What is the difference between a counsellor and a psychotherapist?
The terms counselling and psychotherapy are often used interchangeably and many mental health practitioners use both terms to describe themselves. In this article I explore whether there is a difference between counselling and psychotherapy, what that difference may be and why may matter.
In very simple terms, counsellors work at a more immediate level generally focusing on a current issue that is affecting the client. The work is therefore often considered of more limited duration although this is not exclusively the case.
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. This is reflected in the training depth, duration and intensity of each discipline. Let’s go deeper into this:
Defining counselling and psychotherapy: a brief history
Counselling and psychotherapy are two practices that are closely related that both fall under the category of ‘Talk Therapy’. All talk 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 associating – with their analyst who, as he or she is out of view, gets ‘projected’ onto by the patient. The analyst is therefore not related to as a whole person as the analysand (the person being analysed) knows very little about the life of the analysts and cannot see them due to the seating arrangement.
Psychoanalysis changed the way we thought about the both the actual human mind and its lexicon – repression, ego, libido, to name a few – all of which have 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-20th century that has shaped how we think about infant and child development, as well as our relationship to self and others.
From Freud to modern therapy: the evolution of talking therapies
Classical psychoanalysis 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. It is the practice of these approaches that sits within the categories of counselling and psychotherapy.
Where psychoanalysis would require patients to attend analysis at least three, and often five times per week (and still does), counselling and psychotherapy typically require patients or clients to attend one, or possibly a couple of sessions per week.
An 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 and too much of a time commitment, however, this does not suggest that analysis does not have its place and can often be the only appropriate treatment for some patients. Indeed, some patients will be prescribed ‘psychotherapy’ before entering into analysis and some clients are may be too unwell for weekly psychotherapy where they are too regressed and psychoanalysis may be more appropriate and holding.
Counselling vs psychotherapy: structure, depth, and duration
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 the terms counselling and psychotherapy interchangeable? No.
An anecdote I believe sheds some light on the overlap and difference 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 layperson, 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 therapeutic approach. This is critical when dealing with issues that are deep-rooted and impact on the patient/client’s relationship to self and others. Counsellors do not have this training.
Formulation drives the treatment plan for psychotherapists – knowing what one is treating and why.
In order to learn to formulate, psychotherapists undertake rigorous training which generally extends over a period of four to five years at 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 at depth. The training includes their own process of personal therapy over the duration of their training, a mental health placement and a minimum of 450 training hours of clinical work.
Working at depth with the psychological process – what is happening beneath the content of what the patient is bringing and what is manifesting between the patient and psychotherapist in the relationship – is a complex and core element of psychotherapy. A useful synopsis of this process is that psychotherapists are constantly asking themselves ‘what is it that the patient 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.
What psychotherapists are trained to do that counsellors are not
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 clinical psychologist to claim to be one.
The lack of legislative regulation brings with its 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 clinical psychology (and clinical psychologists are under no obligation to undergo their own personal therapy!) . However, one of the disadvantages is that it can be difficult for prospective patients to ascertain whether a clinician is really as proficient as they say they are.
Regulation of counselling and psychotherapy in the UK
There are two main professional bodies for general 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.
There is a consultation in process between the BACP, the UKCP and other bodies to differentiate between counsellors and psychotherapists in a way that will be meaningful to the lay person, but as of re-visiting this article in June 2023, this process is far from concluded.
Do you need a counsellor or a psychotherapist?
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 requires a more present-based intervention – meaning that it is an isolated experience and not something that relates to the past or is a repeating pattern in your life, then a period of counselling may be sufficient for you.
If, however, you are concerned about how your past experience affects your present life, you want to address the deeper roots of unhealthy ways of thinking and behaving, and look at how you relate to self and others, then psychotherapy would most likely be better suited to you.
And if you have a history of mental health problems, or a diagnosis, then psychotherapy would be the advisable route to take.
“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 begins. 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; I would argue that with such our limited lives it is essential and it is questionable whether anything could, in fact, be more important.
How to choose the right 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 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 supervisor, who overseas their clinical work and ensures that the therapist is working ethically and constructively with each client.
