A Cochrane review included 9 studies with a total of 1384 subjects. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (SMD -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (SMD -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (SMD -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions.
Comment: The quality of evidence is downgraded by indirectness (the results may not be applicable to other health care contexts, as counselling is mainly a UK practice, counselling was not compared with other psychological therapies).