What’s the difference between counselling and therapy?

Counselling1In response to my invitation to friends and family to feedback on the content of this website, someone suggested that maybe I could explain the difference between counselling and therapy. This was a timely reminder that I have all kinds of taken for granted assumptions about what people do or don’t know about the counselling process.

If you’re considering seeking counselling and are starting completely from scratch then this blog post is for you. In order to write it I will try to cast my mind back seven years to my first experience of counselling in order to recall the anxiety and confusion I felt as I approached it for the first time. It really is quite a complex and confusing area!

Firstly, it may or may not be obvious that when we talk about the difference between counselling and therapy we’re talking about psychotherapy – as opposed to things like massage therapy, physiotherapy or occupational therapy. Therapists who work in these important fields (and many others) will very often use counselling skills but they are not doing counselling or psychotherapy, for reasons which will hopefully become clear.

In fact, counselling and psychotherapy are very similar, so much so that a lot of people would say there’s no significant difference, but there is a great deal of debate in counselling and psychotherapy circles about this: other people would say there are important differences between the two things. Readers will have to trust me when I say that the finer points of this debate are not that relevant to people who are looking into counselling for the first time. However, one difference which is worth noting is that people who describe themselves as psychotherapists often (though not always) have done more formal training than people who describe themselves as counsellors and subsequently they often (though not always) will charge more per session.

What confuses matters even more is the fact that there are many, many different types of counselling and psychotherapy (often called theoretical orientations or approaches), some of which work well for some people and some of which work well for others. This is because we’re all so different from one another, we all have different needs and styles of relating to one another and so the number of different approaches reflects this.

I am a Humanistic counsellor which means I work in quite a different way to those who practice Cognitive Behavioural Therapy (CBT) or Psychodynamic counselling, to name two other popular approaches. However, these three, along with most other orientations, have some very important things in common. In his book, Demystifying Therapy, Ernesto Spinelli outlines the key things that counselling and psychotherapy have in common.

  • They both involve quite a lot of talking.
  • As I’ve already suggested, they can both utilise a variety of different approaches based on theories and methods which often differ a great deal and sometimes even appear to contradict one another.
  • They both seek to help the client to clarify and resolve psychological difficulties they’re facing and in so doing give them a better understanding of the way they relate to themselves, to others, and the world in general.
  • They both require a particular, special kind of relationship (often described as a therapeutic relationship) between the counsellor/therapist and the client, which I describe in a bit more detail at the end of this post.

Warm and fuzzy or cold and hard?

The friend who inspired me to write this post described their own experience of counselling and therapy. They had this to say…

“I’ve been given the impression that in general counselling is warm and fuzzy while therapy is cold and hard. I’ve been to both. In counselling they smiled, in therapy they didn’t… maybe that’s the difference?!”

This is an interesting observation. In response I would suggest that how much smiling takes place in a counselling/therapy session is very much dependant on the personality of the counsellor or therapist involved. However, it’s also possible that my friend experienced two different types of counselling. The Humanistic approach is one in which the counsellor brings their personality fully and authentically into the relationship they have with their clients. This helps to foster a feeling of safety and security which creates the right conditions for change and growth. This may involve quite a lot of smiling if the counsellor is a smiley person! Psychodynamic counsellors and therapists do something quite different. By giving as little as possible away about themselves (e.g. perhaps by not smiling much) they hope to turn themselves into a kind of mirror in which the client will eventually be able to see their own process. Stereotypically this kind of approach can be perceived as cold and hard. However, as I’ve already said, it very much depends on the personality of the counsellor. Many clients might not notice much difference between these two approaches in relation to how they experience the therapy.

However, no matter what their approach, most counsellors and therapists now agree that ultimately it is the quality of the relationship itself which provides the key ingredients for change and growth. What this means for clients is that, whether they smile or not, it’s important that they trust the counsellor enough to risk being really honest with them. Inevitably counselling contains uncomfortable and challenging moments. If the relationship is strong then the client and counsellor will be able to work through these moments together. If the relationship is not strong enough then it’s likely that things will end up feeling stuck because the client does not feel safe enough to face their fears, which of course are often the very things which have brought them to counselling in the first place.

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