This is a somewhat contentious area for many practitioners because, as with most fields of endeavour, everyone has their own territorial imperatives and personal definitions. The terms counsellor, therapist and psychotherapist are, for example, often used interchangeably but do not necessarily express the same activities. So with that disclaimer, here is my simple outline of the differences between each of these helping activities, the length of their training and training requirements.
Counselling as a named profession was created by Carl Rogers – an American psychologist who coined the term as a psychological therapy because at the time psychologists in the US were not permitted to use the term ‘psychotherapist’ unless they had undergone medical training. Counselling today is generally thought of as a supportive, exploratory relationship between practitioner and client, based on genuineness, acceptance and empathic understanding which act as ‘core conditions’ necessary for mild to moderate levels of personal change to take place, depending on the mindset and commitment of the client. Counsellors are generally required to have received their own counselling during their training, in order to address their own issues and needs. If in doubt, ask the individual counsellor about his or her training.
Psychotherapy tends to be considered a more ‘in depth’, dynamic and sometimes directive form of therapeutic work involving more time. However, this isn’t necessarily always the case and varies according to practitioner, orientation and patient needs. Many psychotherapies closely resemble counselling in practice and short-term psychotherapy is also possible.
Psychotherapist training is postgraduate and specific to the formation of therapeutic relationships. It usually takes several years to qualify as a psychotherapist and there are currently hundreds of different types of psychotherapy, many of which are similar in their way of understanding human experiences and others very different from one another. Psychotherapists in the UK are usually required to be in therapy themselves for the duration of their training. This is to ensure that when the psychotherapist qualifies enough time has been given to examining personal worldview, bias and blindspots, beliefs, personal awareness and history in detail so that he or she can be more effective in helping other people.
Moderate to significant change can be expected from psychotherapeutic work depending on the skills and intuition of the psychotherapist combined with strong motivation, mindset and commitment of the patient, and often therapeutic tasks are required to be done between sessions as part of the therapy.
A psychoanalyst is a psychotherapist who has specifically trained in a theoretical model known as psychoanalysis. Psychoanalysis in its original form was developed by Sigmund Freud as a method of psychotherapy with specific techniques (e.g. free association) and devices (e.g. lying down on the couch) that encourage the patient to be relaxed, open and honest with the therapist, who typically would sit out of view of the patient to elicit more open expression.
Many variations of psychoanalysis exist today as departures from and developments of Freud’s original model. Psychoanalysts, like other psychotherapists, are required to be in analysis themselves throughout their training. Psychoanalysis is generally known for being a long-term option for patients, although some brief models of the approach have also been created in recent years.
Change in psychoanalysis is assumed to take place as the result of insights and intellectual understanding gained through the talking process.
Existential Analyst/ Psychotherapist
Existential Analysis is a form of psychotherapy that has developed since Freud’s lifetime as a response to his Psychoanalysis. Existential Analysis and other existential approaches such as Daseinsanalyse draw on existential philosophies and phenomenology to understand the individual human being as a free agent struggling to meet his or her needs against the forces within and around us, not least of which is existential angst or anxiety. Angst is viewed, not as a pathological symptom, but as a defining characteristic of Being, which we experience in relation to our awareness of our individual life being finite, our need for meaning, our experiential separateness from others, and our freedom to choose from a multitude of possibilities. Our task as individuals is to take full ownership of our choices and our life by developing our awareness, meaning, values and skilfulness in order to honestly address our physical, mental, relationship and spiritual needs.
Each practitioner of Existential Analysis works in his or her own unique way, with some maintaining a conversive, philosophical approach and others employing a broad range of psychological theories, models and therapeutic methods within an existential framework of understanding. Existential Analysts are required to be in their own analysis for the duration of their training, which involves several years of study and clinical practice at postgraduate level e.g. Masters degree.
My personal formulation of Existential Analysis seeks to effect change at all levels of experience where change means doing things differently, not just gaining insight or understanding. Personal change at a feeling level is facilitated by my use of a wide variety of therapeutic methods that act on different aspects of awareness. And the individual is seen in his or her full context, including the familial, cultural, economic, political and spiritual dimensions, all of which act upon and shape us for good or ill.
