Introduction

In this chapter, we will consider the role of counselling for those presenting with acute and chronic social problems. We will also include the role of counselling for those with physical ill health, with its major role in the prevention of anxiety and depression resulting from illness. The counselling skills of primary care professionals will be considered as well as those offered by trained counsellors.

The development of mental illness is the result of a combination of factors including individual characteristics (biological, heredity, childhood experiences) and the individual's perception of their current environment. Aspects of the individual's environment known to be associated with an increased high risk of developing mental illness have been discussed in Chapter 3. We need to consider the role of acute and chronic social stressors, including relationship difficulties and social problems such as unemployment, poor housing and financial difficulties. The role of social support is also important. Providing social support reduces the likelihood of mental distress resulting from life events and social problems, although controversy remains as to whether it has a direct positive effect upon health or whether it acts only as a ‘buffer’, modifying the effects of stressors (Murray, 1992).

The primary health care team can try to reduce social stresses directly: reducing the stress imposed by marital disharmony by offering marital counselling, for example. The team may also try to reduce the subjective impact of life events.