Counselling or Psychotherapy – Counsellor or Therapist?

Put simply, counsellors work at a more immediate level generally focusing on a current issue that is affecting the client.  Psychotherapists both think and work at a deeper process level considering how the structure of the client’s personality is affecting their experience of relationships and being in the world.

Counselling and psychotherapy are often used interchangeably, however are in fact very different.  The training to become a UKCP registered psychotherapist in the UK is at post-graduate level and covers a four to five year period, compared to counselling which is as little as two years at further education level.  In practice counselling and psychotherapy look similar, however, what appears the same on the surface belies profound differences in thinking and process.

Mark Vahrmeyer Says  “As a psychotherapist (not a counsellor), I really don’t mind what my clients want to call our weekly one-hour meetings together; I know that I am practicing psychotherapy.”

So, what is the difference between counselling and psychotherapy?  And which do you want and need?  And how should you go about finding a psychotherapist?  It can feel like a minefield.

What are counselling and psychotherapy?

Counselling and psychotherapy are two practices that are closely related that both fall under the category of ‘Talking Therapies’.  All talking therapy hails back to the last century and Sigmund Freud, broadly seen as the ‘father’ of modern applied psychology.

Many people know that Freud ‘invented’ psychoanalysis – the practice of patients lying on a couch out of view of their analyst and sharing whatever comes into their mind – free association – with their analyst who, as he or she is out of view, gets ‘projected’ onto by the patient.

 

Psychoanalysis changed the way we thought about the human mind and its lexicon – repression, ego, libido, to name a few – has become ubiquitous in everyday language.  Far from being redundant, psychoanalysis has continued to evolve over the years with a strong British school emerging during the mid-20^th century that has shaped how we think about how we think about infant and child development, as well as our relationship to self and others.

How do counselling and psychotherapy relate to psychoanalysis?

Psychoanalysis as well as Freud’s ground-breaking work as a neuroscientist led to an explosion in us wanting to understand mental health with many trained analysts in the 1960’s in particular pivoting away from traditional analysis towards other more ‘relational’ therapeutic approaches.  Many of these new approaches continue to exist to this day and have evolved as evidence-based practices in treating mental health problems; and it is the practice of these approaches that sit within the functions of counselling and psychotherapy.

Where psychotherapy would require patients to attend analysis at least three, and often five times per week, counselling and psychotherapy typically require patients or clients to attend a session, or couple of sessions per week.

Analysis is also a very long-term affair, frequently taking many years or even a decade.  And it was and is also not uncommon for patients to undergo a second analysis later in their lives.

For many, psychoanalysis is simply too expensive, too much of a commitment and too intense, however, this does not suggest that analysis does not have its place and can often be the only appropriate treatment for more disturbed patients.

Are counselling and psychotherapy less effective than psychoanalysis?

Put simply, it depends.  It depends fundamentally on the patient and the level of disturbance.  Some patients are unsuitable for counselling, but psychotherapy can help them; some patients are unsuitable for psychotherapy, but analysis can help them.  And not uncommonly, patients may start out in psychotherapy with an analyst and then over time when they have developed sufficient ego strength, move to more intense analysis.

How are counselling and psychotherapy different?

We have established that all modern talking therapies hail from psychoanalysis and that psychoanalysis remains an extremely important and in-depth treatment for certain patient groups.  So, are counselling and psychotherapy pretty much similar?  No.

Mark Vahrmeyer says “A saying I often repeat is that I have met many counsellors who call themselves psychotherapists, but no psychotherapists who call themselves counsellors.”  Unlike analysis, counselling and psychotherapy do look, at least to the lay person, rather similar: two people sitting in a room talking.  They meet for a therapy hour (usually) and tend to meet on the same day at the same time, weekly (again, usually).  However, what looks the same on the surface belies a profound difference in depth of thought, application and clinical process.

One of the fundamental differences between counselling and psychotherapy is that psychotherapists are trained to formulate – to diagnose according to their approach to therapy.  This is critical when dealing issues that are deep-rooted and impact on the patient/client’s relationship to self and others.

In order to learn to formulate, psychotherapists undertake a rigorous training which generally extends over a period of four to five years as post-graduate level.  During this training period, they learn to conceptualise in one or more approaches and to become proficient in working with psychological process as a deep level.

Working at depth with psychological process – what is happening beneath the content of what the client is bringing and is manifesting between the client and psychotherapist in the relationship – is a complicated and difficult core element of psychotherapy.  A useful synopsis of this process is that psychotherapists are constantly asking themselves ‘what is it that the client wants me to know about them?’ irrespective of the content of the session.  This can then be brought to light and explored in the therapeutic relationship.

