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LimitationsThere are a number of limitations to this study. First, although the use ofpractitioner severity ratings pre- and post-therapy allowed a more meaningfulanalysis of change for clients who had an unplanned ending to therapy, there was stilla substantial amount of missing data. Data on whether the therapy came to aplanned or unplanned ending were not available for 36% of clients, and pre- andpost-therapy practitioner severity ratings were not available for 45% of clients. Therecould be legitimate reasons for this. For example, the client was still in therapy at thetime the data were submitted, or the client dropped out before attending the firsttherapy session. However, it is unlikely that this explains all of the missing data. Ithas to be acknowledged that there could be a recording bias favouring the successfulepisodes of therapy, rather than the unsuccessful. Second, although the analysis wasconducted by an organisation outside of the services, the evaluation still relies uponthe integrity of the service and its counsellors to provide accurate and completeinformation. Some of the confounding factors found when practitioners evaluatetheir own services may therefore still be present. Third, the point at which theoutcome measures are completed by the clients or practitioners may differ due toadministrative procedures. For example, the client may complete the form either atreferral, or at the first therapy session. This may have an effect on the results and thedifferences/similarities between services. Finally, a control group design was not usedwhich many regard as the gold standard of effectiveness research and necessary toestablish the true effectiveness of psychotherapy. In addition, follow-up data werenot available.Despite these limitations we believe that this paper presents sufficient evidence tosuggest that student counselling is effective for those students who complete a courseof counselling and/or come to an agreed ending to therapy. This is congruent withthe evidence available for the effectiveness of NHS primary care services. As forprimary care, the main challenge now for student counselling services is to addressthe problems of both gaining data from clients who drop out of therapy and of earlyunilateral client attrition itself.
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