DOES COUNSELLING WORK?
984 People Who've Done It, Told Us The Truth:
Our original research from 984 people who've completed counselling, has a clear answer.
The primary question most folks have around counselling - or any mental health treatment is - does it work?
Will it work for me? Will it be effective for my anxiety/depression/anger/(insert your ailment here...)
We surveyed 984 clients who'd completed therapy in the last 5 years, to help us decide once and for all:
Does Counselling Work?
We designed our research to include what professionals consider the key tenets of a counselling relationship, as well as actually getting real-world results.
This is a detailed debriefing on what clients need, want, and expect.
Here's what we looked at: (click to expand)
We wanted to find out about:
See the complete set up of the research here, including audience, demographics, etc.
All the data we gathered is from the client's point-of-view.
This research lays out key insights for counsellors and mental health practitioners:
So...let's dive in:
Part 1 - Buying Factors
First up, how do clients arrive at counselling in the first place?
We wanted to help counsellors understand more about the factors most important to clients, in their decision to proceed with, or "buy", counselling.
This will help counsellors:
It Was (Often Not) Easy To Find The Right Counsellor
Of all elements of the buying decision process, our audience told us that "finding the right counsellor" was the biggest problem they experienced.
"It was easy to find the right counsellor" - do you agree?
Only 44% of 984 agreed "it was easy to find the right counsellor."
56% were either neutral, or felt it was *not* easy to find the right counsellor.
The definition of the "right" counsellor is subjective of course, but we wanted first hand data, in the client's own opinion, for this research.
Looking closer at this sub-segment who disagreed, there are relevant correlations here to number of sessions completed, age group, and presenting problem.
44% of those who found difficulty finding the right counsellor, had completed 16 or more sessions, an early indicator of dissatisfaction from this subsection, that would be confirmed later in the research.
We would have hoped that a greater number of sessions between client and counsellor should have helped foster greater rapport, and an environment supporting change, however this didn't appear to be the case.
In addition, 354/554 - or 64% - of those with difficulty finding the right match, were in the younger age group of 18-34:
Finally, among those who found it difficult to find the right counsellor, the top 3 presenting problems were Depression (204/554), Anxiety (149/554) and Trauma/PTSD (111/554) - undoubtedly complex issues, requiring sensitive handling, and experience:
It's possible that the greater incidence of these presenting problems in this sub-set is indicative of a need for deeper psychological work than counselling alone could provide, e.g. longer term psychotherapy work, or onward referral for more specialist intervention.
This initial difficulty finding the right help, became a theme, which was repeated and corroborated later in the research.
Finding Counselling Help Quickly
"I was able to access counselling as quickly as I needed" - do you agree?
Overall, 561/984, or 57% of clients, agreed they were able to access counselling quickly enough.
The data here was fairly uniform, with no huge spikes to report based on number of sessions, demographics, or most other factors.
The only outlier, was in how clients paid for counselling.
Clients self-attributed to one of 4 categories, in how they paid for the counselling they received:
Here is how easily each group could access counselling:
While insurance services, arguably dealing with the greatest volume of clients, remain just as accessible as free services, clients subsidising their own treatment reported the greatest frustration accessing counselling sessions as quickly as they needed.
Most Important Buying Factors For Counselling
"How Important Are These Factors, When Looking For Counselling Help?"
Counsellors: Would you like to know what you should be focussing on, in your practice, to attract more clients?
We asked clients to rate the factors most important to them, during the process of finding, and starting, counselling sessions.
Here's what they told us. The results here were very tightly packed together, so we've added the full detail below, to help make fine distinctions.
The most important elements, that influence clients to "buy" counselling are (click to expand):
The #1 most important factor for clients, when proceeding with counselling, is Counsellor Competence.
Focussing only on the "Very Important" category:
Location (where the counselling takes place) is the least important factor for prospective clients.
This is good news, given the current covid-19 climate, indicating that the majority of clients may be open to remote counselling solutions such as video/audio conferencing software.
How could you use these results to better structure your practice?
Standalone, these results are interesting. But later, we'll consider the emerging picture of the importance of counsellor competence, in the client's mind.