 

The differences between counselling and psychotherapy in the UK

In the UK, counselling and psychotherapy are not regulated by the government.  This is unlike clinical psychology, which is and it is therefore illegal for someone who is not a psychologist to claim to be one. The lack of legislative regulation brings with it certain benefits and disadvantages.  A benefit is that counselling and psychotherapy offer a broad range of approaches in working with the human mind – arguably broader and deeper that psychology.  However, one of the disadvantages is that it can be difficult for prospective clients to ascertain whether a clinician is really as proficient as they say they are.

There are two main professional bodies for counselling and psychotherapy in the UK: the BACP and UKCP.  The BACP is the main register for counsellors and encompasses the name ‘psychotherapy’ in its title subscribing to the perspective that the two terms are interchangeable.  If a clinician is a BACP member and not a UKCP member, then it is a fair assumption that they are a counsellor.

The UKCP is the main professional body for psychotherapy in the UK.  Members must evidence meeting rigorous training and practice standards.  Full UKCP members are psychotherapists.

How do I know which one I need?

It can be difficult to work out whether counselling or psychotherapy is right for you.  If you are considering the question, then it may be that you are in a period of crisis, such as a life change, divorce, bereavement or are struggling with stress, anxiety or depression, for example.

If you believe that your issue is acute – meaning that it is an isolated experience and not something that you have dealt with before – and your sense is that your relationship to yourself and others is healthy, then a period of counselling may be sufficient for you.

If, however, you are concerned about recurring patterns around your thought processes, relationships to self, and/or relationships to others, then psychotherapy would most likely be better suited to you.

“The unexamined life is not worth living”

The above statement is a quote attributed to Socrates of ancient Greece and is based on his premise that in the face of mortality, certain death, it is incumbent on us all to find meaning and purpose in our lives.  This, it can be argued, is the greatest value of psychotherapy.

Freud stated that it was not until a crisis had been resolved that psycho(analysis)therapy began.  Perhaps this is the greatest value that an ongoing process of psychotherapy can offer us all – it is a deep, intimate, ongoing relationship where, through relating with a separate other who is there to hold us in mind, we can in turn establish a calmer and more ordinary relationship with ourselves.  A relationship wherein the important questions about being human can be examined.  Some see this as a luxury, preferring to be distracted by the mania of modern life.  It is questionable whether anything could, in fact, be more important.

What other factors are important in choosing a counsellor or psychotherapist?

When choosing a counsellor or psychotherapist it is important to not only consider how they present themselves, but also evaluate whether they are truly able to work to the standard that the say they are.  Most clinicians offer an initial consultation and this is a time and place for you to ask appropriate questions to enable you to make an informed decision about whether or not to embark on this important relationship.

All psychotherapists should be members of an appropriate profession body as discussed above.  All psychotherapists should be in clinical supervision with at least one superviser, who overseas their clinical work and ensures that the therapist is working ethically and constructively with each clients.

And, whilst not mandatory, ethical clinicians who take their profession seriously will be in their own ongoing psychotherapy so that they too can be emotionally and psychologically supported in their work and lives.

Lastly, it is essential that you ‘feel’ whether you can work with the counsellor or psychotherapist sat in front of you.  A therapeutic relationship should ‘feel safe, but not too safe’.  What does this mean?  You need to feel that you are working with someone who can remain separate to you; who can hold onto their own thinking mind even when you struggle to do so.  Otherwise they can end up colluding with you and change becomes impossible.

How can I find a counsellor or psychotherapist?

There are many directory websites on the internet that provide lists of counsellors and psychotherapists based on your location.  However, whilst these websites may rank well, this in itself provides no guarantee of the calibre of clinician on offer.

Both the BACP and UKCP provide their own lists of qualified counsellors and psychotherapists enabling clients to search with the assurance that a clinician in in fact registered with the appropriate professional body.

It may also be worth considering approaching a well-established clinic in your local area where a group of qualified clinicians work together to provide talking therapy from one physical location.  The benefits of seeing a psychotherapist who is part of an established clinic rather than a ‘lone’ therapist is that they will have the support and back-up of the clinic if additional support is needed.  As a client, you will also have the benefit of attending a dedicated clinical space for your weekly sessions as well as the security of knowing that you are being ‘held’ by a ‘bricks and mortar’ clinic run by psychotherapists.

Good clinics interview and verify the qualifications and insurance of all their clinicians and ensure that all attend regular practice meetings where support can be offered to each other.

Again the internet can be deceiving in this realm in that quite a few websites that present as clinics, are little more than groups of clinicians spreading the costs of running a website and marketing themselves, and in day to day clinical practice they have no contact with the other members of their ‘clinic’.  So, once again, do your homework.