What difference does counselling make?

This page includes three reports in total, two reports on research carried out by the University of Edinburgh, Counselling and Psychotherapy department in review of feedback received from clients of Simpson House Counselling from client evaluation questionnaires and an abridged report on research conducted by Simpson House Counselling on 'What difference does counselling make?'

What's this about?

We did a research study involving six in-depth interviews with clients from Simpson House, living on low incomes, who had used drugs and received counselling for at least six months.


We wanted to give clients a chance to say what they thought of the service. We wanted to find out what difference counselling had made and what clients had found helpful and also unhelpful. We wanted to learn from clients, to inform how we work as counsellors.

A summary of what we found out:

The study has shown how people who are using drugs and are on low incomes can make significant changes in their lives through participating in counselling for six months or more.

Before counselling: clients described experiences such as being self destructive, isolated, feeling they were losing it, and were unsure about coming for counselling.

Through counselling: clients experienced personal growth, increased care for themselves, were able to relate to others differently, had an improved quality of life, changed their drug using, had actively participated in counselling and were able to judge the services of the counsellor.

The study also highlights for counsellors what is helpful and unhelpful for clients, and this can aid counsellors in their work. Both counsellor and client are actively involved in making change a possibility through working together in counselling, but ultimately it is the client who changes themselves.

"I think it was getting quite old for me coming in and my counsellor sitting there helping me out. I was the one at the end of the day that had to make these changes" - Marie (all the names used in this report are made up).

This is what we found out in more detail…

1. Clients experienced changes through coming for counselling:

a) Clients had been self-destructive

"I was um committing suicide and things like that….I was just real self-destructive" - Marie.

Through counselling clients experienced personal growth and increased care for themselves.

 "Counselling has gave me a lot of confidence in dealing with things….I feel ….empowered" - Brian.

All clients felt they had made progress through counselling, such as increases in confidence, self-esteem, self-acceptance, motivation, assertiveness, and becoming more able to deal with feelings.

b) Clients had been isolated

"it was like being in a prison, you know…. I didn’t really speak to anybody about it…." - Carol.

All clients spoke of being isolated in different ways such as feeling lost or disconnected from others, being fearful of people, feeling marginalised through heavy drug use and that they had lost their social skills.

Through counselling clients became able to relate to others differently.

"But coming to this counselling has sort of like stopped me being isolated too much and me sitting here talking…has proved to me I can get along with people." - Tony.

Clients saw improvements in how they related to others including becoming less violent towards others, more able to relate, to respect others and make changes in relationships, and more able to ask for help.      

c) Clients had felt they were "losing it"

Clients spoke about how before counselling they had a sense of lack of control or ‘losing it’ in relation to aspects of living such as drug use, physical health problems, behaviour, and debt. Some had felt that their life was being destroyed.

"I started losing consciousness …some days I was dying and it was all I could do to get here." - Carol.

Through counselling clients achieved an improved quality of life and a changed relationship with drug use.

Counselling had lead to an improved quality of life for all including becoming more able to take opportunities, consider returning to work, come off benefits, make decisions, take exercise, and have more structure in their lives.

All reported changes in their relationship with drug using, such as stopping or decreasing drug use, increases in understanding reasons for use and reasons for relapse, taking responsibility for drug using and feelings towards using changing.

"I stopped using heroin ….managing with a lot less methadone…..I feel okay about not using, not spending money on heroin and not using it" - Ian.

d) Clients had felt unsure about coming for counselling

"I was scared to begin with’…the feelings it brought up" - Marie.

No clients reported being confident about trying counselling at the outset. Some doubted the value of it, were unsure of how it could help them, lacked understanding of what was involved, or were scared or daunted by the prospect of speaking personally to someone.

e) Clients actively participated in counselling

All clients actively participated in counselling, including working on issues, expressing emotion in sessions, and suggesting changes in how they and the counsellor worked together.

"The way I’m getting on with my counsellor now is different. I think I said to him that ….like he was too laid back or not saying enough or not saying anything, something like that….and that all sort of changed around Christmas or so and now it’s…we’re much more engaged." - Ian.

f) Clients became skilled judges of the services of the counsellor

Each client identified one or more aspects of their current or previous counsellor’s personalities and skills that held significance for them such as stating that they could tell if a counsellor was sincere and really cared. One client offered a suggestion for counsellors based on comparisons of his experience of counselling with different counsellors.

"They need to be a bit more adaptable rather than being the same with every client….I think maybe too many of them go by the book whereas they should have a bit more flexibility and a bit more common sense.. why don’t you try your own style, it might work?" - Tony.

2. What did clients say was unhelpful?

Clients spoke of things that had been unhelpful for them in some counselling relationships. This included an inadequate relationship with the counsellor or lack of choice regarding a counsellor, particularly related to being able to choose a male or female counsellor. Aspects of an inadequate relationship with the counsellor included feeling that the counsellor appeared superior, clients feeling misunderstood, judged, unsafe and feeling a lack of connection with the counsellor.

"But as soon as I start getting this mmm…she’s a bit snobby or whatever, that’s when my old suspicions come back." - Tony.

3. So what helped clients?

The counselling relationships that were helpful for clients included these elements:

  • Having human contact.
  • A sense of togetherness in the relationship.

These are things that both client and counsellor are responsible for:

  • The counsellor actively responding to the client’s needs.
  • The counsellor’s professionalism.

These are things that the counsellor is responsible for:

  • The client valuing the counsellor.
  • The client being actively engaged.
  • The client owning their own process.


Report compiled by Jane Edwards

Research conducted by Jane Edwards and Sarah Loeb
Simpson House Counselling


Download Supporting Documents

(PDF format)

The Views and Experiences of Simpson House Service-Users: Thematic analysis of service-users evaluation questionnaires

Hillarie J. Higgins, Counselling and Psychotherapy, University of Edinburgh, February 2010

Quantitative analysis of Simpson House service users questionnaires

Amanda Burston and Dr. Michael Gallagher, Counselling and Psychotherapy, University of Edinburgh, February 2010

Clients' Views on Simpson House Counselling - Summary


What do you think?

We are interested to hear your comments or questions on this research and if you are, or have been a client of Simpson House Counselling, to hear your comments or questions about your own experience of the counselling service.

Questionnaires are available at reception for clients to provide anonymous feedback on the service.