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What is the difference between counselling and psychotherapy?

By Ms Laurence Baretto de Souza, March 2021.

Counselling and psychotherapy are words that tend to be used along one another or interchangeably. But is there a difference between the two?

You are not the only one to wonder about this. I could not tell the difference before becoming a Therapist. There seems to be some differences in what those terms refer to in the US but this is not so true in the UK somehow. But beyond the linguistic use of these two words, what are the differences between counselling and psychotherapy in practice?

To clarify some of the confusion that exists, I decided to make some distinctions in my own practice of counselling and psychotherapy.

I consider counselling an important base to the work I do, as it is for me, the core of the relationship I have with my clients. Counselling is the foundation to any therapeutic relationship.

Carl Rogers, one of the founder of modern counselling and therapy, identified core conditions and attitudes that have to be created and maintained by the Therapist to enable the relationship to be helpful to the client by creating a safe space to be. These attitudes are a) Being non-judgemental, b) empathy and c) congruence or being authentic. These are necessary conditions for exploration of the clients’ experiences. They are the basic ingredients for compassion within ourselves and with others. In my practice, I also embody the 9 foundational principals or attitudes of Mindfulness as described by John Kabat-Zinn. These principals are non-judging, acceptance, patience, beginner’s mind, trust, non-striving, letting go, gratitude and generosity.

Counselling is about being one human to another. In this part of the therapy, I appropriately attend to my clients natural, healthy feelings and needs. In effect, I act as an available, emotionally responsive healthy enough person for them to be with. This is a very important part of the therapy as it models and repairs the past or current lacking aspects in their lives. In essence, counselling helps people acknowledge and accept more of themselves.

It supports, repairs and heals the clients’ self-esteem by modelling healthy relationships with themselves and others. The aim of counselling is to create and replicated this helpful template onto the clients’ lives.

This part of the therapy is a very important part when we need to make sense of who we are and process our experiences in life. Counselling is the sufficient mode of therapy for me to be in when working with people in grief or dealing with challenges and difficulties in their lives if their difficulties are not exacerbated by mental dysfunctionalities.

If mental dysfunctionalities are present, then counselling is no longer sufficient. This is when psychotherapy comes into play in my practice.

Psychotherapy is part of the therapy where I attend to the habitual processes and patterns in my clients’ minds and seek to understand how these are affecting their lives.

I also pay attention to the healthy and dysfunctional aspects in my clients’ minds and behaviours. Psychotherapy is about learning about and changing some mental habits. It is very much about education, training, refining, transforming and maintaining healthier interactions with our minds. During the education part, my clients and I explore together what is taking place in the mind, becoming more aware of the patterns at play whether these come in the shape of their thoughts, perceptions, patterns of attention and/or behaviours. The clients decide which patterns to change. Practicing this is then very much like going to the gym. We learn new moves and practice those so that these new ways of being mentally can be applied in our daily lives.

I attend to my clients in this way if we are working on addiction, anxiety, depression, hearing voices, OCD, trauma, eating disorders, chronic pain, psychosomatic issues and other mental health problems whether they are diagnosed or not.

I also use psychotherapy to improve and maintain wellbeing and performances if my clients are looking to fulfil potential from a healthy starting point or to extend the therapy beyond good health into high performance.

So, to conclude, If we are dealing with unhealthy mind states, psychotherapy is a necessary part of the work but it is not sufficient on its own. Unfortunately, more often than not, we enter therapy with critical and negative attitudes to our own selves or/and others. So practicing psychotherapy without counselling would not work. In fact, I would even go as far as saying that It could be damaging to people. It would be the equivalent of going to a school where the teachers are unkind or abusive even.

Most of the time, counselling and psychotherapy interact seamlessly in my practice in each intervention and silences to fulfil what is needed in the therapy.

This article is just an overview, the detail of the practice of counselling and psychotherapy is, in the end, a unique experience between each therapist and each client. It will always add up to a lot more than its parts. 

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