Evaluation of counseling services is a recent innovation but is necessary to prevent perpetuation of ineffective practices. Two studies are reported. The first study explores the nature of problems presented spontaneously to the counselor, and the second study evaluates the effect of counseling offered in the first weeks after amputation. In the first study records were kept of the problems raised and 100 consecutive patients were selected who were concerned about emotional issues. In the second study 58 patients’ responses to a questionnaire about difficulties with a number of aspects of daily living were recorded at the first interview and again 4 to 6 months later. Eighteen (31%) of these patients elected to have counseling and their follow up responses are compared with those who declined counseling. The majority of respondents saw counseling as useful or potentially useful. Depression and body image disruption were most frequently raised; these were not universally experienced but were expressed by a significant minority of the patients. The problems reported in study 2 were concerned with practical issues such as performing tasks as well as housing and emotional issues such as depression, anger, and body image. At follow-up, 4 to 6 months after amputation, the group who elected to have counseling showed an improvement in the practical problems relative to those who were not counseled. Emotional problems showed an increase in both groups. Both studies indicated that emotional problems became apparent about 6-24 months after amputation. Counseling offered in the early weeks after amputation was seen as beneficial and showed a positive effect on the experience of practical problems. However, emotional problems become more apparent at a later stage.