EDITING ERROR: There is a part in the introduction where I had to put a new word in - and it sounds ridiculous… I am sorry about that. I meant to say “people have confused what I do with what a psychiatrist does” but ended up saying “what a psychotherapist does”, so needed to replace that word. Doh!
Hello and welcome to The Nice-ish Ramblings podcast with me, the Nice-ish Psychologist, where today I am discussing the second half of a two-part series focusing on the different types of mental health professionals in the United Kingdom. For context, these two episodes developed out some anecdotal experiences I’ve had where I felt that people have confused what I do with what a psychiatrist does. Additionally, even I have often wondered about the differences between what I do versus what a psychotherapist does versus what counsellors do. So, I thought I would dedicate some time to highlighting the differences between the three professions. In sharing these plans on social media, some followers got in touch requesting that their professions within the field of mental health care also be acknowledged.
And so, in the first episode (which, if you are interested is episode 28) I talked about professions that I would consider fall within psychiatric care. Namely psychiatrists, nursing staff (including registered mental health nurses and healthcare assistants), occupational therapists and social workers. In today’s episode I’m going to focus on mental health professionals that encompass what could be considered talking therapies. So today (just in case it’s not already obvious) I'm going to be talking more specifically about the professions of counsellors, psychotherapists, and psychologists.
Now I wasn’t quite sure where to start with this episode because I couldn’t quite figure out the order of things. In researching and writing this episode there seemed to be more certainty about what a psychologist does, while there seemed to be more of a fuzziness and overlap between that of counsellors and psychotherapists (if there are any counsellors and psychotherapists listening and are offended by this, I don’t mean to offend, but the fuzziness might become clear as the episode progresses). Initially I was going to start off by talking about psychologists, mainly because I am one and it’s usually easier to talk about the things you know, right? (Although I will admit that there are some new things I’ve learnt about in relation to psychologists, but I won’t give those away just yet.)
However, as it transpires, it seems to me that the best way to highlight the distinctions between all three professions is to start with counsellors, move through to psychotherapists and finally onto psychologists as there seems to be a bit of a building on from one to the next – although it’s not quit as linear as that. I mean, thinking about it now, I probably should have just invited a counsellor and a psychotherapist onto the podcast to help me out. But we learn, right! On that note, if I don’t get all of this quite right, please let me know – but also, please forgive me. My intention is to try provide clarity around the different professions, not to diminish one or to overstate the importance of another.
So, let’s start with counselling then. In looking for definitions to what a counsellor is I visited a few websites. Firstly, the National Counselling Society (NCS) notes that “counselling is a type of talking therapy that allows a person to talk about their feelings, needs and problems in a safe, structured, confidential setting. The foundation of effective counselling is providing clients with a professional therapeutic relationship based on non-judgmental respect and offering empathic understanding. Counsellors may employ a number of additional ways of working to further support their clients’ healing and development.” Similarly, the British Association of Counselling and Psychotherapy (BACP) notes that “people seek counselling to help them resolve emotional, psychological and relationship issues. Clients may be experiencing difficult and distressing events in their lives, such as bereavement, divorce, health problems or job concerns. Or they may have more general underlying feelings of anxiety or dissatisfaction with life.” It goes on further to say that “counselling involves a series of formal sessions where the therapist and the client talk about the client’s issues and feelings. Even short-term therapy typically involves six to 12 sessions. The sessions take place at a regular, agreed time and in a ‘safe’ private place where the client and therapist will not be overheard or interrupted.”
From what I can tell there are different stages of training that one can do to become a counsellor which can take three to four years. For example, the BACP notes three stages of training with the first being an introduction to counselling, which helps with gaining the basic counselling skills. The website doesn’t note what those are, though, but I’m guessing it might be skills like active listening and motivational interviewing. This first stage also provides and overview of what further training will involve if a fuller commitment is made. The second stage of training is getting a certificate in counselling skills, which provides a deeper understanding of counselling theories, ethics, and self-awareness. It notes that “this training may also be useful if your job involves advising or helping people, even if you don’t plan to become a therapist.” So, I am guessing that if you only have training up to stage two you can’t call yourself a counsellor proper. This can only happen if someone has done their core practitioner training, which is noted on the BACP as the third stage of training and provides skills, knowledge and competence to work as a counsellor or psychotherapist (see, this is where this all gets fuzzy – counselling and psychotherapy are often spoken about interchangeably).
