Psychotherapy and Counselling Services Referral
The recognition and treatment of anxiety and depression, and knowing when to refer to psychotherapy or counselling is a challenging area of clinical practice, especially in primary care where there are many patients with various presentations and a multitude of causes for distress. There is evidence showing patient preference for psychotherapy and counselling above treatment by medication.

The somatic symptoms of depression and anxiety present the most significant barrier to recognition that psychotherapy may be of help because patients who somatise their symptoms will often lead their physician to think there is a physical reason for the symptoms. This preoccupation with physical illness often delays or prevents diagnosis. Care models focus on recognizing depression by initially assessing patient mood and interest, suggesting psychotherapy and counselling for patients who have mild depression, and pharmacologic and psychotherapy or counselling for patients who have moderate-to-severe depression.

Some physicians feel that barriers arise most frequently from factors centred with the patients, their psychosocial circumstances, and their attitudes and beliefs about depression and its care, and about pop-psychology attitudes to what psychotherapy and counselling are. Most primary care patients who experience depression state that they would prefer psychotherapy over antidepressant medications.

A particular concern with patients accessing private psychotherapy is the cost.

Hugh Palmer Psychotherapy has a sliding fee scale of £35.00 to £80.00 determined by income and circumstances (if home visits are required, this will add to the cost).
However, much lower fees may be negotiated in consultation with the referring G.P.

Indications for Psychotherapy and Counselling
“What treatment, by whom, is most effective for this individual, with that specific problem, and under which set of circumstances?” Put simply, the assessor seeks to determine which type of psychotherapeutic intervention is likely to be most appropriate and at what level.

This calls for:

• Expertise in a thorough psychiatric evaluation beyond just making a psychiatric diagnosis
• Knowledge about different forms of psychotherapy and counselling and the general indications for each
• Knowing how to initiate the necessary referrals to psychotherapy and counselling services.

Evaluation of Psychotherapy and Counselling
Very often the referring doctor fails to follow up with patients they have referred for psychotherapy and counselling. This is unwise from various points of view. Firstly, many patients do not even turn up for the first counselling session and some patients drop out of psychotherapy and counselling even under the best hands. Secondly, psychotherapists need to be accountable to the referring doctor to a certain extent.

Contracts
I am happy to negotiate contractual arrangements for providing psychotherapeutic services. Please contact me to discuss this.