title: Differences in clinical characteristics between patients assessed for NHS specialist psychotherapy and primary care counselling.
abstract: OBJECTIVE
  Although several studies have described patient populations in primary care counselling settings and NHS (National Health Service) specialist psychotherapy settings, there is a paucity of studies specifically comparing differences in clinical characteristics between the two groups of patients. The aim of this study is to ascertain if specialist psychotherapy referrals represent a more challenging client group than primary care counselling patients.
  
  
  METHODS
  We compare the socio-demographic features and severity of presentation in the symptomatic, interpersonal problems and global adjustment dimensions of a sample of patients (N=384) assessed by a primary care counselling service located in North London and a sample of patients (N=853) assessed in eight NHS psychotherapy centres located within urban settings in England.
  
  
  METHODS
  Both the groups completed the Brief Symptom Inventory, the Inventory of Interpersonal Problems and Clinical Outcomes in Routine Evaluation Outcome Measure.
  
  
  RESULTS
  Patients referred for specialist psychotherapy services were more dysfunctional than those referred for primary care counselling. The linear function constructed to discriminate the groups showed that a combination of more psychotic symptoms, social inhibitions and higher risk of self-harm effectively identified those referred to psychotherapy services, while patients exhibiting greater levels of somatic and anxiety symptoms and non-assertiveness were more likely to be seen in primary care settings. However, similarities between the two samples were also marked, as shown by the overlap in the distribution of clinical outcomes in routine evaluation clinical scores in the two samples.
  
  
  CONCLUSIONS
  The findings are discussed in terms of their implications for policy and service delivery of these two types of psychological therapy services.
authors.affiliation: West London Mental Health Trust & University College London, UK. m.chiesa@ucl.ac.uk
authors.forename: Marco
authors.initials: M
authors.lastname: Chiesa
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Bateman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003376:Counseling; D004739:England; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010552:Personality Assessment / Q000706:statistics & numerical data; D011320:Primary Health Care; D011594:Psychometrics; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D012017:Referral and Consultation; D012917:Social Adjustment; D013038:Specialization; D013222:State Medicine; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention