ABSTRACT
Within the primary care setting, the largest percentage of referrals for counselling present as depression and/or anxiety. If the general practice writes a referral letter, he/she will normally state the symptoms that the patient has presented in consultation. The frame is the boundaried setting of counselling. Many people present themselves in crisis in the primary care setting, and these patients often find themselves put forward as an urgent referral for counselling. An emergency situation can arise if a patient comes in for her first session and is obviously severely clinically depressed/anxious/ suicidal and unable to function. Counsellors and therapists can strive to create readiness for change and encourage patients to use what they found helpful in the session to achieve change. A patient may be awaiting divorce proceedings or may have been accused of the abuse of a vulnerable person. This "difficult" patient can create strong reactions in the primary care staff who care for and treat them.