Now, while this might not be 100% percent accurate, from a browse through the directory of institutions that provide training for counselling listed on the BACP website, it seems that the two primary therapeutic modalities that are offered for counsellors are that of integrative counselling and person-centred counselling.
Person-centred counselling (or the person-centred approach rather) was developed by Carl Rogers in the 1940s, who believed that given the right conditions a person can reach their full potential and become their true self, which he referred to as “self-actualisation” (I’m assuming this is off of Maslow’s Hierarchy of Needs). These three conditions are unconditional positive regard (which involves showing complete support and acceptance of a person no matter what that person says or does), congruence (where the therapist is real and/or genuine, open, integrated and authentic during their interactions with the client), and empathic understanding (which is the therapist's ability to understand sensitively and accurately the client’s experience and feelings in the here-and-now). The BACP notes that “with a person-centred counsellor, you’ll be encouraged to bring your own issues to the session – the counselling is led by you and not directed by the counsellor. Many clients, with no prior knowledge of counselling, believe that the counsellor will sort their problems out for them. A person-centred counsellor will help you to explore your own issues, feelings, beliefs, behaviour, and worldview, so you can become more self-aware and achieve greater independence.”
Integrative counselling, on the other hand, is a form of counselling that “draws on techniques from different types of therapy” and may include elements of the person-centred approach just mentioned. Alongside this, integrative counsellors may draw on elements of psychodynamic therapy as well as cognitive behavioural therapy (or CBT). To briefly elaborate on these, psychodynamic approaches involve bringing awareness and attention to your subconscious – the parts of your mind that are just below the surface, that are automatic, which we pay less attention to but have a really fascinating influence on the way we behave. While the CBT approaches will looks at thoughts, feelings and behaviours and helps you to change some of these where they are unhelpful using a variety of practical strategies and tools, such as journaling, thought diaries, cognitive restructuring and re-framing, etc. These are just two examples of modalities that counsellors might use, but I guess it is possible that counsellors can go onto further training and add other modalities to their therapeutic toolbelt as it were.
As for psychotherapists, the UK Council for Psychotherapy (UKCP) notes that “psychotherapists support people facing challenges in life, whether an emotional crisis such as grief or anxiety, job loss, relationship difficulties, [and] addiction. Or it may be a sense that something is not right.” Which, I’m not going to lie, on the face of it does not seem to be that much different from what was described about counselling. According to a 2017 Guardian article the main difference between a counsellor and a psychotherapist is the training in the sense that, as noted above, one can work their way up to being a counsellor from the ground up with no previous qualifications. However, psychotherapy is more of a post-graduate degree achieved after already completing an undergraduate degree in something else (which interestingly, according to this same article, does not have to be in a field related to counselling or psychotherapy). On this basis, a person will then choose a specific modality of psychotherapy to train in, be that psychodynamic, cognitive behavioural, existential, cognitive analytic, schema therapy, dialectical behavioural, hypnotherapy, just to name a few. At this point, it also worth noting that there are a few arts psychotherapies, too (I think that’s what they’re called), which are rooted (I think) in psychodynamic practice. These would encompass art psychotherapy (which uses art based materials to allow a person to express or process the things that may be going on for them), music psychotherapy, and drama psychotherapy; both of which use music and performance to do do what art psychotherapy does, but just with different expressive mediums.
It seems that there is quite a lot of overlap between counsellors and psychotherapists. However, there are a few differences noted. One article from a website called The Counsellor’s Guide highlights that one of the differences is in the length of time one might receive an intervention. That being that counselling is considered a short-term process – lasting weeks or months, while psychotherapy would be considered a longer-term process – more open ended and ranging from months to years. Another website highlights some further differences by noting that: “A counsellor is more likely to help with a specific difficulty, current problem or surface issue” (their words not mine). It goes on to say, “An example might include a bereavement or a difficulty that is not necessarily rooted in the past. A psychotherapist is more likely to help with more deep-rooted difficulties that affects a client’s life. Examples might include child abuse or trauma.” In relation to this, the same paragraph notes that “a psychotherapist or counsellor however might help with either type of issue. A psychotherapist might help a client with psychological difficulties in life caused by internal difficulties whereas a counsellor might help a client with a problem triggered by external circumstances.” So, still not 100% distinctive on the differences between the two talking therapies.