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. Your psychotherapist is not there to be your friend nor to ‘validate’ the way you live your life. They are there to help you understand yourself and how you operate in relationships with others.
Finding a reputable psychotherapist or clinic
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 patients to search with the assurance that a clinician in in fact registered with the appropriate professional body.
You may also wish to consider whether you psychotherapist of choice is part of a clinic like Brighton and Hove Psychotherapy – a ‘bricks and mortar’ organisation who hold clinic meetings, is populated by clinicians working with different client groups and who can cross-refer to each other. There are many directories of clinicians on the web who purport to be ‘practices’; few actually are, so do your research and ask questions!
Lastly, the field of mental health has been identified by ‘big tech’ as a goldmine and increasingly us bona fide clinicians working in physical collegial settings are facing stiff completion from websites purporting to be able to ‘hook you up’ with the most suitable clinician based on your needs. Aside from this being no measure of whether someone is well-trained, ethical and able to clinically work with you, there have been numerous privacy scandals where patient data has been sold or used by other third parties. One of the most basic tenets of psychotherapy is that confidentiality is sacrosanct and this is being violated by these platforms at the expense of vulnerable people.
All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.
Thanks. I need to get more materials on Counseling and Psychotherapy.
Great article, thank you for the clarity you shine into this area. It is valuable to me as I am searching for what type of practitioner to help a friend in distress but whose issues are long-standing and fundamental.
One query on the text: you say “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.” should the first reference be to psychoanalysis?
Hi there,
Thank you for your comments. You are absolutely correct – thank you for pointing out this mistake. I have amended the text.
Hello, please can I know the name of the author of this article and the year they wrote it? Thanks.
The author is Mark Vahrmeyer
I am currently studying Counselling Level 3 and working on a research essay. I recognize that Mark Vahrmeyer vetted and reviewed this article. Does that mean he is the accredited writer too?
Thank you
Thank you for your comment. yes, Mark Vahrmeyer wrote this blog piece.
Sorry to disagree, but the idea that psychotherapists work on a deeper level than counsellors is simply incorrect. There is no specific depth at which a counsellor works. It is simply a question of branding. If a person wants to sound more like a psychologist, they brand themselves as a psychotherapist, whereas if a person wants to sound more friendly and approachable, they brand themselves as a counsellor.
A simple search on Google Analytics reveals that next to nobody who is seeking therapy searches for the term ‘psychotherapist’, instead most people opt for ‘counsellor’. For this reason, I brand myself as a counsellor, despite also being an accredited CBT therapist. I have friends who are clinical psychologists who do the same, and for the same reason.
Please don’t be fooled into thinking that somebody who brands themself as a psychotherapist has access to some special insight because it simply isn’t the case. Successful therapy is a factor of the strength of alliance between client and therapist. Everything else is dressing.
Thanks very much for your comment David. No need to apologise for disagreeing – that’s why we like comments – everybody gets a say.
In return, I must say I disagree with your comments and shall address each one (the answers assume you are UK based as we are):
Whilst some counsellors work at depth and some counsellors choose to refer to themselves as psychotherapists, there is a profound difference. The UKCP and BPC both recognise what constitutes psychotherapy level training and the vast majority of counselling training does not come close to this standard. Most counselling training is a FE (Further Education) level whilst psychotherapy training is at Masters. IN the UKCP SCoPEd (Scope of Practice and Education) is a collaborative process between the UKCP, BACP, BPC and others to differentiate between what constitutes depth training and depth work. This is likely to be formalised in the near future and will make a distinction between counselling and psychotherapy. This is simply a fact.
You perspective on ‘branding’ is perhaps one you use but is not based on any research. I am a former head of marketing for large organisations and would suggest that this really does not constitute ‘branding’ in any true sense of the word. In my experience, those of us with 4 years of masters training and UKCP registration have earned the title ‘psychotherapist’.
I have no comment to make about Google Analytics as this does not form part of any valid argument around the differences between counselling and psychotherapy. We are happy with our ranking and use the term ‘psychotherapy’ where appropriate.
