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What is Psychotherapy and Counselling? Part 6 - Is there a difference?

Should I go for psychotherapy or counselling? What is the difference?

Sometimes, going ‘to talk to someone’ is a good idea. Your doctor has suggested medication. Or a friend suggests ‘seeing someone maybe...’.

Where to start? A counsellor or a psychotherapist? These words are used interchangeably. And the counsellor and the therapist do similar work with clients.

This is, however, my broad-brush distinction:

first, a counsellor will work with you short-term over 6 - 8 (sometimes 12) weekly sessions; a psychotherapist will work in weekly sessions in an open-ended way over several months, perhaps a year, perhaps several years (depending on the complexity of your problems);

secondly, a counsellor may ask you to identify a goal or problem that the two of you will focus on and he/she will gently nudge you if you ‘stray off course’; a psychotherapist will be prepared to work with you in a less focussed way, allowing you to bring all sorts of issues to the sessions so that both of you can explore your life whilst addressing both past and current difficulties;

thirdly, a counsellor may offer to work only with ongoing and specific issues e.g. anger management, alcohol or substance abuse, bereavement; a psychotherapist will be prepared to work with childhood and past issues, especially if your current problems are complex and multi-faceted e.g. childhood or ongoing domestic abuse, complex trauma, self-harming, suicidal ideas.

There is necessarily a considerable overlap between the work of a counsellor and a therapist. Many of us are qualified in both ways of working and will adjust our working style depending on your needs and the time you have available. Also we may start working together for six weeks, but then agree that a bit more time is needed. Or we’ll start working open-ended, but make such progress with a particular goal that you feel that the ‘work is done’ after six weeks.

A young man, who came to see me as he was having panic attacks as he could not communicate with his parents about important life choices, decided, after three sessions where we did some role plays, that he would talk to his parents and did so very successfully. The panic attacks stopped. There was no need to carry on with what we thought would be lengthy therapy.

I hope this shows that there is a lot of flexibility and ongoing adjustment when you do go to ‘talk to someone’. And that no issue or problem is too small...I shall write about that next time.

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