Overall, though, from what I can gather I think there are potentially three things that might distinguish a counsellor from a psychotherapist. And I guess it’s important to note that this is differentiation is on a very general and basic level. The first being the type of training they receive; the second being the length of time that a person would see either one; and thirdly, whether a difficulty is more acute and has the potential to be resolved with some guidance and support, or whether a person has a more long-standing psychological difficulties rooted in past.
Now, what about fucking psychologist, eh? Well, according to Wikipedia (you know I love a Wikipedia definition) “psychology is the scientific study of the mind and behaviour. Psychology includes the study of conscious and unconscious phenomenon, including feelings and thoughts”. It also goes on to say that “as social scientists psychologists aim to understand the behaviour of individuals and groups”. Now, I have spoken at length about the differences between the two main types of psychologists that exists in a previous podcast episode. So if you are interested in learning more about these distinctions, please go listen to episode 17 of the show. However, if you can’t be bothered, in brief there are basically academic psychologists and applied psychologists (also known as practitioner psychologists).
An academic psychologist is mostly focused on improving the research and evidence base within the field of psychology, and they do this by doing lots or research and will generally remain in the field of academia – for the most part – teaching, getting involved in further research and helping others learn about and/or do more research. It’s a very helpful and important sector of the field of psychology. On the other hand, while applied and practitioner psychologists are also interested in doing research to a degree (they have to do thesis as part of their doctoral training) they are primarily practitioners in the sense that they take what has been learned about in psychology and apply that to human beings in a vast array of settings.
According to the VeryWellMind website there are apparently 20 different types of psychologists. For example, aviation psychologists, who study the behaviour of pilots and other flight crew members. Aviation psychologists also perform research on airline safety, develop new training equipment, and help select suitable employees. Who the fuck knew that? There are also consumer psychologists (also known as marketing psychologists) who research consumer behaviour and develop marketing strategies to promote business. So, those are the bastards who likely came up with the idea that every once in a while shops just move their shelves around. And, consequently, after months of knowing exactly where to go and get your weekly food items with military efficiency, you then have to fart arse around the shops looking for the stuff you want and then buying additional crap cos you’re like, “Oh look, it’s two for one on Ginsters pies” when the last thing you need is a Ginsters-fucking-pie!
Anyway, I digress.
Now, without any disrespect to aviation and consumer psychologists - their work is no doubt invaluable (albeit in the case of consumer psychologists, somewhat annoying) - the psychologists more commonly associated with the field of mental health are likely clinical, health, education, developmental, and counselling psychologists. I would also argue forensic psychologists, but this might not be across all forensic settings. Now, as far as I know, all practitioner/applied psychologists have to do a three-year doctoral degree where they go on placements and learn about working therapeutically with the population and or within the relevant discipline of psychology. Additionally, these particular practitioners will also be trained in a number of therapeutic interventions, which range from, for example, Cognitive Behavioural Therapy (which is the alleged gold standard according to the NICE guidelines – the National Institute of Clinical Excellence), Systematic Family Therapy, and Psychodynamic Therapy. In this way, psychologists are also psychotherapists, capable of providing therapy. Because of their level of training, psychologist are also integrative in the way that they think about an individuals difficulties, and because of their expensive training and exposure to a wide variety of psychological theories, they are able apply these theories to individuals, staff, and work environments. They are also required to think about improvement to services by conducting service evaluations, and should theoretically continue to add the body of research, although this is often not possible to do given time constraints and busy case loads. It is worth noting that counsellors and psychotherapists, if working in organisations like the NHS, would likely end up doing this anyway, but these would be additional skills scaffolded onto their therapeutic skills; whereas (and as afar as I know) these are skills taught as standard on psychology doctoral training. Additionally, it is very important to stress here that in the UK psychologist are not – I repeat – they are not medically trained and can therefore cannot prescribe psychiatric medication.
