Counselling is not appropriate for all patients with cancer
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7176.128 (Published 09 January 1999) Cite this as: BMJ 1999;318:128
- Clare Moynihan, Medical sociologist.,
- Alan Horwich, Professor of radiotherapy,
- Judith Bliss, Statistician
- Academic Department of Radiotherapy, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey SM2 5PT
- Department of Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5PT
EDITOR—Young makes important points in stating that psychological interventions differ in theory and practice1; each intervention must be defined so that the correct terminology is used by health professionals to facilitate appropriate interventions. She claims that our evaluation of the use of adjuvant psychological therapy in patients with cancer erroneously interchanged the terms “psychotherapy,” “counselling,” and “adjuvant psychological therapy,” and that we dismissed “the benefits of counselling for patients with cancer on the basis of a study that used adjuvant psychological therapy.”2 She infers that the low response rate in our study may indicate that adjuvant psychological therapy might not have been “appropriate” although other approaches to counselling might have been effective.
We believe that since all categories of counselling are part of the “therapeutic enterprise” 3 4 the terminology is interchangeable. Information giving and reassurance are a form of counselling since they help to “contain” the person to whom they are given, “containment” being the necessary condition of patient support.
We do not, however, dispute that different approaches have their own theoretical underpinning nor that they are made explicit. Our report provided a reference to the theory underlying adjuvant psychological therapy.
When we elicited consent from patients to enter the trial, the method of counselling was described. The low response rate suggests, among other things, that these patients had an ability to cope, or a wish to be seen to be coping, or simply an aversion to the ethos of counselling. Patients' refusals to participate are as interesting as their acceptances, and it is imperative that we listen to their voices.
We do not dismiss the benefits of counselling for patients with cancer. We have evaluated a specific approach in a specific group of patients with cancer and concluded that adjuvant psychological therapy need not be routinely offered to men with testicular tumours. We make a plea for caution with regard to the blind faith that counselling will be gratefully received and will be effective despite a dearth of sound evidence.