This paper reviews the evidence for the effectiveness of counselling and psychotherapy, and highlights the factors that contribute to its success.

Overview

Following a brief historical summary of three mainstream approaches, this paper addresses the similarities and differences between the terms counselling and psychotherapy. After settling on counselling as the default term, the paper then provides a comprehensive definition, explores counselling's essentially voluntary nature and examines the practice and research divide between individual, couples and family focused work. Though there is good evidence for the effectiveness of individual, as well as couples and family counselling, it is acknowledged that amassing the evidence with respect to couples and family work has proved to be a more challenging task. The finding that the strength of counselling effectiveness has altered little over the past 40 years is then linked to the question of how counselling works. The evidence points away from a medically grounded focus on differential effects of particular models of counselling, towards common factors - especially the nature of the counsellor-client alliance - that appear to be present in all successful counselling outcomes. The common factors findings, in turn, suggest the need for a shift in focus from the relative efficacy of differing models of counselling to research into counsellor training and the ongoing development of counsellor expertise. A key correlate of this continued development has been shown to be counsellors' capacity and willingness to seek and act upon client feedback. Moreover, the formalisation of a feedback-informed approach via validated, user-friendly client feedback protocols permits the monitoring of outcomes on both a case-by-case and aggregate basis. This in turn provides a way forward with respect to developing an ongoing accountability framework for counsellors, counselling agencies and their funders.