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. 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. 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 currently exist over two hundred different types of psychotherapy, some 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 motivation, mindset and commitment of the patient and often therapeutic tasks are required to be done between sessions to make therapy more effective.
A psychoanalyst is a psychotherapist who has specifically trained in a theoretical model known as psychoanalysis. Psychoanalysis was developed by Sigmund Freud as a form of psychotherapy with specific techniques (e.g. free association) and devices (e.g. the couch) that encourage the patient to be relaxed, open and honest with the therapist. Many variations of psychoanalysis exist today as departures from and developments of Freud’s original model. Psychoanalysts, like 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. Psychoanalysts are required to be in their own analysis during their training. Change in psychoanalysis is assumed to take place as the result of insights and understanding gained through the process.
Existential Analysis is a form of psychotherapy that has developed since Freud’s lifetime as a response to his Psychoanalysis. Existential Analysis draws 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 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 at postgraduate level. 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.
CBT therapy – Cognitive Behavioural Therapist
CBT has become popular due to its widespread promotion as a simple problem-solving approach that everyone can understand. It derives its ideas from a variety of other therapies and renders them into simplified procedures specific to psychiatric problems e.g. depression, phobias etc. It’s 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 their problem thoughts. CBT sees change as arising from changing thoughts and habits. You can do CBT on yourself from a self-help book and CBT computer software that helps you examine your ‘negative thoughts’ and their impact upon your feelings and behaviours. 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 themselves during their training, since the relationship between therapist and patient is not considered a significant factor in therapeutic change.
A psychologist in the UK is someone who holds a Batchelors 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. Clinical psychologists are not necessarily trained in psychotherapy 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. Psychologists are generally not required to have undergone any therapy themselves during their training. If in doubt, ask your psychologist about his or her training.
A psychiatrist in the UK is a medical doctor who has done additonal training in psychiatric medicine. A psychiatrist in the UK – 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 have undergone any personal psychotherapy during their training. Change in psychiatry is attributed to the action of medications or other treatments like ECT acting upon the functioning of the brain.
Using sections of the Mental Health Act in the UK and in collaboration with Social Services, Psychiatry can legally force treatment, restraint and incarceration upon a patient without their consent if they are considered a risk to themselves or others.
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