Counsellor Takeaways - Buying Factors
Part 2 - Key Tenets Of Counselling
Before gathering qualitative, subjective opinion on client satisfaction levels, it's important to baseline counsellor's performance in terms of their fulfilment of key counselling tenets, which many consider to be essential elements in any therapeutic relationship.
In the research, we asked clients to separate their opinions, on what was achieved during counselling (results) .v. how it was achieved (key tenets).
"My counsellor fulfilled the key tenets of a therapeutic relationship" - do you agree?
We asked clients to rate the performance of their counsellor in the following specific areas (click to expand):
While the majority of clients reported a positive experience in most key tenets of the therapeutic relationship, there was a noticeable drop-off in opinion, in 4 significant areas:
We learned earlier, that that #1 most important buying factor for clients, is Counsellor Competence.
Now we can see from the above data, this is the one key area where we're letting them down the most.
The story that's beginning to emerge is that counselling clients appreciate the experience and environment provided by counselling, but the counsellor's ability to get results, remains #1 priority.
Counsellors are generally fulfilling most of the key tenets of a therapeutic relationship well...
But fall short on nurturing the aspects of acceptance, hope, empathy, and perceived competence.
Counsellor Takeaways - Key Tenets
Part 3 - Results From Counselling
Now we're getting to the meat of the issue.
The issue that brought me to counselling, is resolved" - do you agree?
Surprisingly, only 38% of total participants agreed that the issue they came to counselling to overcome, was actually resolved:
It would appear, that long term counselling clients struggle the most, to get their issues fully resolved - especially younger clients.
However, it's important to make clear that 207 out of 430 participants who had completed 16 or more sessions of counselling, were still actively in treatment at the time of the research.
Therefore, metrics for success, cannot be judged conclusively, for this demographic.
Sidenote - Whilst introductory information to the survey made it clear that we were looking for those who had *completed* a course of counselling, this was obviously not clear enough, based on the responses above.
This is a shortfall in our data collection, that we would of course correct, if we were repeating the research.
Results Across Age Groups
Results From Those Who Had Tried Other Means To Overcome Their Issue
"Before counselling, did you attempt to overcome your issue via other methods?"
So...we're now building a profile picture of the commonalities among clients with greatest difficulty achieving results: Age 18-34, 16+ sessions, attending for PTSD/trauma, and have previously tried other modalities to overcome their issue.
Despite these somewhat depressing statistics, most do report that their issues have at least somewhat improved via counselling sessions...
"Has the issue that brought you to counselling, improved?"
The majority saw a number of improvements across multiple areas of life, following counselling.
Quality Of Life Improvements, Since Counselling
"Since counselling, have there been improvements in other areas of life?"
Since counselling, 78% reported an increased understanding of self.
Quality Of Life Improvements .v. No Of Sessions
Is it possible that this client group had initially presented with less complex problems, and taken the time to fully resolve them?
We cannot extrapolate this from the data, however this is a common opinion among counsellors we spoke to, with real-world experience.
Compared To Other Attempts To Remedy The Problem, How Did Counselling Stack Up?
This is a juicy one.
727/984, or 74%, of our audience had previously made other attempts, via different modalities, to tackle the problem, that they were now applying counselling to.
Reassuringly, 496/727 (68%) told us counselling helped MORE than their other attempts to remedy the problem they were experiencing:
The top 3 issues where counselling did not help more than other modalities, were:
Counsellor Takeaways - Results
Part 4 - Client Satisfaction
The answer to "Does Counselling Work?", cannot be understood without measuring client satisfaction levels, with the overall counselling experience.
The satisfaction score questions we asked, are subjective, intentionally so - this is the 'opinion poll' part where we want to ascertain an understanding of clients' overall happiness with all aspects of the counselling experience.
"Would you undertake counselling again, if the need arose?"
88% Would Complete Counselling Again
A whopping 866/984 (88%) said they would undertake counselling again, if the need arose, with only 118/984 (12%) stating they may not repeat counselling in future.
"Were You Satisfied Of Your Counsellor's Ability To Help You?"
74% Were Satisfied Their Counsellor Could Help Them
726/984, or 74%, told us they were satisfied their counsellor had the ability to help them.
But again we see a noticeable age differential here - 75/115 (65%) of those who were not satisfied their counsellor could help them, were aged 18-34:
Is This Goodbye?
