ABSTRACT
The incorporation of counselling as a distinct therapeutic process within the medical setting has raised questions with regard to issues of appropriateness, confidentiality, accountability, cost and effectiveness. As many as one-third of problems seen in primary care settings are psychological in nature, and research has shown that people with psychosocial problems are treated more often by general practitioners (GPs) than they are within psychiatric or social services (Shepherd, Cooper, Brown and Kalton, 1966; Blacker and Clare, 1987; RCGP, 1973). When taking into account the busy nature of the general practice setting, it becomes evident that GPs will find it very difficult to handle cases of this nature alone. It is important, therefore, to examine how best to organise and/or equip the primary care team to manage psychological problems, and how resources can be utilised to supplement and support the primary care team (Corney and Jenkins, 1993). Recent literature in the field reflects the rapid development of counselling in the primary health care field, the practice of counselling psychology in general medicine and the addition of counsellors as part of the primary health care team in the UK (e.g. Corney, 1992; Higgs and Dammers, 1992; Paykel, 1990; Thompson, Schwankovsky and Pitts, 1993; Boot et al., 1994; Waseem, 1993). A number of studies have highlighted benefits, problems and possibilities for the future of counselling in primary health care. Most research can be categorised under one of five main headings: liaison between the counsellor and other professionals; evaluation of treatment in primary care and patient satisfaction; general practitioners' ability to counsel; family therapy in general practice; and problems with referrals. This chapter reviews this literature and identifies certain gaps in current research which may need to be addressed.
