Counselling or Psychotherapy – Counsellor or Therapist?
These terms 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, what that difference may be and why it matters.
In very simple terms, 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. This is reflected in the training depth, duration and intensity of each discipline. Let’s go deeper into this:
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-20th century that has shaped 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?
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, 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 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.
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 the terms counselling and psychotherapy interchangeable? No.
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 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.
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 client is bringing and is manifesting between the client 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 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 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. 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.
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 early 2022, this process is far from concluded.
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 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.
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 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.
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.
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!
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
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.