Introduction

It has been estimated that as many as one-third of all patients who consult a doctor do so because they have a ‘personal problem’, or real physical symptoms, causing them distress and reflecting an underlying psycho-social problem (Pereira Gray, 1988). Often patients first present with such ‘life-problems’ or psychosomatic symptoms during a medical consultation lasting a matter of minutes. If the doctor has no psychological training, the ‘life-problem’, or psychosomatic symptoms may well be medicalized, i.e. treated solely or principally as an organic complaint. Treatment then tends to take the form of psychotropic drugs. The consequence may well be that the condition becomes chronic, or fails to improve, resulting in yet more frequent consultations and further prescriptions. Many observers have commented on the enormous amount of personal distress that this scenario causes to patients and the huge resulting costs to healthcare providers (Maguire & Pitceathly, 2002).

Counselling, among other forms of psychological help, may well be beneficial for patients presenting with such problems. The counsellor working with people in medical settings can provide time in which patients may express feelings about loss of abilities, roles and self-esteem and assist them in coming to terms and/or coping with these and other changes. In addition to the psychological benefits of counselling, there are at least some indications that the presence of a counsellor in the primary healthcare team leads to a reduction in patients' psychosomatic symptoms, a consequent reduction in drug prescription rates and a reduction in the demand for the time of medical staff.