.

Lipsey, M. W. & Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181- 1209.

Michelson, L., Marchione, K., Greenwold, M., Glanz, L., Marchione, N., & Testa, S. (1990). Cognitive-behavioral treatment of panic disorder. Behavioral Research and Therapy, 28, 141-151.

Rowland, N., Godfrey, C., Bower, P., Mellor-Clark, J., Heywood, P., & Hardy, R. (2000). Counselling in primary care: A systematic review of the research evidence. British Journal of Guidance & Counselling, 28(2), 216-233.

Safran, J. C., Segal, Z. V., Vallis, T. M., Shaw, B. F., & Samstag, L. W. (1993). Assessing patient suitability for short-term cognitive therapy with an interpersonal focus. Cognitive Therapy and Research. 17, 23-38.

Smith M., Glass, G. & Miller, T. (1980). The Benefits of Psychotherapy. Baltimore, MD: John Hopkins University Press.