Does Counselling Work?

Written by Steve Rose

Steve Rose, PhD, is an addiction counsellor who assists those struggling with substance abuse, gambling, gaming, and internet addiction.

The other day I decided to take a look at the scientific evidence on counselling. As a counsellor myself, I’ve seen it work, but I was curious about what others are saying. I searched the phrase, “does counselling work?” and was surprised by the top result. An article in the Independent stated that although counselling works in the short-term, it has no long-term benefits.

Shocked by the conclusion, I dug deeper, looking into the studies they cited, in addition to doing my own review of the literature. I discovered that the studies on the short-term benefits of couselling did not provide an accurate picture of the evidence and did not consider the various forms of counselling.

After digging deep into the scientific literature on whether or not counselling works, I came to the following conclusion:

Counselling works in the short-term and long-term, so long as it is practiced by a skilled counsellor using evidence-based techniques, in addition to having strong empathic interpersonal abilities to facilitate a supportive therapeutic relationship.

As a counsellor, I’ve personally seen many long-term transformations, but as a researcher, I know I cannot rely on anecdotal evidence. This article is a summary of my review of the literature.

The titles of each study cited below are hyperlinked if you would like to read more.

Counselling Works in the Short-term

The scientific evidence unequivocally supports the effectiveness of counselling in the short term. Several high-quality studies point to these benefits.

The following Cochrane Review concludes that counselling works in the short-term but not in the long-term:

Counselling for mental health and psychosocial problems in primary care

Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term.

Why might there be no evidence for long-term effectiveness?

The above review focuses on a narrow definition of counselling, distinguishing it from cognative-behavioural therapy. This is problematic since many counsellors practice cognitive-behavioural approaches and other evidence-based techniques.

The following study also finds short-term benefits but fails to demonstrate long-term benefits by relying on a similarily narrow definition of counselling:

Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial

In this randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.

The following systematic review and meta-analysis reinforces the evidence on the short-term effectiveness of counselling, but again distinguishes it from evidence-based mental health interventions such as cognative-behavioural therapy:

The clinical effectiveness of counselling in primary care: a systematic
review and meta-analysis

Counselling is associated with modest improvement in short-term outcome compared with usual general practitioner care, and thus may be a useful addition to mental health services in primary care.

The following study focuses on the effectiveness of counselling for quitting smoking, finding compelling benefits after six months:

Does individually-delivered counselling help people to stop smoking?

Combining the results of the studies showed that having individual counselling could increase the chance of quitting by between 40% and 80%, compared to minimal support.

The above evidence demonstrates the effectiveness of counselling at the three to six-month mark. Let’s now consider studies on the benefits of counseling in the long-term.

Counseling Works in the Long-term

This longitudinal study followed up twenty-one months after counselling ended, finding the positive effects were maintained:

A naturalistic longitudinal evaluation of counselling in primary care

Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.

The following study delves into the specific processes responsible for the long-term effects of counselling:

The long-term effects of counselling: The process and mechanisms that contribute to ongoing change from a user perspective

Mechanisms integral to sustained impact were: the active engagement of people during and between sessions to work toward their own solutions; and acquisition through the change process of skills which could be further built on after the counselling ended.

This means counselling works in the long-term when client autonomy is supported. This means having clients practice skills between sessions, which can be applied independently after counselling is complete.

Evidence for Various Types of Counselling

The studies supporting the short-term benefits of counselling generally defined it as a client-centered emotionally supportive role, neglecting the fact that many counsellors are qualified practitioners of various evidence-based techniques.

The following study demonstrates the long-term benefits of cognitive-behavioral approaches:

CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective.

The above study demonstrated positive effects over forty-six months. The long-term effectiveness of this approach may be attributed to its emphasis on facilitating independent coping skills. Once practiced, clients can continue to use these skills when counselling has ended.

Internalizing effective coping skills may be the key to long-term effectiveness. This is reinforced by studies on the effectiveness of self-help methods. According to thirty-three studies in A meta-analytic study of self-help interventions for anxiety problems, using self-help methods without having engaged in counselling can also be effective long-term.

Beyond a cognative-behavioral counselling approach, several other forms of counselling also have strong evidence for their effectiveness.

According to a meta-analysis of eighty-six studies on the effectiveness of humanistic therapies, this approach shows substantial stable gains over time:

In randomized clinical trials with comparative treatment control clients, clients in humanistic therapies generally show amounts of change equivalent to clients in nonhumanistic therapies, including cognitive behavioral therapy.

Motivational Interviewing is the most recent counselling approach based on a humanistic foundation and is particularly effective for addiction. For the evidence on the effectiveness of its approach see the following list summarizing the research: Systematic and Meta-Analyses of Research on Motivational Interviewing

Lastly, the most recent form of behavioral therapies are also strongly supported by research. Acceptance and Commitment Therapy is considered a third-wave behavioral approach, focusing on process rather than the content of cognitions. For a list of the 330 randomized controlled trials conducted on this approach, click here.

Does Online Counselling Work?

