Myndgard

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Using the wait well: what the evidence says about support before counselling

What the evidence says about supporting students on a counselling waitlist: psychoeducation, single sessions, guided self-help and safety-netting.

By Myndgard Limited

Banner reading: Using the wait well

January is often when counselling waiting lists lengthen. Students come back after the break, exams loom, and problems that were contained in the autumn surface again. Most services already triage and prioritise risk. The harder question is what happens for everyone else in the weeks between first contact and first session.

This post looks at what the research says about waiting itself, and about the forms of support that have been tested for the time before therapy starts.

Waiting is not neutral

It is tempting to think of a waiting list as a pause. The evidence suggests it is more than that.

In a qualitative study of young adults aged 19 to 22 on UK mental health waiting lists (Punton, Dodd and McNeill, 2022), participants described three things: relying on whatever else they could find, struggling to function in study and daily life, and developing negative beliefs, including a sense that they were not "bad enough" to deserve help. It was a small study of seven people, but the themes will be familiar to anyone who answers a counselling service inbox.

At service level, an analysis of England's IAPT programme (Clark and colleagues, The Lancet, 2018) found that the time people waited to start treatment was one of several organisational factors negatively associated with clinical outcomes. And in a 2022 poll for the Royal College of Psychiatrists of 535 adults with a diagnosed mental illness in Britain, 43% said the wait between referral and their second appointment had made their mental health worse. That poll concerned specialist mental health services rather than student counselling, so it is a signal, not a direct comparison.

There is also a quieter finding from trial methodology. A network meta-analysis by Furukawa and colleagues (2014) found that people randomised to a waiting list in depression trials did worse than people who simply received no treatment, raising the possibility that being told to wait can itself dampen improvement. The authors were careful: the evidence quality was limited and the difference did not survive some sensitivity analyses. Still, it is a reason to pay attention to how the wait is framed.

Some people improve while they wait

The opposite is also true. A systematic review by Whiteford and colleagues estimated that, among adults with untreated depression recruited from primary care, about 23% would remit within three months and 53% within a year. Wait-listed samples were less likely to remit than primary-care samples, and the authors note the findings may not apply to more severe depression.

This is the logic behind what NICE calls active monitoring. In its 2022 depression guideline (NG222), for people with less severe depression who do not want treatment or who feel they are improving, NICE recommends giving information about the nature and course of depression, making sure the person knows how to seek help, and arranging a further assessment, normally within two to four weeks. Watchful waiting, done properly, involves both watching and contact.

What has been tested for the time before therapy

Psychoeducation. Information about what the person is experiencing, what tends to help and what to expect from counselling is the most common ingredient in waiting-list support. A 2024 systematic review of interventions for children and young people waiting for mental health services (Valentine and colleagues) found 18 studies with 1,253 participants; 94% of the interventions included psychoeducation. All studies reported some benefit in outcomes, feasibility or acceptability, but the authors stress that the studies were small and often low quality.

Single-session interventions. These are structured, one-off programmes, sometimes self-guided and sometimes delivered by a practitioner. A meta-analysis of 50 randomised trials with 10,508 young people (Schleider and Weisz, 2017) found a modest average effect (g = 0.32), larger for anxiety (0.56) and smaller and non-significant for depression (0.21). Effects were larger against no-treatment controls than active controls, and smaller at follow-ups beyond 13 weeks. Most of that evidence comes from children and adolescents rather than university students.

Guided self-help. NICE's guideline lists guided self-help, structured materials with support from a trained practitioner, typically over six to eight sessions, as the first option to consider for less severe depression. An older meta-analysis by Cuijpers and colleagues (2010) of 21 trials with 810 participants found no meaningful difference in outcomes between guided self-help and face-to-face therapy for depression and anxiety. The word "guided" carries weight: the support is part of the intervention.

Safety-netting is part of the offer

None of the above replaces a clear route to help. NICE's recommendation 1.4.4 is the most practical summary we have found. It says services should tell people if there is a waiting list and how long it is likely to be, keep in touch at regular intervals, make sure people know how to get help if things get worse and who to contact about their place on the list, and consider self-help materials and social support in the meantime.

For a counselling service, that translates into a few concrete habits: an honest estimate of the wait, a named contact, a scheduled check-in, and crisis information that is easy to find rather than buried in an auto-reply.

Where Myndgard Discover fits

This research is the reason we built Myndgard Discover, a short daily emotional-literacy programme for students on a counselling waitlist, with brief reading modules, an optional check-in and a practical exercise each day. It is educational, not treatment, and it does not replace triage, safety-netting or counselling itself. The university sees only anonymous, cohort-level figures.

In practice

  • Tell students how long the wait is likely to be, and update them if it changes.
  • Make contact during the wait. A brief check-in is part of active monitoring, not an extra.
  • Offer structured psychoeducation and, where you can, guided rather than unguided self-help.
  • Treat single-session and self-help options as additions to the queue, not substitutes for it.
  • Keep crisis routes visible at every point of contact.

If you're struggling: Samaritans 116 123, text 50808, or 112/999 in an emergency.

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