Having said that, when I posted a brief outline of this episode’s content on my Instagram page, someone let me know that psychologist can in fact apply to be what is known as an approved clinician, which according to some guidance from Health Education England is formally defined as “a person approved by the appropriate national authority to act as an approved clinician for the purposes of the Mental Health Act 1983”. So, an approved clinician is someone that is approved to be an approved clinician! I think what this means is that overall responsibility of someone mental health care used to sit primary with a psychiatrist. However, more recently it has been acknowledged that other health care professionals such as psychologists, nurses, social worker and occupational therapists can apply to hold this position (which, by all accounts seems to be quite a big task to undertake). However, psychiatrists obviously have prescribing powers (as they are medical doctors, remember). But I think under this it’s possible for non-medics to apply for prescribing powers. I am aware that nurses can do this. So, theoretically if a psychologist were to apply for approved clinician status, then I think they could also apply to be a prescriber... However, I have not found anything that says this explicitly, nor can I find anywhere that anyone has done or is doing this. So, if anyone has additional insights let me know.
Sitting under the umbrella of psychologist, we also have trainee psychologists and assistant psychologists. Very briefly, then, a trainee psychologist is someone currently completing their training to become a registered psychologist. So, everything that I have just discussed about what a psychologist needs to do in order to become a registered practitioner, that is a trainee psychologist. They can effectively hold a case load of their own to manage and will slowly, over the course of three years, take on more and more clinical responsibility, while at the same time attending lectures at uni, completing various academic assignments, all while trying to plan, recruit for, analyse and write a thesis. Which is pretty much – in terms of length – a short novel.
Assistant psychologists, also known as aspiring psychologists in some respects, are pretty much that. They are assistants to registered psychologists within services, who work under the direction and supervision of those registered psychologists. The specific tasks that an assistant psychologist are asked to carry out will vary depending on the nature of the service they work in, but can range from administration and scoring of psychometric assessments, report writing, delivering low intensity group interventions, and - depending on the level of skill and experience - may also deliver low level individual interventions.
Now, in terms of psychologists, counsellors and psychotherapists, you might be wondering how to know if one of them is legit and trustworthy. For practitioner psychologists and arts therapists (the art, music, and drama therapists), they have to be registered with the Health and Care Professions Council (the HCPC). Also, the term “psychologist” is not a protected title, therefore anyone can call themselves a psychologist if they want, but can only register with the HCPC as a registered practitioner if they have completed an official doctorate in any of disciplines of psychology already mentioned. Academic psychologists, as stated in episode 17 - which I mentioned earlier - don’t register with the HCPC, but can (along with practitioner psychologists) apply for Chartership with the British Psychological Society (the BPS). In terms of counsellors and psychotherapists, they technically don’t have to register with anyone, and the term “therapist” and “counsellor” are also not protected titles. Which again means that if anyone wanted to, they could call themselves a therapist or counsellor. However, therapists and counsellors are strongly encouraged to register with some form of governing body, such as the BACP, the NCS, or the UKCP (all those governing bodies whose websites I cited earlier). Also, in order to prove they have completed some kind of training and have some kind of therapeutic skills, psychotherapists and counsellors will usually have some kind of accreditation from some kind training body. For example, in the UK, if someone trained purely as a CBT therapist, their training would need to meet the standards set out by the British Association for Behavioural and Cognitive Psychotherapies (the BABCP). So, if you are looking to work with a counsellor or therapist, make sure to check whether they are accredited and if they have joined some kind of governing body.
And that’s it - that’s it for today’s show. It’s possible that might feel like quite a lot, and I wouldn’t blame you if that feels like a bit of information overload. Hopefully I have managed to bring some clarity to the differences between the three professions. As you can see there are quite a lot of overlaps, and perhaps only a handful of distinct differences, but there are differences nonetheless. If I have failed to capture those differences accurately, I am sorry - but I tried to read up as much as I could about them all - so, if things aren’t too clear, then I blame the source material.
Additionally, whenever I refer to websites or things that I've read, you can always go and check them out within the transcripts I sometimes write for this show. For this particular podcast, I put hyperlinks in the relevant sections where I referenced sources. So if I say something that piques your interest please do go back and have a look through the transcripts, and you’ll find what I’m talking about linked there.
If you have enjoyed this episode, then please do let me know; either through rating it, sharing it, or come tell me directly. Equally, I am open to hearing your views on what has been discussed. Until next time, have a good day. Or not. No pressure.
Nice-ish.
Music
Opening: “Chilled Ambient Minimal”
Closing: “Seven” - Tobu
30: UK Mental Health Professionals - Talking Therapies