With the recent media and government focus on the regulation of counselling and psychotherapy, we thought it timely to explain what these terms mean. When you’re searching for emotional and psychological assistance, how do you tell a psychologist from a counsellor, and what’s a psychotherapist anyway? How are they trained? What do they do? And what does regulation mean for you and for the industry?
What is counselling? Counselling means different things to different people. To some it’s a process where specific issues are discussed with an aim to resolution. To others, counselling involves a wide-ranging, interpersonal exploration that can lead to personal growth. A third view of counselling is as a means of social control or punishment, as in “the full-forward has apologised to his teammates’ wives and is being counselled about the incident”.
Is counselling what psychiatrists do? Well, sort of. Psychiatrists are first of all medicos, trained in the delivery of a scientific service. Psychiatrists often have comparatively little counselling training, and while there are exceptions, psychiatrists don’t tend to spend a huge amount of their day actually listening to people. Their strong suit is the diagnosis of so-called mental disorders and prescribing the drugs that seek to cure these or minimise their symptoms. This focus on the effects of drugs on mood and behaviour is referred to as psychopharmacology.
Well then, what about psychologists? A more diverse bunch. Some members of this species seem to have a form of Psychiatry Envy, spruiking the vital importance of seeing psychology through the stern and sterile lens of positivistic science while seeking to conscript all therapists into this world view via an often confusing cocktail of language collected from economic rationalism, pre-war physics and medicobabble. They might be heard littering their language with words such as “psychopathology”, “empirically validated”, “evidence based”, and “efficient”. Their relationship with counselling is somewhat unclear as it is possible to qualify as a psychologist without ever having sat in the same room as a client. Despite this, there are many psychologists who completed their training (and expanded upon it) with the expressed view of counselling people. Some of them are actually very good at it.
And do counsellors counsel? This is possibly an even more disparate group than the psychologists. This bunch can be divided into several different categories, the most important of these are “professional counsellors”. Professional counsellors often have a tertiary education and training that is far more relevant to the person-to-person encounter than that undertaken by psychologists or psychiatrists. The best of these counsellors come through courses with strong experiential and personal development components. The worst of these practitioners have little or no training or have paid for the quick and nasty correspondence courses that routinely rise and fall on the internet. Qualifications from these places are often accompanied by a free set of steak knives. It’s worth noting that while the words “psychiatrist” and “psychologist” are protected terms, the word “counsellor” is not.
What is a protected term? While it may sound like an endangered sea bird, a protected term means that one must qualify to use the word via a tertiary institution, register with an appointed professional body and remain registered while practicing. Put another way, the words “psychologist” and “psychiatrist” are protected by legislation. Presently no formal qualifications or registration is required if one is to assume the moniker of “counsellor”.
Is Dr Phil a counsellor? Umm, yes, kinda. Dr Phil is to counselling, as a McHappy meal is to fine dining. He is in fact a CBT-trained psychologist who has given up his work as a counsellor in order to dispense advice instead.
Is Cognitive Behavioural Therapy counselling? It can be. CBT is a brand or style of counselling. There are lots and lots of these brands, and although nobody knows exactly how many, more than 400 distinct varieties have been identified. (Watch out for the David Attenborough documentary on this subject). This broad palette may say as much about the complexity of human nature as it does about the profession of counselling. Other styles, brands, schools or methodologies include, psychoanalysis, narrative, person-centred, existential, feminist and Gestalt.
With so many brands, which is the best? A blow-by-blow account of the unending civil turf wars that have raged in bloody and bitter fashion between these different modalities could fill many bound volumes … so … we’ll cut to the end instead. There is no “best”. Perhaps the most fascinating psychotherapeutic research to emerge in the past decade has reduced this intermethodological warfare to the level of a couple of sports fans engaging in a my-team-is-better-than-your-team type argument. The research discovered it wasn’t the type of therapy that was of primary importance; rather it was the ability of the counsellor to form a strong and supportive therapeutic relationship with the client. Counselling success is also highly dependent on a range of fluid contexts making the question “which type of therapy is best” as redundant as generically asking which golf club is the best, or, which chess move is the most efficacious. The answer … it depends.
Are counselling and psychotherapy the same thing? To everyone outside of the field(s) there is no appreciable difference, although the label “psychotherapist” can sound more impressive in certain social and professional circles. Try it out yourself. My hairdresser thinks counsellor sounds “nicer”, but her colourist thinks psychotherapist sounds more “serious”. They may be onto something there.
What will regulation do? At the present time, many counsellors choose to register voluntarily with a professional counselling body. These organisations have requirements for membership that include but are not limited to, training, supervision, insurance and a complaints procedure for clients. The peak organisation for counsellors and psychotherapists in Australia is the Psychotherapy and Counselling Federation of Australia. At best, the enforcement of regulation will recognise practitioners who are doing good quality counselling and prevent the unethical and dangerous operators, including de-registered psychologists and psychiatrists, from working in the field. At its worst, regulation will lay out a minefield of fastidious “accountability” that will seek to stifle innovation in practice and replace it with a form of nervy risk management. Regulation will above all not us from our own responsibility to choose our helpers wisely.