The difference between a counsellor, psychotherapist and psychologist
Learn about your choices when looking for a therapist.
If you’ve been struggling with relationships, feeling overwhelmed, stuck or lost, navigating grief and loss or life transitions, experiencing symptoms of depression, anxiety, disordered eating or trauma, you may be wondering how to get help. Most people don’t know the difference between a psychologist, counsellor or a psychotherapist and it can make seeking help really confusing. While there are things counsellors and psychotherapists can’t do, supporting you through the above mentioned challenges is absolutely their arena and what they’re trained in. Let’s talk about the main differences between counsellors, psychotherapists and psychologists and clarify your options when choosing a therapist.
Psychologist
You may be aware that in Australia your GP can help you access a Mental Health Plan, which will allow you to see a psychologist for 10 sessions per calendar year with a part of the cost covered by Medicare. Psychologists can provide formal assessments, diagnosis and may work with clients presenting with severe mental illness. These are things counsellors and psychotherapists don’t do. If you’re not looking to be diagnosed or assessed for a particular mental health condition, you may not need a mental health plan and a referral to a psychologist. Counsellors and psychotherapists may be a great option for you. If you would prefer to receive therapy within the medical model, you may still choose to see a psychologist. All psychologists in Australia are trained in Cognitive Behavioural Therapy (CBT), a structured approach to therapy where you’ll be taught to replace unhelpful thoughts with more helpful ones and through the process change how you feel and act.
“Thoughts are like blossoms on a flower—there’s a stem and then a whole root system beneath them. Thought substitution alone is like plucking off a dandelion bloom, glue-gunning a daffodil blossom on the stem, and expecting daffodils to keep blooming. In this case, lasting change requires digging up the roots of one flower and planting a new bulb to grow the other. These new bulbs are embodied experiences; the soil is the context that supports our blooming.”
Hillary L. McBride, The Wisdom of Your Body: Finding Healing, Wholeness, and Connection through Embodied Living
CBT is focused on treating the symptoms rather than the cause of our problems and is more of a “quick fix”, hence the Medicare rebate. However, it’s not always the best option (especially in the long run) and certainly not for all clients. As in the quote above, it’s like replacing the blossom of one flower with a different one and expecting the plant to keep thriving and producing the new blossoms. Wouldn’t you like to know why this thought, that’s causing you distress, is there in the first place. Where is the root of this unhelpful thought? What’s feeding it? How did the seed get planted and how did the environment support it in growing? Nurturing and growing healthy plants needs the right conditions. Similarly, learning to relate to the world around us in new, perhaps healthier or less limited ways, requires safety, a strong therapeutic relationship and the client’s trust in the therapist. That can often take quite a bit longer than 10 sessions and the focus needs to be on creating these conditions, not on finding broken bits and quickly fixing them.
What are your other options?
If you would prefer to try a different therapeutic approach to CBT, you can look for a counsellor or a psychotherapist. This way you’re able to choose a therapist that is trained in a therapeutic style that will suit you as a person or specialises in an area specific to your needs. Counsellors and psychotherapists don’t fall under the Medicare system, therefore you do not need a referral and there’s no limit on the number of sessions. While counsellors or psychotherapists do conduct their own assessment of your presenting issues and risks when you come to therapy, they are not interested in fitting you into a diagnostic criteria. You will be met as a whole human being with your own unique experiences. You’ll be seen and heard and provided with support in finding ways to thrive in life.
Who is a counsellor
Counsellors are expert listeners, trained in creating a safe, supportive environment where you can get in touch with what’s going on for you and find your own answers. They spend years learning and practising specific skills that help you open up, gain insight and make sense of the events taking place in your life. A large focus of their training is placed on the therapeutic relationship which, as research consistently shows us, is the single most important aspect of effective therapy. During their studies, counsellors learn the theory and practice techniques of various therapeutic approaches and complete placements where they gain experience under the supervision of senior practitioners. The focus of their qualification is on the practical skills of therapeutic work. Counsellors can specialise in a particular area of expertise such as drug and alcohol use, relationships, anxiety, depression, grief and loss, domestic and family violence, trauma etc. They can also be trained in a chosen therapeutic style, similarly to psychotherapists.
Who is a Psychotherapist
Psychotherapy generally goes deeper than counselling and is usually more long-term. Psychotherapists support their clients in getting to the root of their issues and helping them heal. Apart from various therapeutic techniques (depending on the therapist’s training), there is a strong focus on building the therapeutic relationship, creating safety and healing through the connection between the client and their therapist. Your psychotherapist may be trained in a number of modalities. These may include somatically focused work, relational, experiential and holistic therapy (such as gestalt therapy), psychoanalysis, art therapy, mindfulness based therapies, dance and movement therapy, ecotherapy and many more. You choose what works for you. Psychotherapists not only complete a lot of practical training in their chosen modality, they are also required to attend personal therapy alongside their training. This is, in my opinion, absolutely essential to becoming a good therapist (and not something psychologists are required to do as a part of their training). Read more about therapists in therapy here.
Regulatory bodies
Almost all counsellors and psychotherapists are members of a professional association such as Psychotherapy and Counselling Federation of Australia (PACFA) or Australian Counselling Association (ACA). To become a member they have to complete required levels of education and practical experience. To maintain their membership, every year practitioners have to attend professional development, regular clinical supervision and comply with the ethical codes of their associations. Depending on their qualification and experience they gain different levels of membership. For example, a PACFA clinical member, has to hold at least a Bachelor degree, complete at least 750 hours of direct client contact work and 75 hours of clinical supervision post graduation. They are qualified and experienced professionals. In Australia, counsellors and psychotherapists aren’t legally required to be members of a professional association, so look for one that is to ensure they have the right qualification and experience. You can then check these details on the association’s website.
The trouble with the Mental Health Plan
If you do choose to access therapy through the Mental Health Plan, there are some things to be aware of. Your records will be stored with Medicare and can be accessed by other health professionals and insurance companies (unless you opt out, so know that that’s possible). You’ll still pay a gap fee on your rebated 10 session, which is usually close, sometimes more than, the amount charged as a full fee by counsellors and psychotherapists. Once your 10 sessions are done, you’ll be paying the full fee if you want to continue therapy.
Finding the right therapist can be a bit like dating, you need to be a good match. Sometimes it’s about trying a few therapists and different therapeutic styles to finally meet someone you click with. Ultimately, remember that the choice is yours, not your doctor’s or anybody else’s. Don’t limit yourself by looking at the Mental Health Plan as the only option. There are lots of very skilled and knowledgeable therapists who do not work under the Medicare scheme and might be the perfect match for you. You have the right to choose what works for you.
