Counselling and interpersonal therapies for depression: towards securing an evidence-base

Both generic counselling (delivered by BACP level counsellors in primary ca re settings) and the interpersonal therapies place a central value on the r ole and function of relationships - both within and outside the practice se tting - as a vehicle for understanding and treating people presenting with depression. Recent studies have compared generic counselling with antidepre ssant medication, usual GP care, cognitive-behaviour therapy (CBT), and as an adjunct to GP care (i.e. in combination with GP care). Findings suggest either that there is no difference between generic counselling and other tr eatment conditions, or that there are small advantages to counselling over usual GP care but only in the short-term with such differences disappearing at 1-year. Studies investigating the interpersonal therapies (IPT) have es tablished that the content of such therapies differ in their content from b ehavioural and cognitive therapies despite the outcomes being broadly simil ar. Considerable research effort has focused on the process of change in IP therapies. Important factors include the level of prior commitment by the patient to psychological therapy and their confidence in the therapist. Pat ients with well assimilated problems tend to do better in CBT than psychody namic-interpersonal therapy. Therapists need to be flexible and responsive to patient needs particularly concerning interpersonal and attachment issue s. Future research in counselling needs to identify the effective component s of generic counselling and relate these to a theoretical base. In the IP therapies, there needs to be a greater focus on the change outside the ther apy session and on the effectiveness of such therapies in non-research sett ings.