"Downgrading of counselling in NICE guidelines for depression"

About: NICE, IAPT, NHS mental health services

(as a staff member),

New draft NICE guidelines may soon downgrade counselling and psychodynamic psychotherapy for the treatment of depression. They state that counselling can only be offered if low intensity or group CBT have been declined, and that even then the practitioner much explain that there is uncertainty about its effectiveness.

The uncertainty about the effectiveness stems from the hierarchy of research evidence used by NICE, where the randomised controlled trial is the gold standard. Cognitive Behavioural Therapy (CBT) benefits from being able to show evidence from many RCTs, while much less quantitative research has been carried out into counselling. In the view of many people, counsellors, other professionals and patients, this doesn't prove in any way that counselling is less effective, just that there is less evidence for its effectiveness.

However, if these NICE guidelines come into force, there seems to be a great danger that counselling and other forms of psychotherapy other than CBT will be squeezed out of the NHS, restricting patient choice and depriving people of a service that many have found to be a life-saver.

Professional bodies such as the British Association of Counselling and Psychotherapy are of course planning a response to the NICE consultation. However it seems to me that the voice of the patient will be much more important in influencing NICE. Are there people out there reading this who have benefited from counselling? There may be people for whom the idea that counselling may no longer be offered for free on the NHS would raise a lot of anxiety. Please add your opinion, and help to make sure that NICE recognises counselling as the invaluable treatment for depression that it is.

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