Marriage counselling in general practice: an assessment of the work of marriage guidance counsellors in a general medical practice

This study describes, discusses and assesses the impact of a marriage guidance counselling service in a general medical practice. It considers the role of the counsellor in the primary health care team, the appropriateness of providing a counselling service in this setting and the nature and effect of the counselling as experienced by individual clients. The material derives from records provided by the counsellors, from medical casenotes and from interviews with 83 clients counselled at the practice, with their counsellors and with their CPs. The counselling service did appear to be a valued and valuable addition to the range of practice services. It was viewed by clients, counsellors and CPs. as contributing to the quality of patient care, as increasing access to counselling for potential clients and as improving the status and job satisfaction of counsellors. Over half of the clients interviewed had found the counselling of substantial and lasting help and only one-fifth reported no help at all. However, there were significant discrepancies between the assessments of clients, those of their counsellors and those of their CPs., emphasising the dangers of equating client satisfaction with professional judgements. There was also no evidence from medical casenotes to substantiate the claims that counselling in this setting reduces demand for medical services. In addition, if this was to become a general policy development, there were argued to be some unresolved issues in areas such as the desirability of moving towards access to counselling through medical referral? the motivation of clients for whom counselling was 'prescribed'; and the pressures on unpaid, part-time counsellors and on their voluntary marriage guidance organisation, in terms of the most appropriate use of their limited resources and the difficulties of working along side a statutory, highly professionalised service, provided largely 'free' at the point of demand.