I have no knowledge of the level of your training in CBT. If you are UKCP registered as a psychotherapist then that is what you are. Perhaps your training is not to that standard?
Re Clinical Psychologists, we have had more that 5 on team over the past few years – two colleagues are leaving this month to pursue other interests. They both used the term ‘Clinical Psychologist’ and not psychotherapist because that is what they are. They work short-term and on focused issues and charge more that psychotherapists who work on an open-ended basis. ‘Clinical psychologist’ is a legally protected term in the UK as you may be aware.
I am not ‘fooled’ into thinking anything – thank you. I have been trained to formulate and work at a level of clinical depth that most counsellors have not. I am not special – all my UKCP colleagues fall into the same category.
Lastly, if you believe that therapy starts and ends with the ‘strength of the alliance between client and therapist’ you may wish to avoid working with more serious pathologies, mental health disorders or personality disorders as in all of the former, it depends on a lot more than simply ‘the alliance’.
Mark Vahrmeyer
I completely agree with you Mark. Having recently qualified as a psychotherapist, and currently in process of attaining UKCP registration, I am aware of the hard work, rigorous training, supervision, personal therapy and various CPD hours I had to undergo over a period of 6 years, in order to graduate at a Masters level qualification (UKCP). Having been through this rigorous psychotherapy journey, I am now proud to classify myself as a Psychotherapist and not a Counsellor.
Dear Bena, thank you for reading my article and for commenting. Good luck with you onward journey as a psychotherapist.
Mark
I agree to some extent with both of you – what you say about counselling is a massive generalisation. It is true that counselling covers a much broader level of depth and training qualification standard compared to psychotherapy. It is yet misleading as people like me did train on a level 7 (masters level) and did so for 4 years, yet my training had set such a high standard that we can only qualify as psychotherapist’s after 5 years. The only difference is a thesis, mental health placement and case study. This is an academic difference and says nothing about the depth of our work. There are maybe not that many counselling qualifications that have the same standard as psychotherapy trainings but certainly there are some. Your generalisation is misleading for clients and also misses the fact that many people get a basic counselling qualification and then seek further training in their specific area of interest. This may in fact qualify them to a higher standard and allow them to work at greater depth compared to a psychotherapist who only did one basic training. My training covered from the very beginning topics of transference and countertransference as well as the developmental stages and certainly does not focus on isolated present-time issues. It would be more helpful to make people aware that counselling has different levels of qualifications and that they can look out for level 3 and 4 vs. postgraduate diploma for example, to help them differentiate the level of depth the counsellor is likely to work on rather than making such a simplistic separation that negatively affects the reputation of counsellors.
HI Simone,
Thank you for taking the time to read my blog and for commenting. I do wonder if your example of training is the exception that proves the rule. Very few counsellors train on a psychotherapy (UKCP, BPC) course. You did and, as you point out, you could only qualify as a psychotherapist after 5 years which is as it should be – 5 years of training is what is expected by the UKCP.
Very few counsellors enter the profession after a training such as yours and many decide that a part-time year- or two-year course at a local FE college suffices to claim the title of counsellor and not infrequently, psychotherapist. This is misleading for clients/patients and unethical.
You cite the fact that many counsellors continue with training after qualifying. Again, so they should. And the same goes for psychotherapists. Training (CPD) is not only expected but a requirement post qualification. I am unsure what you mean by ‘a psychotherapist who only did a basic training’ as five years at Masters level is hardly ‘basic’ and that disregards further CPD.
I would dispute that the only difference between a four and five year training is a thesis, mental health placement and case study, and that these are nothing. A case study at UKCP level is produced over a period of around a year with high levels of supervision. A mental health placement in a psychiatric ward is helpful to formulation. Lastly, for the UKCP, candidates are required to be in personal therapy for the duration of their training – 450 hours. The BACP (counsellor training) has no such requirement.
There are, of course, very good counsellors and poor psychotherapists out there – I know some! However, this does not detract from the general differences in training and competence of the two trainings.
Brilliant David.
At last someone stands up for the depth of work and the therapeuric allience makes me so cross to make distinctions.
Its all therapy.