Since the world has recently turned to online platforms, this question is more relevant than ever. I reviewed the evidence for online counselling in my article Does Online Counselling work? and came to the following conclusion:

According to recent evidence, online counselling is effective for treating mental health and addictions. Multiple studies show it is generally as effective as face-to-face counselling and has the benefit of expanding access to mental health and addiction treatment.

For a more detailed review of the evidence on online counselling, check out the full article here where I summarize several high-quality studies on online counselling for mental health and addiction.

Conclusion

There is a large amount of strong evidence pointing to the fact that counselling works in the short-term. Although the evidence is mixed on the long-term effectiveness of counselling, this can be primarily attributed to a narrow definition of counselling that does not include many of the evidence-based techniques cited above.

If you are interested in taking a deeper look at the research on this topic, you can find several studies summarized in this systematic review of the evidence.

Beyond the scientific evidence, I have personally seen the transformative effect of counselling in my work in various roles within the addiction field. Throughout counselling, clients find a safe outlet for expressing difficult thoughts and emotions, in addition to learning how to more effectively cope when these difficulties are present.

Counselling works by helping clients overcome mental barriers to living the life they want. A collaborative counselling relationship fosters a deep sense of trust and mutual respect, helping someone become the best version of themselves.

Want to Try Online Counseling?

Here are a few options worth checking out:

BetterHelp.com is one of the most flexible forms of online counseling. Their main benefit is lower costs, high accessibility through their mobile app, and the ability to switch counselors quickly and easily, until you find the right fit.

It’s almost like having a counselor in your pocket, since you can text, voice-message, or set up video calls whenever you need support. 

For persons struggling with anxious thoughts, depressed moods, low self-esteem, low motivation, or loneliness, check out Better Help here to learn more.

Online-therapy.com also offers support for persons looking to optimize their mental toolbox. Click here to learn more about their program based on the evidence-based practice of Cognitive-behavioral Therapy (CBT).

*As an affiliate partner with Better Help and Online-therapy.com, I may receive a referral fee if you purchase products or services through the links provided.

If you are looking for a specialist near you, use the Psychology Today therapist directory here. Although prices are generally higher on this directory, many of the practitioners accept insurance. 

As always, it is important to be critical when seeking help, since the quality of counselors are not consistent. Also, one of the most important factors in successful treatment is the quality of the therapeutic relationship. If you are not feeling supported, it is important to seek out another practitioner. I wrote an article on things to consider here.

Curious if online counseling works? I wrote an article here, looking at the evidence.


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6 Comments

  1. willowwrites

    Hi Steve…I’ve been following you for awhile and enjoy your articles. I wanted to give you a personal view of the experience I just went through with online counselling. I followed your recommendation and tried BetterHelp. I had to sign up for a month just to get started (And was charged for the entire month ahead of time. When I opted out, I was charged for 2 full weeks – no free trial even though I mentioned it and no half a week as there were still a few days left in the second week.

    As for the sessions, out of the two weeks, the counselor assigned to me sent me two (obvious) form emails—one an introduction and the other asking a series of questions she wanted me to answer for her—both received in the middle of the night. I replied in depth the following day. Two days later I received a reply a few sentences long and was asked a couple more questions -again received in the middle of the night. Answered again the next day then waited two to three more days for a reply which was a few sentences long and contained a couple more short questions. I answered and waited for a couple more days for a reply. The next reply was an audio message that was just over a minute long and the counselor read back to me a section of my last email…all the while the TV is playing in the background. That was enough for me. I paid $130 for a few minutes of time spread out over 2 weeks, and no interaction or parameters for online sessions. When I went to cancel I mentioned about the trial week for free but that was not honored. I feel cheated.

    I let the counselor know I had opted out. She responded a couple of days later wishing me the best. Then after all is over I get another form email from the counselor telling me she will be going on vacation. Wow, I felt truly listened to.

    Such a disappointment and a waste of money that I really didn’t have to throw away.

    Reply
    • Steve Rose

      Wow.. thank you for sharing this. This is completely unacceptable behavior from a counselor. Also, that would seem misleading if they charged you, since it’s supposed to be a free trial. I am so sorry this happened to you. Although this service is an accessable lower cost option, I don’t want to send people there of that is the service provided. As in every setting, there is a wide range in quality of counselors and unfortunately, I’ve seen too many people encounter situations like this in my local community. I will look into this further and reassess sending people. I do believe you shouldn’t have been charged, since the free trial is meant to assess the quality of the person you have been assigned. Can you contact them and explain the situation? If so, let me know what they say. Here is their contact email address: contact@betterhelp.com

      Reply
      • willowwrites

        Wanted to follow up and let you know that my money was refunded and they attributed it to a computer glitch. No mention was made regarding the actions and/or lack of action of the counselor.

        Reply
        • Steve Rose

          Thank you for letting me know. I’m glad you got the refund! I’m sorry to hear their customer service is completely neglecting your bad experience. I am currently writing an article, inspired by your experience, to help people find better support.

          Reply
  2. Alice Carroll

    It’s interesting to know that counselling is a good way to be more aware of my own coping mechanisms. I’ve been losing a lot of weight lately, making me a bit concerned about my nutritional intake. Maybe getting to talk to a counselor can help in making me realize how the things in my life may be affecting me appetite and my diet.

    Reply

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