Christian counselling and your GP surgery

You may be surprised to discover that the supposition of popular philosopher and TheTimes’s columnist, A.C. Grayling, and your local GP probably coincide — roughly one third of all visits to the doctor’s surgery have a psychological cause.

It is widely accepted that there is a very real, but often indefinable, grey zone between diagnosable physical ailments, that GPs are trained to treat or refer, and recognised mental health issues which are referred on to the psychiatric service.

Two patients

A patient sits herself down somewhat self-consciously on the edge of a chair in her GP’s consulting room. It’s a bleak, rainy February morning. She tells the doctor she has constant headaches, feels faint and is not sleeping. Less than an hour later another patient dashes into the surgery, late for his appointment. Be-suited and nearly affluent, he is talking irritably into his mobile. He complains of palpitations, feeling sick and ‘run down’. ‘Yes’, he admits, ‘It’s frantic at work’. Our GP has around five minutes with each patient, knows instinctively, because she has seen these two patients before and checked that there are no presenting physical reasons for their symptoms, that she is dealing with problems in the grey zone. Because she can see no other solution she reluctantly prescribes anti-depressants, washed down, in the case of our mobile-berating friend, with a sick note for that demanding boss.

In defence of many fine GPs, it is known that in increasing numbers they are wary of simply prescribing a numbing-down course of anti-depressants, and are keen to find other ways forward.

Of course, many Christian counsellors, while careful not to downplay the value of a carefully managed course of anti-depressants or anti-anxiety drugs, can see that the symptoms presented by our rainy February and nearly affluent patients are only being deadened and deflected by a GP who guesses that there is more to their problems than meets the eye and stethoscope but has neither the time nor the expertise to do other than she did.

The real problem

If you are a trained counsellor you have probably helped clients presenting symptoms similar to those sketched above. You know that, given the right context, our first patient may disclose a background of sexual abuse as a child, who now finds herself in an abusive and violent relationship. And our second a tendency towards perfectionism stemming from a critical father, a propensity to heap expectation onto self and a desperation to be accepted and successful. Of course, skilled counselling might lead to the discovery of different underlying problems, but underlying problems there probably are, and counselling, as well as, or instead of, anti-depressants, might better help.

Working model

Christine was a Practice Nurse working in Primary Care. Alongside her nursing she trained to become a counsellor, receiving Christian counselling training with CWR and completing a secular counselling diploma course and other Cognitive Behaviour Therapy courses. For 18 years she has offered a counselling service at her local GP surgery in Reading, Berkshire. It is a large practice of 13 doctors, serving 28,000 registered patients. Working on our notional ratio of one in three, the setting provides significant demand for Christine’s training and experience.

Initially, Christine offered her services free of charge as a volunteer. She then found a Trust to support what was clearly a much-needed initiative. Later, Christine was directly employed by the surgery. Two consulting rooms were specially built and her team augmented. Christine and her team of five Christian counsellors offered a highly regarded and much sought-after service. She was also asked to offer counselling training to GPs as part of their Vocational Training Scheme prior to a career in general practice.

It proved remarkably difficult to lay hold of hard facts about the extent to which counselling is today complementing the care offered by GP surgeries. The Department of Health keeps no central record and suggests that it is a matter for local Primary Care Trusts. None of the several PCTs that were contacted could shed any light, commenting in turn that it was a matter for individual surgeries. It seems that there are no centrally held statistics.

Funding

GP practices receive funding from their local PCT, out of which they are mandated to provide ‘Core Services’. Funding is also provided for ‘Extended Services’. It is from this latter funding stream that surgeries are able to make referrals to ‘alternative’ practitioners, various complementary therapists and also counsellors. Extended Services money can be spent at the discretion of individual surgeries. Some, seeing the need and worth of counselling, allocate a meaningful portion to it. Occasionally, this is spent in collaboration with other nearby surgeries, funding a range of counselling specialists across a region to which any participating GP can refer patients. In practice, the call on limited Extended Services funding is clamorous and the amount spent on counselling, often squeezed. The general anecdotal consensus is that most GPs would welcome the chance to confidently refer patients to recognised counsellors but are all too often financially constrained.

Opportunity

It is now generally accepted by the church in the UK that within the education sector, stretched human resources and only modest government funding have created openings for Christians to contribute to faith aspects of the national curriculum and to pastoral care. For similar reasons, the health care sector now presents meaningful opportunities for Christians to get involved. Just reflect on the GP’s dilemma — a growing awareness of the benefits of counselling, concerns about routinely prescribing anti-depressants and the too-quickly exhausted surgery budget.

Christine is an enthusiast. Although PCT funding for the counselling service she managed in Reading was stopped two years ago (there appears to be contradictory spending trends across the country), she and a colleague have set up a private service within the surgery. Regardless of the vagaries of funding, the openness of GPs generally to refer patients for counselling is greater than ever. ‘I would urge Christian counsellors and those considering training to become counsellors, to seriously contemplate working in tandem with a GP surgery. The need is great and the work both challenging and worthwhile.’ The team in Reading, while subsidising some patients and receiving small amounts from charities for others, are busier than ever offering cognitive behavioural therapy; stress, anxiety and anger management techniques; bereavement counselling, and much more.

So, how might a local church with a team of counsellors or an individual Christian counselling professional make the most of current circumstances? Perhaps three ideas might be advanced:

1. There are occasional opportunities for counsellors to be employed (usually part-time) by GP surgeries. Funding is limited and competition to fill vacancies stiff. Christian counsellors ought to ensure that their training and knowledge are up to date, their CVs strong, and that they are accredited.

2. Funding, not the will to refer, is often the issue. A church or group of churches might be able to raise the funds to support a counsellor, enabling counselling to be offered at their local surgery free of charge or for a small donation.

3. Talk to your local GP surgery. If you are able to offer a reputable counselling service in your church or from another convenient venue in your community, it may well be that local GPs will gain the confidence to refer patients to your service.

Training

If it is established that a significant minority of those who visit a doctor really need counselling, not medicine, and that in parallel most GPs would rather refer a patient for counselling than resort to the decades’ old reflex of treating the symptoms rather than the cause, then there is an argument for Christians, keen to shed abroad the love of Christ, to access counselling training and push this door wide open.

Many would argue that a blend of Christian and secular training is best. Christine would certainly argue for the benefits of including some specifically Christian understandings and exploring ‘wholeness’. She talks energetically of the way in which encouraging a patient to explore issues around, for instance, unforgiveness, has led to counselling breakthroughs and the chance to consider Christian values. Of her own training she says, ‘The CWR model provided a grid that other models fit into. CWR’s training was so helpful and undergirds all my counselling work.’

Action

There will be many Christians alert enough to grasp the potential of offering counselling skills in response to our GPs’ regular grey-zone dilemma and in so doing serve their community and touch the lives of many in real distress who would never think of turning to their local church for help.