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Counselling for Depression (CfD)

What is it?

Counselling for Depression (CfD) is a model of psychological therapy recommended by NICE for the treatment of depression and approved for delivery within the Improving Access to Psychological Therapies Programme (IAPT). It is one of the therapies recommended in addition to CBT. The other recommended therapies are: Behavioural Couples Therapy, Dynamic Interpersonal Therapy and Interpersonal Psychotherapy. CfD is described in the following terms:

Counselling for depression is a manualised form of psychological therapy as recommended by NICE (NICE, 2009) for the treatment of depression. It is based on a person-centred, experiential model and is particularly appropriate for people with persistent sub-threshold depressive symptoms or mild to moderate depression. Clinical trials have shown this type of counselling to be effective when 6 - 10 sessions are offered. However, it is recognised that in more complex cases which show benefit in the initial sessions, further improvement may be observed with additional sessions up to the maximum number suggested for other NICE recommended therapies such as CBT, that is, 20 sessions.

The CfD model of therapy is derived from the Skills for Health humanistic competence framework devised by Roth, Hill and Pilling (2009)[1] which provided the basis for the National Occupational Standards (NOS) for psychological therapists. This framework was developed using therapy manuals from randomised controlled trials and exemplar texts which have impacted significantly on practice, ensuring that the therapeutic competences are closely aligned to the evidence-base and hence predictive of good outcomes for patients. The specific areas of humanistic practice on which the CfD competences are based are person-centred and experiential therapy. The competences identified in the Counselling for Depression framework are therefore a subset of those produced by Skills for Health with some additions.

The model targets the emotional problems underlying depression along with the intrapersonal processes, such as low self-esteem and excessive self-criticism, which often maintain depressed mood. The therapy aims to help patients contact underlying feelings, make sense of them and reflect on the new meanings which emerge. This, in turn, provides a basis for psychological and behavioural change. It is a manualised model of practice specifically devised for counsellors working in the IAPT programme.

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