Thanks for taking the time to comment. However, you present no evidence or theory as to why ‘it’s all therapy’. The whole point is it isn’t. People may offer something therapeutic and helpful but that does not make it psychotherapy. Depth psychotherapy is something very distinct and specific. One can try and argue against this but the arguments tend to come from those who are not psychotherapists and have not undergone a specific psychotherapy training.
Talking a walk in the woods can be helpful and one may use the word ‘therapeutic – it does not make it psychotherapy. Difference is frustrating but it matters in treating patients.
Mark
There are so many falsehoods in this article, it’s very misleading.
For example, ‘If a clinician is a BACP member and not a UKCP member, then it is a fair assumption that they are a counsellor.’
There are literally tens of thousands of psychotherapists registered with BACP.
Hi Alison,
Thank you for your comment. You claim there are ‘so many falsehoods’ in the article but only cite one – I can therefore only reply to that one:
The ‘tens of thousands’ of psychotherapist registered with the BACP do mostly not meet UKCP or BPC standards of what constitutes a psychotherapist. The problem with the BACP is that the terms are used interchangeably. This is exactly the point I am highlighting in my piece.
SCoPeD – Scope of Practice and Education – which is under review at present will ratify the differences and I think you will find that the number of BACP ‘psychotherapist’ will fall considerably.
UKCP considers someone a psychotherapist who has trained at post-graduate level for 4 years (on top of a foundation year), undertaken a mental health placement, gained 450 hours of clinical experience and been in personal psychotherapy for the duration of the course. How many BACP psychotherapist meet this criteria?
I think what’s going unmentioned here are the socio-economic and socio-cultural elements to the distinction. Training labelled Psychotherapy is generally substantially more expensive, precluding those from lower socio-economic groups. The representation of diverse communities is woefully low, as you need substantial resources and free time to be able to complete the training. The scale of investment also breeds a protectiveness around what that investment means, hence a certain condescension notable in UKCP qualified practitioners versus their BACP qualified colleagues. BACP courses also need investment, obviously, but there tends to be more flexibility and less punitive fees. There are courses you can complete for UKCP accreditation that peddle little more than pseudo-scientific mumbo-jumbo, just as there are academically excellent ones. They key, I think, is the specific course, not so much the accrediting body. Just as the key is the specific practitioner rather than the nomenclature.
Thank you for your comment. There seems to be a fairly recent movement to politicise the difference between psychotherapy and counselling trainings with the implication that UKCP psychotherapy trainings are ‘for the elite’ and no better than BACP trainings.
UKCP accredited trainings, there are reasons for this:
UKCP trainings are longer – 4 to 5 years at post-graduate level;
UKCP trainings are at a higher academic level (post-graduate) and thus attract post=graduate fees;
The intensity of training is generally higher – full weekends monthly or one full day per week.
You reference some UKCP courses as peddling ‘mumbo-jumbo’ – can you elaborate?
In my experience, most UKCP registered psychotherapists are protective of the title and their training not as a result of the financial; expenditure, but precisely because they have sacrificed to train at a higher level and that should be recognised.
1. Longer does not necessarily mean better.
2. Higher academic level of training is no predictor of quality of therapist. There is a slender correlation between skill in essay writing and skill in the therapeutic moment.
3. Many psychotherapy courses are charged at a significant premium as set against other Master’s degrees. Why?
4. Intensity of training. Varies by course. Many counselling courses have whole days per week.
5. Elaborate on the mumbo-jumbo? Don’t really want to cast aspersions on specific courses. But a cursory look at the UKCP website will bear much mumbo-jumbo fruit. Although the spectre of new age, Esalen-esque, human development movement thinking is a drag on mental health provision as a whole.
6. Protective of their title and yet legally the title is unprotected and legally they have no more claim to the title than anyone. Now, ethically, that is a different question.
The implication that I am ‘politicising’ this is odd. To suggest that the fees and course structures are anything other than exclusionary is deluded. It’s not about politics. It’s about quality and variety of mental healthcare provision and talking therapies by and for people other than the upper middle classes who, by some measure, are the only ones who can afford to both train and attend.
Thanks for elaborating on your views.
