Although patients were generally appreciative of the counselling received, there was only limited evidence of improved outcomes in those referred to counselling. Stricter referral criteria to exclude the severely depressed may have yielded more conclusive results. It is also difficult to estimate the effect of recruitment by screening rather than GP referral, which may limit the applicability of the results to routine clinical practice, and may have interfered with the normal working alliance established between the GP, patient and counsellor. A patient preference trial may, therefore, have been more appropriate.
The results indicated that there were similar improvements for both CBT and psychodynamic counselling, but a larger population may have shown different results. The same results between experimental and control groups were found when analyses were conducted on those referred to the psychodynamic counsellors only. The lack of improvement in the initially severely depressed patients may have been due to the chronicity of their problems, and investigation into treatment for these patients remains important The therapy in this study tended to be short term, which is typical of most general practice counselling, but longer-term and more intensive therapy might possibly result in added benefits above GP care for the more severely depressed. It might be advisable to conduct a further trial of counselling in mildly depressed patients to investigate whether the findings of this study are confirmed. In the meantime, patients in this study are being followed up for 3 years to examine the long-term outcomes and between-group differences.