"How satisfied were you, with how counselling ended?"
Only 54% Were Satisfied With How Counselling Ended;
18% Were Openly Unhappy
Again we see a heavy weighting here to the younger age group - 294/447 (66%) who were either "Neutral" "Dissatisfied" or "Very Dissatisfied" with how counselling ended, were in the 18-34 age bracket.
Slicing the data a different way, of those who were neutral or unhappy with how counselling ended, a total of 62% were suffering from anxiety or depression when first presenting:
"How satisfied were you, with your overall experience of counselling?"
75% Were Happy With Their Overall Experience Of Counselling
Ranking The Top 9 Reasons Clients Stop Attending Counselling Sessions
Why do clients stop attending counselling?
We've all been there - a client who's making excellent progress, suddenly stops attending sessions.
It's natural to wonder upon the real reasons behind these lapses.
"What is the reason you're no longer attending counselling?"
Beyond those still in counselling, or who no longer needed help, the top 9 reasons were:
Interestingly, only 2% cited Covid-19 as the main reason they were no longer attending counselling - although the data was taken early in the crisis, and likely many counsellors had not yet moved to a virtual platform.
3% were no longer benefitting from counselling as either the counsellor or client had changed addresses - as counsellors we need to ensure that continuity of care is in place, for any clients no longer our care, no matter the reason.
Counsellor Takeaways - Client Satisfaction
Part 5 - Houston, We Have A (Counselling) Problem
What is the one aspect of counselling which clients dislike the most, or struggle most with, to overcome?
"What was your biggest challenge, frustration, or problem, with counselling?"
They told us directly...
The biggest frustration, challenge or problem clients have, throughout the entire counselling process, is the one we saw right at the start of the "buying process":
Finding The Right Counsellor
These 3 reasons remained the top 3 biggest problems individuals have with counselling, even where counselling was their first attempt to overcome the problem with any modality.
These 3 reasons also remained consistent across age groups and types of presenting problems.
So....time to get working on them.
Non-Paid Services Struggle More To Achieve Positive Results From Counselling
We were slightly concerned to see a qualitative, fundamental issue such as achieving positive results, as high as number 3 on the list.
There does seem to be a correlation in the data between paid .v. free services - of those who felt achieving positive results was the biggest issue, 36% received counselling free of charge, a whopping 40% received counselling via an insurance policy, while just half that - 18% of complaints about lack of positive results - came from those who paid for treatment personally.
The lowest number of complaints about lack of positive results came from those who received subsidised counselling.
Are insurance and free services overstretched? To the point where it's impacting on client outcomes?
Perhaps the data here speaks of (i) the beginning of a shift from free to policy-based services (ii) and/or the resultant strain, upon the resources, of those servicing the counselling work behind these policies.
Counselling Still Helps More Than Other Modalities
Nevertheless, nearly 46% of those who told us the biggest problem was achieving positive results, told us counselling *still* helped more than other modalities' attempts to overcome their presenting problem.
So, even in those who've struggled to get positive results from counselling, therapy still helped more than other methods....but just not enough to fully resolve it.
When Counselling Goes Wrong
So what explains this apparent pattern of "improvement, but incomplete resolution of issue" , that we're beginning to see emerge?
"If counselling did not work for you, why do you think that was?"
Clients tell us, the #1 reason why counselling didn't work for them, is:
"Events that took place outside therapy disrupted my progress."
The top reasons clients believe counselling didn't work for them:
This data remains consistent across and throughout presenting problem types, number of counselling sessions completed, gender, and many other dimensions.
Whilst this offers us some reassurance that clients *do* recognise counsellor competence and progress during sessions, the data tells us they have significant problems maintaining the results achieved, either between sessions, or in the longer term.
As Counsellors, We Are Failing To Connect With Younger Clients
One of the only discerning factors among those dissatified with counselling is a startling disparity across age:
- 83% of those reporting that counselling didn't work for them are aged 18-44;
- only 17% of the age group 45-65+ felt that counselling did not work for them.
Longer Term Clients Report Greatest Concern Over Key Counselling Tenets
Worryingly, nearly 44% (52/119) of those in longer term counselling (16 sessions+) cited the main reason they believed counselling did not work for them, was an issue with one of the counselling tenets: trust/safety/respect/impartiality/hope/acceptance.