In reply to your post:
1) Longer does not necessarily mean better, however when combined with training at university post-graduate level combined with four years of personal therapy (with an equivalently trained professional) and being taught to formulate (which counselling courses don’t) then generally it does mean better.
2) See above reply
3) Masters degrees are put funded by government in terms of how they in turn fund higher education. Psychotherapy training are generally private. Although, some masters trainings through universities are the same prices as other masters – see Birkbeck or Goldsmiths.
4) Counselling trainings MAY have whole days per week but for a significantly shorter period of duration
5) You have not elaborated so I cannot comment.
6) Just because a title is not protected does not infer a lack of distinction between UKCP level training and counselling courses. The term ‘psychologist’ is also not legally protected but most would argue a difference between psychologist and psychotherapy (unless they lacked basic understanding of the field).
We live in a capitalist society. It is not a utopia where all can access whatever training they want. It (society) is thus hierarchical in virtually every way conceivable. Some may be excluded from psychotherapy training because they cannot afford it – this may be unfair but then so is the whole capitalist system – many people are excluded from many things. The idea that life is fair is naive. However just because there is a hierarchy does not invalidate real difference in skill and competency.
I managed to fund my training by working extremely hard building a practice whilst training. My MA was written on trains up and down to London and in a car parked where I would type away between sessions. Where there is a will there is often a way. Therefore, you are politicising training and inferring that the only benefit of a UKCP training course is in some way to maintain the power of the ‘elite’. This seems very reductionist and dismissive of those of us who have trained for many years to get where we are.
As a practice we have had now 10 years of experience of working with associates and many have been with us for much of this time. We generally only take on well trained and highly experienced UKCP registered psychotherapists as we have had bad experiences with lesser trained counsellors. That does not mean all counsellors are poor nor that there is not a place for counselling. We however are a psychotherapy practice principally.
I am a BA (Hons) Psychology graduate and this article helped me clarify for myself whether it is most suitable to me to pursue a career in Counselling, Psychotherapy, or Clinical Psychology. Also helped me clarify the distinction / confusion between BACP and UKCP. I was aware about the – clear- difference between Counselling and Psychotherapy but the interchangeable use of the two words had confused me.
Thank you for taking the time to reply to our blog. I am really pleased that you found the content helpful and that this has enabled you to take a decision.
Having read all of the article and the comments. I’m now more confused than ever!?
My son 34, suffering from CPTSD and on the autism spectrum (aspergers) I was looking for someone experienced in both, who would ‘listen’. We’ve wasted £1000s on ‘therapists’.
Hi,
Thank you for your comment. I am sorry you have had this experience, but it is not uncommon. The article aims to clarify some of the differences between counselling and psychotherapy and serve as a guide. If you wish to contact us privately to discuss your son then we can provide some specific guidance.
I’m in the very early stages of training to become a counsellor and I think you put forward a very valid point. It’s very clear to me that a Psychotherapist is way more advanced than a Counsellor, I’m saying this as it’s simply a fair point to make.
Good on you (Brighton and Hove Psychotherapy) for standing up for your article, I found it very useful, thank you.
People need to take charge of their limitations, face the facts and move on.
I’m going to become a qualified counsellor in the near future (hopefully), it would be insane for me to call myself a Psychotherapist, and I wouldn’t want to either, it would be dishonest and unethical. I am going to be a counsellor, helping those with any present life issues overcome their hurdle, anything more than that than I will be referring them to a Psychotherapist.
Best wishes to one and all, and for all those finding fault with this short but substantial and fair article, take a chill pill 🙂
Thank you for taking the time to comment and for your frank appraisal of my article. There is absolutely nothing wrong with being a counsellor and the work is important. And, psychotherapy offers something different – they are not mutually exclusive.
Best of luck with your training!
Mark
I’m on an integrative counselling course that ‘introduces’ lots of different theories and approaches. Whilst it allows us to register with BACP at the end, the idea I suppose is that we continue to pursue relevant bits further if/when able. E.g. if we like what we learnt about TA, do more of it, etc.
