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  • Writer's picturepippa

Counselling or psychotherapy... how do I choose?

Updated: Jun 8, 2023

If you're trying to decide whether counselling or psychotherapy is right for you, then this might help you make that choice - or decide it doesn't matter. It's quite a contentious topic at the moment, generating a lot of discussion amongst those in my profession, so here goes.

Spoiler alert: there's no hard and fast answer to this, so it's wise to be discerning about anything you read which says that there is a definitive difference.

I'll start with a very recent announcement by one of the membership bodies, the NCS (National Counselling Society), who have (as of 15 May 2023) officially changed their name and branding to the National Counselling and Psychotherapy Society (NCPS). Why should you care, I hear you ask... good question! While the NCPS are yet to publish their reasoning for this change, it's likely that members who call themselves psychotherapists did not feel they were being properly represented by the term NCS.

Neither counselling nor psychotherapy are regulated by the government in the UK. Moreover, "counsellor" and "psychotherapist" are not regulated terms, so anyone can call themselves one or both (or simply a therapist). There's a lot of work going on behind the scenes to put nationally recognised regulations into place, with lobbying at government level from well-respected individuals.

Both counselling and psychotherapy fall under the broad term of "talk therapy", which hails back to the 20th century and the work of Sigmund Freud, sometimes called the 'father' of modern applied psychology. Freud 'created' psychoanalysis, evoking a motif of patients lying on couches with a rather distant figure of the psychoanalyst which has been played out in books, films and TV series over and over again.

To avoid going off on a tangent, it's fair to say that many elements of Freud's work have been problematic, with often hugely unethical practices, but it paved the way for an explosion of interest and research in what we now call the field of mental health. Many of these practices have carried on evolving to this day and now encompass what we call counselling and psychotherapy.

In the 1960s, many trained psychoanalysts moved away from this model of traditional analysis towards more relational therapeutic approaches. There were lots of fascinating offshoots away from the Freudian model, including Gestalt and Cognitive and Behavioural therapy, which I can go into in another post.

Carl Rogers coined the use of the term person-centred therapy, in which the client (he used this over the word patient) was the expert and the therapist's role was to walk in their shoes and show full acceptance of them as they are now. He came up with the core conditions of empathy, unconditional positive regard and congruence, which are still the cornerstones of counselling today (more on that in other post).

Rogers was an advocate of the term counsellor over psychotherapist; his view was that the client and therapist were on an equal footing and felt that counsellor was a more egalitarian term which would help keep the therapy accessible and affordable. This is an argument which has been carried into the current debate to address a perception that counselling is the 'little sister' of psychotherapy.

There is some consensus that counselling is usually defined as a broadly affordable way for anyone (child or adult) to access support with their mental health. Sessions usually take place on a weekly basis and last the 'therapeutic hour' (50 minutes). Post-pandemic, and with the cost of living crisis, many therapists (myself included) now offer flexibility such as fortnightly sessions, to try to fit around the needs of their clients. The sessions can be open ended, with regular reviews with the client to check how they feel the sessions are progressing in line with their therapeutic goals.

Psychotherapy is usually viewed as longer term process for complex or chronic mental health conditions, requiring more sessions and sometimes going on for many years. Formally trained psychotherapists will formulate and diagnose clients, which counsellors will not do. As a rule, the training process for psychotherapists is longer and requires more qualifying hours with clients, but there is no set guidance on this.

So how does this affect you, in your search to find someone to support you on your healing journey? It probably won't! If you find a counsellor - or psychotherapist - or one who uses both terms interchangeably - who answers your questions about their training and experience which you feel resonates with your needs and more importantly, whom you like and build a strong therapeutic relationship with, then you can decide for yourself if it matters what they call themselves!

I personally prefer the term counsellor for my own practice as my ethos is to be inclusive and accessible. When considering names for my website, the feedback I had was that counselling sounded more friendly than psychotherapist, which felt like a good 'fit' for me. So Pippa Counselling was the result!

If you'd like to ask anything about this post or to see if you'd like to start counselling sessions with me (either in person in Exeter or online anywhere in the UK), then please get in touch via the contact form.


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