Those in treatment for 16 weeks+ reported this concern more often than clients in any other timeframe of therapy.
Counsellor Takeaways - Problems With Counselling
Part 6 - Segmenting By: Presenting Problem
We noticed significant patterns in the data, when viewing through the lens of each presenting problem type.
Victims of Trauma/PTSD had the most difficulty succeeding in therapy
"OTHER"/MULTIPLE PRESENTING PROBLEMS
This group described themselves as having a presenting problem lying outwith the categories of Depression, Anxiety, Trauma/PTSD, Relationship Issues, Self-Esteem, Bereavement, or Addiction.
Often, the notes added by clients referred to co-occurring issues, or attempting to remedy multiple issues at once, through counselling.
59% of those with multiple treatment issues, told us that the issue they attended counselling for, was not resolved.
Conversely, 59% of those attending for Addiction issues, felt that the issue they attended counselling for, was resolved - the highest resolution rate of any problem-type.
55% of those seeking help for Bereavement felt it was easy to find the right counsellor; where only 10% felt it was not easy.
90% of those seeking help for Relationship issues felt the experience of the counsellor was important.
Counsellor Takeaways - Segmenting By Presenting Problems
Part 7 - Do Clients Recommend Counselling, To Others?
Since therapy is such a personal experience, and practices are built upon word of mouth referrals, satisfaction research couldn't be complete, without understanding if clients would recommend counselling, to others.
Human beings tend to recommend specific people to friends and peers, so we made sure here to make a clear distinction between recommending counselling itself, as opposed to the client's counsellor personally.
"How likely are you to recommend counselling itself (and not your personal counsellor) to a friend or colleague?"
51% were "extremely likely" to recommend counselling to others; and 88% were "likely" (6) or greater, on our scale.
Part 8 - How Clients Describe Counselling, In Their Own Words
The ultimate qualitative feedback on whether counselling works or not, is of course, in the client's own words.
"Please describe your overall experience of counselling, in one word."
Here's what they told us (click to expand):
The graphic shows words in bigger sizes, proportionate to the quantity of repetitions, from clients in the data.
It's reassuring here to see terms like "enlightening," "empowering," and "helpful," featuring so prominently.
We must remember, it takes a lot for someone to reach out and ask for help, when they feel vulnerable, and counselling clients deserve our very best.
Part 9 - Discussion
As counsellors, we know better than most, that drawing conclusions and giving meaning to data (and events) can be a dangerous business.
Nevertheless, narrowing the data down, we can see some commonalities that could help us improve counselling practices.
Certain questions during the survey looked and felt similar - deliberately so.
We wanted to see if we could achieve consistency in clients' responses, between elements of the therapeutic relationship, versus real-world results, across different question types.
Pulling the threads of the data together, we consistently saw a repeating pattern of clients expressing positive sentiments toward the *elements within* counselling, such as, most aspects of the therapeutic relationship, how counselling improved their lives laterally, and how well counselling performed relative to other attempted interventions. Their qualitative feedback on counselling was also hugely reassuring.
By reading the responses to different questions, we can see that clients are telling us they see tangible improvements in their issues as a result of counselling, but not full resolution.
The underlying message from the data seems to be that counselling clients enjoy all the qualities, environment, and softer elements the therapeutic relationship provides, but are unhappy with the real-world results achieved from counselling, especially within certain client demographics and presenting problems.
Part 10 - Conclusions & Final Takeaways
So, Does Counselling Work?
As counsellors, we should take huge comfort and reassurance from the fact that:
It would be difficult to conclude from this, anything other than "Counselling Works."
However, it's clear we still have work to do, to address shortfalls in:
So...we've drawn back the curtain, to reveal clients' real thoughts on therapy and counselling, and how it affects their lives.
Now, over to you - how will YOU use this invaluable feedback from clients to improve your practice?
Complimentary infographic sharing the key findings:
How The Research Was Done
Demographics (click to expand)
Everything In Perspective
Healthy context and perspective is central to therapy, and should be central to your view of therapy itself too.
For comparison and context purposes, these (academic) studies highlight/reveal/lay out their findings from an academic standpoint/evidence based.
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