Berkshire Healthcare NHS Trust, UK
Cardiff and Vale NHS Trust, Department of Liaison Psychiatry, Room 222, Rawnsley Unit, Monmouth House, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
Guys, Kings and St Thomas School of Medicine and Institute of Psychiatry, London, UK
As the authors of the Cochrane Collaboration review on psychological debriefing (Rose et al, 2002) following exposure to a traumatic experience, we were concerned to see our research taken out of context during the recent media debate on counselling and psychotherapy. Our research related to the lack of evidence supporting a one-off intervention following trauma. Even its proponents would not regard this intervention as counselling or psychotherapy. Yet journalists have cited this research as new and generalised its findings to the extent of proclaiming that all counselling and psychotherapy is not useless but dangerous. This is unjustified.
The research is not new. We first published this as a systematic review in 1998 (Rose & Bisson, 1998) and it continues to be updated in the normal way. The generalisation of our findings is scientifically unacceptable and, more importantly, potentially harmful. It is clear that counselling and psychotherapy are not beneficial to everyone. However, there is good evidence that many psychological treatment approaches are effective, including multiple-session early intervention following traumatic events for those with acute stress disorder (Bryant et al, 1999).
Mental health problems are stigmatised, yet we now have powerful evidence-based psychological treatments for many common but serious disorders such as depression, phobias, panic disorder and obsessivecompulsive disorder. It would be regrettable if the legitimate debate on the role of counselling for everyday problems and difficulties were to inadvertently prevent people with treatable disorders from accessing helpful psychological therapies.
REFERENCES
Bryant, R. A., Sackville, T., Dang, S. T., et al
(1999) Treating acute stress disorder: an evaluation of
cognitive behavior therapy and supportive counselling techniques.
American Journal of Psychiatry,
156,
17801786.
Rose, S. & Bisson, J. (1998) One-off psychological interventions following trauma a systematic review of the literature. Journal of Traumatic Stress, 11, 697710.[Medline]
Rose, S., Bisson, J. & Wessely, S. (2002) A systematic review of brief psychological interventions (debriefing) for the treatment of immediate trauma related symptoms and the prevention of post-traumatic stress disorder. Cochrane Library, issue 4. Oxford: Update Software.
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