What a difference a year makes. For all of us the world is an inconceivably different place to a year ago. Not only are we all living with greater uncertainty, we have all had to enormously adapt to living, socialising, relating working, and not least, having therapy in a different way.
Almost exactly a year ago I wrote a blog on entitled ‘The Difference Between Counselling and Psychotherapy’, which has received some traction. More recently, the age old question pertaining to the difference between these to related disciplines has come bursting forth through a collaborative project SCoPEd project which seeks to set out training requirements and practice standards for counselling and psychotherapy. This project is receiving a lot of attention
(accompanied by fierce criticism) by many in the ‘talking therapies’ field. I have no wish to get drawn into the intricacies and politics of the actual project but do firmly believe that from a client’s perspective, standardisation of training requirements and robust practice standards that differ between counsellors and psychotherapists can only be a good thing. More so, I believe that they are essential.
Many of my clients come to be after trying some form of ‘talk therapy’ which may or may not have been helpful. Many come because they are unclear about why they don’t feel better and have ‘stumbled’ across me and my practice via a search engine. Few really understand that there is a difference between counselling and psychotherapy and few understand what they may need and why that may be a psychotherapist.
The fact few understand this has nothing to do with the fact that there is a fundamental difference and put simply, the more I have trained and the more years of experience I have, the more cognisant I have become not only of the differences, but also of how to assess what someone needs and whether they are in fact suitable for therapy.
I have written extensively about the differences between psychotherapy and counselling in my blog a year ago and if you are interested, you can read them here. My blogs are aimed predominantly at lay people who may be considering entering into therapy, rather than at the counselling and psychotherapy community.
Why do clients need to understand the difference between counsellors and psychotherapists?
At present the distinction (in the minds of many) is blurry. Many counsellors believe the two terms to be interchangeable and are thus aggrieved by any proposed framework that should distinguish between the two disciplines: most counsellors think they are psychotherapist; few psychotherapists consider themselves counsellors.
The distinction matters from a duty of care perspective. Deeper work with clients dealing with complex trauma, personality disturbance and psychiatric disorders requires an in-depth understanding of how to identify these issues and an assessment of our ability to work with such clients and the client’s ability to ‘make use’ of the therapy, their robustness.
Turning clients away
My practice is generally full as my work is long-term, however, when considering taking on a new client I undertake a clinical assessment of their suitability for therapy. I aim to answer the question: ‘can I help this person?’ It may seem counter-intuitive, however, I am far more likely to turn down clients pre- or post-assessment now than when I first started out as a counsellor.
Why? Because I now know what I do not know and where my limitations lie.
A GP will not undertake surgery as they have been trained in general practice. They can, however, recognise that a patient needs to see a specialist who can offer an expert opinion and in-depth complex treatment. A GP is invaluable precisely because they are aware of what they do and don’t know and work within their limitations.
This is the ethical responsibility that I believe all counsellors and psychotherapists would carry at the forefront of their minds, however, without training in formulating (our word for diagnosing) how can a clinician know what they don’t know? Herein lies the problem.
Do no harm
The Hippocratic Oath, subscribed to by medical professionals the world over applies to us too. In trying to help (rescue, fix, therapise, relate to) a client, unless we are acutely aware of what we are dealing with, we can do more harm than good.
Is there a place for counselling?
Unequivocally yes. Counselling is enormously beneficial and most psychotherapists started their careers as counsellors in some capacity. Counselling is often all a client needs and it can bring about enormous change for many. However, it is not appropriate for more complex or serious relational or personality disturbances.
In turning clients way it is not solely or even frequently because their requirements lie beyond my abilities; I often suggest to prospective clients that counselling may be more appropriate for them, especially if they have no prior experience of ‘talking therapy’ and are wanting to work through a time-limited issue.
And beyond psychotherapy?
The clients I do turn away as their requirements lie either beyond my knowledge base or holding capacity, I do so from a position of ‘doing no harm’ and making an often tough ethical decision. It may be that that person requires psychiatric support but it may also be that their level of disturbance is best treated by a multi-disciplinary team. And then there is, of course, psychoanalysis.
Inaccessible for many – sadly as Freud saw Analysis as being something that should be accessible for the general population – provides something that psychotherapy cannot: the ability and framework within which to work at depth with powerful regression.
To summarise, the difference simply must be acknowledged and accepted between the professions for the safety and well-being of clients and patients. To do otherwise is plain hubris.
Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.
Further reading by Mark Vahrmeyer