Counselling or Psychotherapy?
The two terms are often used interchangeably but is there a difference between counselling and psychotherapy? And if so, how do I know which is right for me?
You may have been considering seeing a therapist for a while, searching through seemingly endless profiles and advertisements online- each individual selling their services as both counselling AND psychotherapy. You may have wondered if there is a difference between the two - perhaps one is simply a more Americanised title for the other? Asking a search-engine doesn't proffer any conclusive answers and you may write the whole subject off as irrelevant and of no significance. WAIT! I believe this article might be just what you need to point you in the right direction.
Eric Berne originally developed this concept as a metaphor for human growth and yet it translates wonderfully in to a visual demonstration of the difference between counselling and psychotherapy, as I see it
Firstly, let's talk about the loose definitions we can find online. Web MD says 'counselling is more short term than psychotherapy...(the latter) focuses on a broader range of issues.' Okaaay, that's vague. Another website describes counselling as 'any sort of talking therapy that is time-limited, short-term and deals with issues that a client is currently feeling stressed or unsettled by.' Psychotherapy is then described as 'also a talking therapy that explores a client's current feelings of discomfort, but it aims to find the very roots of your issues rather than just finding a way to manage them.' This is a better way of explaining the difference and yet still one that leaves the prospective client wondering which talking-therapy it is that they might need.
A psychotherapist has undergone longer initial training than a counsellor (usually four years as opposed to two), yet this doesn't necessarily mean that they are a better practitioner. Psychotherapy training involves the trainee undergoing at least 160 hours of personal development with their own psychotherapist- a factor that may lead to a more self-aware and empathetic practitioner. Yet I have worked with plenty of psychotherapists that seem unable to put themselves in their client's shoes.
We can speculate and argue about definitions and differences until the cows come home and it would be of little value to the very person at the heart of it all: the client. And so I'd like to share with you a simple and useful analogy that has arisen from Transactional Analysis theory, which might put an end to your deliberation: The stack of pennies.
Eric Berne originally developed this concept as a metaphor for human growth and yet it translates wonderfully in to a visual demonstration of the difference between counselling and psychotherapy, as I see it. So reader, I'd like you now to picture a stack of pennies- each penny representing a developmental stage of your life. Your first few pennies may correspond with being born and those early months of important bonding with your caregivers. Your next pennies are your earliest memories- siblings being born, learning to walk and talk and how you felt in your family unit. The older you are, the taller your stack- we never stop developing, even in to adulthood, although it is certainly a much slower and less remarkable process for most of us. Your imagined stack is tall and straight, strong and capable of holding ever more pennies.
Now think about those times in your life where you have experienced trauma; those painful memories that we all have buried inside of us. Your parents divorced; you had a childhood illness; the death or illness of a sibling; abuse; alcoholic caregivers; boarding school; being bullied; eating disorders- if you experienced anything that unsettled you at a developmental stage then you can take the corresponding penny and bend it. Now put it back in the pile and look at what has happened to those pennies above; they don't sit quite as straight and strong now, do they? All of those pennies that sit atop the uneven one are less secure; the bent penny/pennies change the entire balance of the stack.
You feel aware that something is wrong; perhaps you have become depressed or anxious. Your sleep might be affected - perhaps you find it hard to switch off your over-thinking. Often clients feel as though they're going crazy. You are not crazy: you have built your life as best you can on an unstable foundation and, at some point, things will come tumbling down.
And now that you have an idea of your penny-stack, I can return to the point of this article, which was about defining the difference between psychotherapy and counselling:
A counsellor can show you how to hold your stack so that it feels more steady.
A psychotherapist can help you locate the bent penny/pennies and straighten them, returning them to the stack and restoring balance and security.
Hopefully this will help you with your decision with a treatment direction; there are lots of different styles and modalities within both counselling and psychotherapy and your next step might be to consider which type sounds more appealing to you. Remember, you are not marrying your therapist- if you decide for WHATEVER reason that the practitioner you have chosen isn't the right person for you, discuss this with them and seek a better fit. Whether you choose a counsellor or a psychotherapist, it is in my opinion that the most important factor in your therapy being successful is the relationship between you and your therapist.
*For more information on how to choose a therapist, please read my other article entitled 'Finding the Right Therapist'.