My course tutor is registered with both BACP and UKCP. We’ve had so many absolute pieces of gold from her over the past couple of years. In a recent discussion about SCoPEd and the difference between counsellors and psychotherapists (she can call herself both but calls herself a counsellor), the gold that comes to mind was something like, ‘when people are protective about titles, it might tell us more about the person than the title’. There’s definitely some navel-gazing in the article.
I was on a UKCP registered TA course information session recently because I’m keep to do more after my current course if/when I can afford to. TA really resonates in theory and practice. But the course ‘sell’ came across similar to this article. I’m sure there is some amazing learning and growth to be had, and the number of client hours with supervision expectations will very likely point people toward being equipped with something ‘extra’, but the assumption that it equates to something ‘better’ is just that, an assumption. It ought to, and likely for many does, but it’s clumsy to suggest it simply does. The people selling the course wound up many of those interested in taking the course, mostly because of how dismissive they were of what we had done so far in our training to register with BACP and the arrogance in which they held their ‘superiority’. Perhaps those pursuing titles will still likely be focussing on that, and understandably, the more they’ve invested, the more vehemently they’ll defend it. But it still focusses on the wrong thing.
There’s definitely a quantity vs quality debate going on, and the two are often confused in many spheres. I was in education (primary and secondary) for 10 years and worked in teacher training too – I can say with absolute certainty that there was no correlation between the most qualified and experienced staff and the impact they had in their role. Some of the NQTs had more quality in their little fingers and would positively impact on more children in a year than many have in their careers.
Regardless, there are lots of effective counsellors and psychotherapists out there, and who knows, perhaps for every effective one there’s an ineffective one, regardless of title. There’s no shortage of anecdotal stories from people who’ve looked for help and either been disappointed or horrified. And of course, lots of amazing success stories. It’s messy, and I hope with some regulation, even if fairly soft still, it helps people find quality help more quickly.
But all in all, if the most important thing is to keep the most important thing the most important thing, who’s calling themselves what won’t be it, neither will the number of hours someone’s done or what theory they can spout. If we ask ourselves what matters to clients, it’ll more likely be ‘the moment my counsellor/therapist remembered my dog’s name’, or, ‘when they saw me as me’, which just makes me smile.
Hi Eddie,
Thanks for taking the time to post such a lengthy comment to my blog. I agree with a fair few of your thoughts and, of course, there are poor clinicians who have trained for many years and decent ones who have trained for less. This is true of any profession.
My main argument is not one you really addressed which is that psychotherapists are trained to work at a process depth that counsellors simply are not. Four years of post-grad training equips a UKCP psychotherapist to formulate (diagnose), which is not something counselling courses teach.
I am a clinical supervisor as well as a clinician and have supervised (and do) counsellors and psychotherapists, trainees and fully qualified. As a general rule, the super-vision I offer is modelled to the individual but also to their training. I expect less depth and process work from counsellors and if they wish to deepen their knowledge and clinical practice in this domain I recommend further training at UKCP level.
The other point which you did not raise is the fact that psychotherapists have to undergo a minimum of four years of weekly psychotherapy with a UKCP trained therapist. Counsellors may or may not have to undergo some counselling but it is of limited duration and on some courses ‘optional’. I personally advocate for psychotherapists being in ongoing psychotherapy throughout their careers and I walk the talk.
Psychotherapy is in its original an apprenticeship, where the earning comes through ones own psychotherapy and supervision. This is simply significantly more robust and of longer duration for psychotherapy candidates.
I am not attempting to ‘sell’ anything. But, I dispute your suggestion that the prime motive of the courses at UKCP level is to upsell and that psychotherapists registered with the UKCP or BPC are maintaining some sort of illusion of superiority.
The profession is currently in free-fall. There are far too many shoddy trainings and ‘diploma mills’ pumping out poorly trained therapists. This, combined with the ever decreasing access to psychological support through the NHS is a disaster. The lay person may not know the difference between counselling and psychotherapy but as a foundational rule – there is a profound one.
Psychotherapy training does not ‘weed out’ all the narcissists and lazy therapists, but having gone through a rigorous London training, I can tell you each year more and more students dropped out in not making the grade leaving a cohort who largely were competent and able to work at the required level.
