Psychotherapy and Counselling

There is unnecessary confusion between the terms psychotherapy and counselling.

What is Psychoanalytic Therapy? – A Personal View, Part 2

The first two apparently alternative titles that need to be sorted out are the basic ones of psychotherapy and counselling.

This is particularly necessary here in Ireland, where the government is currently planning to introduce a formal professional distinction between psychotherapists and counsellors.

In its original sense, the word counsellor means someone who listens in confidence and gives advice.

For instance, Shakespeare’s Pericles says to his advisor Helicanus:

Fit counsellor and servant for a prince,
Who by thy wisdom makes a prince thy servant,
What wouldst thou have me do?
Pericles, scene 2.

In this broad sense of the word, intelligent counselling is part of the work of every competent psychotherapist. Some traditions in psychotherapy frown on the idea of the therapist giving advice. This is notably true of the old classical schools of psychoanalysis which encourage the therapist to say as little as possible. But what is to be avoided in psychotherapy is the giving of bad or stupid advice, or the therapist trying to compensate for what he cannot change in his own life by trying to change things in the life of his client. All psychotherapy involves some advice and counsel, even if this is no more than the implicit advice to turn up on time for one’s appointment.

The term “counselling” was first popularised in the context of psychotherapy in the 1940s by the American psychotherapist Carl Rogers (1802-1987). He used it partly because at the time in the US the title of “psychotherapist” could only legally be used by those with a medical qualification and partly because he wanted to stress that what is valuable in psychotherapy are those things that are not specifically medical about it. (Freud had made the same point in 1926 in his The Question of Lay Analysis.)

Rogers however did not attach any particular theoretical significance to the term “counselling”. For instance he did not use it to distinguish his own brand of “humanist” or “person-centered” psychotherapy from other psychotherapy, as he might have done.

Rogers himself writes in the opening pages of his Counselling and Psychotherapy (1942): “There has been a tendency to use the term counselling for more casual and superficial interviews, and to reserve the term psychotherapy for more intensive and long-continued contacts directed towards deeper reorganisation of the personality. While there may be some reason for this distinction, it is also plain that the most intensive and successful counselling is indistinguishable from intensive and successful psychotherapy.” (Chapter 1, page 4, my emphasis)

Since Rogers’ time the term counselling has become more widely used but it has retained the connotation of emotional help that is undertaken for a shorter duration than traditional psychotherapy, or that is in some sense less deep than full-scale psychotherapy.

For instance, when the survivors of a traumatic event are offered emotional therapy they receive what is invariably referred to as counselling. They are not usually said to be offered psychotherapy, though that is in fact what it is, even if it lasts for a restricted period.

The popularity of the term counselling is undoubtedly due to one genuine advantage it has over that of psychotherapy. This is that it gets us away from the implicit assumption that emotional distress is an “illness” to be “cured”, rather than an inevitable part of the human condition that we all must deal with at some point or another.

As a result counselling is now the most popular general term for what specialists have traditionally called psychotherapy. Nowadays, most people who are in psychotherapy even for several years will say they are attending their counsellor, not their psychotherapist. In all modern contexts now it has in fact become impossible to make any consistent distinction between the terms psychotherapy and counselling.

For this reason, many practitioners, including myself, now regularly describe themselves as psychotherapist and counsellor. This is the clearest and most accurate way to describe to the general public what we are and what we do. In practice, the two words are merging into a single professional title.

These two terms now refer to the same thing, and they are offered by the same people. Throughout this essay I shall therefore treat the terms psychotherapy and counselling, when referring to the contemporary scene, as synonymous.

Tomorrow: What is Psychoanalytic Therapy? – (3) The Origins of Psychotherapy: Freud and Psychoanalysis

Author: Marcus Bowman PhD

I am a psychoanalytic therapist working in Cork.

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