I’m confused! What’s the difference between psychotherapy and counselling

"I’m confused! What’s the difference between psychotherapy and counselling?”

By Vincent Ryan

When someone is looking for mental health support for the first time it's natural to wonder what’s available. And part of that question may be, “I’ve heard about counselling and psychotherapy. Is that just two words for the same thing? Or are they really different?”

The short answer is that mental health experts in Ireland are still debating this question.

For instance, the Irish Council for Psychotherapy asserts that psychotherapy and counselling are distinct professions with different levels of expertise. On the other hand, the Irish Association for Counselling and Psychotherapy asserts that there is no proficiency difference between counselling and psychotherapy. This debate is heating up since statutory regulation is on the horizon for the Irish mental health professions overall.

Today in Ireland many professionals refer to themselves simply as a “counsellor and psychotherapist” and don’t draw a lot of attention to any distinction between the terms.

If there is a useful distinction that could be made between counselling and psychotherapy what might that be?

It may be useful to think about what counselling and psychotherapy have in common first, before considering what, if anything, might distinguish them.

For a start, it is usually some problem that motivates a person to seek out a mental health professional. Few would seek a counsellor or psychotherapist for the sake of it.

The problem that brings the person into therapy may be quite vague or may seem very clear. It may involve one key symptom or various symptoms. There may have been an obviously stressful event coming before (e.g. bullying, bereavement, job loss) or no obvious single event. Either way, the problem usually interferes with the person’s life and causes enough suffering for the person to seek help.

Regardless of what they call themselves, counsellors and psychotherapists work to help a person to face and resolve their problems. However, some problems may be simpler and more amenable to short term treatment, while others problems may have been around for a long time for the person, perhaps all of their lives in some cases, and may be slow to respond to treatment.

If there is to be a distinction between counselling and psychotherapy it would probably concern the nature of the problem the person faces and the depth of the work required to resolve it. As the government’s previous mental health framework document, A Vision For Change (2006) put it:

“In general terms, counselling is concerned with a circumscribed difficulty arising from an identified precipitating cause and is short-term in application, whereas psychotherapy is concerned with more fundamental and inherent difficulties of longer duration and with less easily identified causes.”

An example might help to illustrate this. Let’s consider two contrasting people, let’s call them Ben and Jim.

Ben has a fairly full life. He enjoys his work and has mostly good relationships, with some ups and downs. Recently he lost his job. He quickly becomes depressed when he discovered he might be in for a long job search. He is feeling anxious over mounting money problems. And he is also getting into a lot of arguments with his partner. He goes looking for a professional to help him with his problems.

On the other hand, Jim is someone who has struggled all his life, with both work and relationships. He is very unsure of himself. He finds it very hard to relax and enjoy life. He’s not sure what is “wrong” but he is quite unhappy. He realises that he wants to do something so he seeks out a mental health professional.

In helping us to think about mental health problems, as the Vision For Change document has sought to do, we can see that there is a sizeable difference between these two clients. Whereas Ben has clear and recent symptoms and problems and a clearly identifiable cause (lost his job), he might benefit from just a few sessions of counselling to “get back on track”. Jim seems to suffer with “more fundamental and inherent difficulties of longer duration and with less easily identified causes” which may require a much longer and deeper kind of work, in order to “find a new track” for him.

Of course, regardless of the form of therapy, there can be surprises also: Ben might discover deeper issues uncovered by the job loss. And Jim may discover that by making simple changes to his life he becomes much happier. Sometimes these things only come to light through the process of discovery, whether it is called “counselling” or “psychotherapy".

It’s also useful to remember that therapy doesn’t always have to be long term to go deep and effect profound change. A single session of therapy can sometimes be life-changing. The tale of Milton Erickson and the "African Violets Lady” is a classic example of this. Though admittedly this is rare and results usually take patience, effort and time.

The likelihood is that there may be a debate for some time about the labels “counsellor” and “psychotherapist” in Ireland. When considering working with a counsellor or psychotherapist for the first time it may be useful to ask him or her how they view the matter. How do they approach thinking about and working with a new client? What’s their view on the difference between counselling and psychotherapy, if any? This should always be a welcome conversation. And even if there is no definitive answer it may serve to shed some light to help the person decide if this professional may be able to help them find the answers they seek.

REFERENCES:

IACP, (2015). Irish Association for Counselling and Psychotherapy: Position paper on statutory regulation 2015. Downloaded from: http://www. irish-counselling.ie/files/UserFiles/IACP-Position- Paper-on-Regulation-and-the-Difference-between-Counselling-and-Psychotherapy-April-2015.pdf

ICP, (2015). The Irish Council for Psychotherapy: Position paper on statutory registration and the distinction between the related professions of counselling and psychotherapy. Downloaded from: http://psychotherapycouncil.ie/wp-content/uploads/2015/01/ICP-Position-Paper-January-2015.pdf

Government of Ireland (2006) A Vision for Change: Report of the Expert Group on Mental Health Policy. Stationary Office, Dublin. Downloaded from: https://www.gov.ie/en/publication/999b0e-a-vision-for-change/

Jane Parsons-Fein (30 Oct 2015). Milton H. Erickson M.D. Treating Depression

Retrieved from: https://youtube.com/watch?v=-rH9v5JYmB4