I would also add in that where one trains makes a significant difference. Many universities now offer psychotherapy courses which has improved access for those not based in London, however, the London schools who have a history of being psychotherapy training institutions, many started by the ‘greats’n the field. Prior to being shoe-horned into an academic framework (where they arguably do not belong) they bring with them a legacy of training students, have staff who have trained under some of the great contemporaries and thus are preferable for more rigorous training. The same counts for whom you choose to have psychotherapy with – where did they train, how long have they practiced, how have they advanced the field?
So, in conclusion, it is not about who is calling themselves what. And the tiles are not protected by law which gives room for charlatans to exploit them. However, the titles and corresponding level of registration (BACP, UKCP, BPC) are an important starting point of difference of levels of training, personal therapy requirements, supervision levels, psychiatric placement, training hours (450 for the UKCP) and ongoing CPD. Thereafter, investigate the individual and their experience.
What matters to clients (patients in my language) is of course the feeling of being ‘known’ as you suggest in your final paragraph. But if you think clinic competence when working with serious pathology and personality disorders does not matter more, this is a grave error of judgement. Clinical acumen and judgement matters most. We are there to do a job and guide patients through the conflicts in their mind. Few of my patients leave sessions ‘smiling’, but most keep coming back as they know that I understand the work that they are asking me to do. This is the same for my colleagues who work at depth.
Good luck with your training!
Mark
Thanks Mark,
Your main argument – that psychotherapists are trained to work at a process depth that counsellors simply are not – I agree with. The rigour, depth and expectations of pure psychotherapy courses is intentionally high.
And your point that you ‘personally advocate for psychotherapists being in ongoing psychotherapy throughout their careers and I walk the talk’ – I agree with too. Further still, I think it should be blanket requirement for many professionals working with people more generally. It goes without saying for counsellors and for psychotherapists, but from experience I’d say it would be incredibly beneficial if, for example, more teachers were supported with their own ‘stuff’ before offloading it onto their pupils. I’m sure that applies to many other roles where currently there is no expectation that professionals are ‘working on themselves’ when also working with others. But that’s my pie in the sky thinking.
Disputing my suggestion that ‘the prime motive of the courses at UKCP level is to upsell and that psychotherapists registered with the UKCP or BPC are maintaining some sort of illusion of superiority.’ – I can only, and was intending only, refer to the TA course information session given by one specific provider, who I’m comfortable saying were doing as I described. This has no direct bearing on UKCP, likely just on the people doing the presenting and/or the training provider. It’s just unfortunate that by proxy, they could be seen to represent their profession, and a big part of their narrative could be distilled down to, ‘UKCP is better BACP & your BACP qualification is comparatively worthless’. Nice. But that’s nothing new, again, in any line of work, you’ll always have people who do the profession and those they represent proud, or otherwise.
‘The profession is currently in free-fall. There are far too many shoddy trainings and ‘diploma mills’ pumping out poorly trained therapists. This, combined with the ever decreasing access to psychological support through the NHS is a disaster.’ I agree also with this point, but I think we need to be careful on the optics around ‘diploma mills’ as you call them. As stated in my first message, this can in some cases be seen as naval gazing based on a series of assumptions. And it resonates with the culture that was being presented at that TA course information session. But I understand the point you’re making and agree that there is likely a race to the bottom taking place, and I’m currently seeing it in the gulf of quality amongst placement providers as well. It’s so important to keep the bar high.
Linked to this though, I think the biggest frustration amongst those wanting to further their training in order to deepen and broaden their practice and – to keep the bar high – (I’m speaking for myself here primarily, but reflecting conversations with course colleagues as well), are the prohibitive costs. Fees are already eye watering, and with all the additional costs associated with the courses on top of those fees, it’s just not attainable for many. It seems the vast majority of courses are not eligible for student loans, so require incredibly deep pockets to access. And as we know, deep pockets are not evenly distributed. And I think this may also underpin the general dislike of the tone coming from (some of) the psychotherapy community – that perception of hand and thumb to nose singing “nah nah nah nah nah”.
