How does Psychotherapy differ from Psychology & Psychiatry?

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Having decided that you might want emotional/psychological support in the form of professional assistance, which profession to consult can be confusing in itself! Psychologists, psychotherapists and psychiatrists offer varieties of psychological assistance, and the terms ‘counsellor’ and ‘psychotherapist’ are often used interchangeably.  Also confusing is that while the training and skill base of those offering psychological services differ, there can also be areas in which they overlap.

As a counsellor and psychotherapist, my focus is on the subjective experience of clients – i.e. their own feelings, and feelings about, the issue/s with which they present. Diagnosis of disease or disorder is not what psychotherapists and counsellors are qualified to do. Subjective experience (‘how it feels’) is central to health, well-being and healing, and counselling and psychotherapy provide a context in which the quality of subjective experience can be engaged with.

This may or may not involve addressing of a ‘problem’ as such. While it is common for people to seek professional assistance when something is ‘wrong’, many life experiences can be challenging in ways it can be helpful (therapeutic!) to address in the context of counselling or psychotherapy.  These professions are not about the giving of ‘advice’. Counsellors and psychotherapists facilitate a space in which clients can engage with their experience in the presence of a skilled, attuned and empathic ‘other’ who is outside their existing circle of contacts and who offers a different vantage point for that reason. Could you benefit from seeing a therapist?

By contrast, psychiatrists focus on pathology and mental disorder, and specialise in its diagnosis, treatment and management.  Unlike psychotherapists and counsellors, psychiatrists are qualified medical doctors, are able to prescribe medication, and tend to work within the biomedical paradigm.

Psychologists are not medically qualified (and like counsellors and psychotherapists, do not prescribe medication). But the training of psychologists draws more directly on scientific method/s than does the training of counsellors and psychotherapists. Note that this does not of itself mean that ‘non-scientific’ training and interventions are necessarily ‘ineffective’. Psychologists often administer assessments, inventories and scales in which they are trained (in contrast to psychotherapists and counsellors who do not have this training and emphasis). The biomedical inflection of psychology training also accounts for the frequent use by psychologists (in common with psychiatrists) of The Diagnostic and Statistical Manual of Mental Disorders (the fifth edition of which is now available, and according to which client problems and presentations are classified).

Both psychologists and psychiatrists diagnose (i.e. in contrast to counsellors and psychotherapists who do not). Counsellors and psychotherapists generally do not see themselves as ‘treating’ their clients (a term which pertains to biomedical discourse). They also prefer the term ‘client’ (rather than ‘patient’) for this reason. Many counsellors and psychotherapists do work, however, with serious client issues, which may or may not need medical attention as well (in which case collaboration with a general practitioner or psychiatrist is also common). It is significant that notwithstanding his own medical training, Sigmund Freud (‘the father of psychoanalysis’) did not believe medical training to be a requirement for lay analysts (1926, 1927).

The distinction between counselling and psychotherapy is less meaningful than it used to be. In contrast to counselling (which tended to be short term and geared to specific and immediate issues) psychotherapy was initially longer-term and associated with a degree of personality restructuring. But since the field of psychotherapy now includes many brief ways of working, and counselling can itself be long-term, the distinction between them is now less clear-cut. Both can also involve similar training, the length and intensity of which varies according to the school and method/s employed.

While there are now many modalities and approaches, both psychotherapy and counselling tend to emphasise active listening, consistent empathy, unconditional positive regard, and a receptivity to ‘walk in the client’s shoes’ (the latter of which is fostered by the personal growth emphasis which is a dedicated component of most counsellor training). Though often highly skilled, counsellors and psychotherapists tend not to see their role as that of ‘expert’, but rather as one of ‘walking alongside’ the client. Both also increasingly emphasise a ‘strengths-based’ approach to client abilities (i.e. in contrast to the implicit ‘deficit and disorder’ perspective of biomedical discourse).

The personal growth component which tends to be characteristic of counselling and psychotherapy training is much less a feature of psychology training (which often lacks it completely, notwithstanding the several years of tertiary study and subsequent work required for registration as a psychologist).  Other components such as counselling skills and reflective listening (which tend to be taught early in the training of counsellors and psychotherapists) are generally acquired later by psychologists in comparison (some of whom go on to do training in psychotherapy, with the reverse also occurring). Like psychologists, the training of psychiatrists (which follows a medical degree) similarly lacks personal development components and the focus on counselling skills which can be invaluable in clinical settings. Some psychiatrists and psychologists become skilled in this respect and some are also psychotherapists.

In western culture, ‘the belief that healing comes from outside is deep-seated and powerful’ (Weil, 2003:8).  But Andrew Weil (a teacher of integrative medicine with an emphasis on natural healing who is also a physician) points out that ‘the true source of healing is inside us, not outside’ (ibid). Our subjective experience is both crucial to our quality of life, and a vital component of healing.

For these reasons, healing of any kind is unlikely to be assisted in the absence of attentiveness to a client’s subjective experience. All health professionals (whatever their focus and skill base, and in addition to formal qualifications and registration with the appropriate professional body) should be attentive to this at all times.

 

Sigmund Freud, The Question of Lay Analysis [1926] (New York: Norton, 1959).
Andrew Weil, Healer: Transforming the Inner and Outer Wounds (New York: Penguin Putnam Inc., 2003).