ABSTRACT
This chapter describes counselling for patients with severe and long-term mental health problems in a general practice setting. It also describes examples of recent work with four patients who have been diagnosed respectively as suffering from a serious sexual problem, dementia, bi-polar affective disorder and agoraphobia. The team culture is a mixture of rigour and pragmatism, with each counsellor working in their own way within a shared policy about the use of resources, waiting-list management and the menu of services on offer. It is important for all the work but particularly that with severely disturbed patients that the team is supervised by a trained psychotherapist with a substantial mental health background and some years of experience in general practice counseling. The work takes place within a specific general practice setting where a differentiated approach to counselling has been evolved using several different service options.