Integrative psychotherapy brings a number of therapeutic ideas and methods together and ‘integrates’ them using a central principle – in my case this is the existential perspective – so that they work in synergy. This offers patients the benefit of wide and varied ways of understanding and exploring their experiences within the therapeutic relationship (e.g. Gestalt, Psychodynamics, Person-Centred, Focussing, to name a few). The term ‘Integrative’ Psychotherapy also refers to viewing the patient as a whole person, considering the affective, cognitive, behavioural, and physiological dimensions of Being and the social and transpersonal (spiritual) context of each person’s life.
CBT therapy – Cognitive Behavioural Therapist
CBT has become popular due to its widespread promotion by public health services like the NHS as it is quick and cheap to train staff to do CBT. CBT is also a simple problem-solving approach that everyone can understand and do as it is based on instruction manuals of standardised techniques. It derives its ideas from a variety of other therapies and renders them into simplified, standardised procedures specific to psychiatric problems e.g. depression, phobias etc. This assumes that discreet dysfunctions operate in closely similar ways in each person and can be solved using standardised protocols and techniques.
CBT is called an ‘information processing’ model, which basically means it approaches the person as if his or her brain acts like a computer. The theory is that when you put ‘good information into’ the computer (‘positive’ thoughts), you get good (positive) feelings and behaviours coming back out and vice versa. A person’s problems are thus located in the ‘negative’ ways we think about things. CBT sees change as arising from changing these ‘negative’ thoughts and habits. You can do CBT on yourself from a self-help book and CBT computer software that helps you examine your thoughts and their impact upon your feelings and behaviours. Many other ‘alphabet’ therapies have evolved out of the CBT model in the so-called ‘Third Wave’ therapies e.g. DBT, MDT, ACT etc.
Training courses for CBT therapists range between a few months to a year or two depending upon the level of training chosen. Practitioners of CBT are not required to have undertaken any psychotherapy or self-development work themselves during their training, since the relationship between therapist and patient is not considered to be a significant factor in therapeutic change.
A psychologist in the UK is someone who holds a Bachelors degree in psychology. The degree is based on a broad understanding of the history, theories and statistical methods of psychology, and a psychologist might go on to do additional training in a specialism such as clinical psychology, advertising psychology, sports psychology etc. Clinical psychologists are not necessarily trained in psychotherapy unless they do additional training in it, but tend to use a mixture of psychological models, such as CBT, to inform their work with patients. Counselling psychologists, as the name suggests, are psychologists who have chosen to focus on the therapeutic application of psychological models within a counselling relationship. Psychologists who use the title ‘Dr’ have usually undertaken a clinical doctorate program, which is academic research in a chosen area of interest, and they are not medical doctors.
Psychologists are generally not required to have undergone any personal psychotherapy or self-development work themselves during their training. If in doubt, ask your psychologist about his or her training and personal experience of therapy.
A psychiatrist in the UK is a medical doctor who has done additional training in psychiatric medicine. A psychiatrist – by virtue of his or her medical degree – can prescribe medication or other forms of psychiatric interventions. Patients are normally referred to psychiatrists in the NHS via their family doctor, but some practice privately. Some psychiatrists may also be psychotherapists if they have elected to do additional training in psychotherapy. Psychiatrists generally have not been required to undergo any personal psychotherapy or self-development work during their training.
Change in psychiatry is attributed to the action of medications or other aggressive treatments like ECT – Electro-Convulsive Therapy – acting upon the functioning of the brain and nervous system which in turn affect thoughts, speech and behaviour, sometimes with serious and permanent adverse side-effects.
Using sections of the Mental Health Act in the UK and in collaboration with Social Services, Psychiatrists can legally force treatment, restraint and incarceration upon a patient without their consent if they are assessed as posing a risk to themselves or others. Psychiatrists issue psychiatric diagnoses, which are sometimes required in order to access Mental Health services within the NHS. However, such diagnoses are often contentious and arbitrary in their application, and no form of diagnosis is required to either understand or treat mental or emotional distress.