I’d love to know the stats on this (and don’t expect you to have them), but it seems that both counselling and psychotherapy are already predominantly represented by a fairly narrow demographic – namely white middle-class (?). A quick look at ‘find a therapist’ on both BACP and UKCP suggests predominantly female as well. (I’m conscious of the influence of my postcode though in those results). And this is an issue for both disciplines; we’d massively benefit from more diversity and I hope that’s something we can agree on. I’m also aware that it’s not simply deep pockets that allow people to access higher end courses, some of course is done through blood, sweat and tears.
But if it is the case that a narrow demographic have disproportionate access to higher level training (i.e. UKCP accredited psychotherapy courses) contributed to by the many privileges associated with that demographic, you can see why there would be growing frustration at the perceived/felt distancing from ‘those that have’ (access to higher level qualifications) towards those that don’t.
Coupled with your point about decreasing support in the NHS – there are quality people out there wanting to help, who likely can provide help, but who can’t because they cannot access the level of qualifications to enable them to do so, and who maybe are feeling looked down on by those who can. And yes, ‘life’s unfair’ / ‘that’s just life’, and maybe some of the push back from counsellors on this issue is routed in jealousy, but it’s made more demotivating when a key proponent that facilitates a divide is access to funds. It was never a level playing field, and maybe it never will be, but if a ‘diploma mill’ is the best someone can access, and that person has great potential, we shouldn’t be so quick to dismiss the great work they may be offering to those in need, just because of where they trained. But I appreciate your point about the history and depth of well-established training providers.
Fundamentally perhaps there is a culture clash at play, and your separating clients from ‘patients in your language’ is another subtle representation of that. I couldn’t agree more on your point about working with serious pathology and personality disorders – but I’d also question any assumption that says a psychotherapy qualification automatically means you can (or should). It’s such a relative statement to any individual’s level of training, competency, and experience. And I appreciate that serious pathology and personality disorders are vague terms in this context. But even though obvious, it’s important to state that neither counsellors or psychotherapists are doctors, even if you do call those you work with patients.
To try and put all of the above into as simple terms as possible, the answer to the question ‘what’s the difference between counselling and psychotherapy?’ risks being interpreted as ‘the difference is that psychotherapists are better than counsellors because they can afford to be’. I know this isn’t what you’re saying, but where there are blanket assumptions being made (particularly around quantity = quality) and no acknowledgement of some of the contributing factors that allow for a distinction to be made (namely, and likely commonly, privilege), you can see why it’s getting people’s backs up – this, and likely the discussion around SCoPEd as well.
I’d love to hear your thoughts on the differences between BPC and UKCP – seemingly two professional bodies focussing solely on psychotherapy and not counselling. Are they different? If so how and why?
Hello again Eddie,
Thank you for your detailed thoughts – in principle I agree largely with how you present your argument and also fully agree that a nuanced and in-depth piece on the differences between counselling and psychotherapy can be presented. Equally, that perhaps lies beyond the realms of a pithy blog!
Is a undertaking a UKCP psychotherapy training a privilege? Yes. Many cannot afford it and this obviously should change (though I have no real idea how). I am less sure about the lack of cultural difference in the field as it is a discipline that was devised by a persecuted minority – the Jewish people. And it is practised all over the world. I am not UK educated nor raised and so bring a cultural understanding to the field even though it is packaged in the skin of a ‘white male’.
You asked about my views on the differences between the UKCP and BPC. Well, the obvious is that the BPC share common values as all membership schools are psychoanalytically informed. I believe that is one of the weaknesses of the UKCP in that there are so many schools of thought that it can seem hard at times to locate consensus about the future direction of the profession as well as actually defining psychotherapy. Full disclosure – I am a voluntary UKCP press spokesperson so would rather not go into this further.
Returning to the quantity versus quality issue – no, the former does not necessarily lead to the latter. There has been a general ‘dumbing down’ across the field which includes psychotherapy. This is a great shame. Personally I would like to see it return to more of an apprenticeship model rather than being shoe-horned into HE studies where it does not belong. Ultimately, psychotherapy is ore and art than a science.