Who Does What? Talking Therapies Explained
'Shrinks' come in various guises: psychoanalysts, psychologists, psychiatrists, counsellors and psychologists
Understanding what type of practitioner they are may help to make more sense of the work they do
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Counselling or psychotherapy
First off, you may wonder about the difference between counselling and psychotherapy. Even the professionals aren't agreed on a definitive distinction, as both involve talking to someone who is trained to listen and respond in appropriate and helpful ways.
However, generally, counselling deals with a specific issue over a short period of time (‘goal-oriented’), while psychotherapy tends to work at a deeper level, exploring the psychological roots of a problem, over a longer period of time. 'CBT' is a well-known counselling intervention, 'psychoanalysis' is probably the best known psychotherapy. Just to add to potential confusion, there are short-term psychotherapies, and counsellors who may work with you for months or even years in a less goal-oriented way. There are also 'psychotherapeutic counsellors' who fuse both approaches.
Counsellors tend to be professionally accredited with the British Association for Counselling and Psychotherapy (BACP), while psychotherapists tend to be professionally registered with the United Kingdom Council for Psychotherapy (and/or BACP). As another general rule, training to be a psychotherapist takes quite a lot longer than training to be a counsellor.
This is the oldest of all the psychotherapies and worth mentioning on its own as it is probably the one most embedded in our cultural psyche. This is the stuff of Sigmund Freud, dreams, symbolism and Woody Allen. It is based on understanding human behaviour through unconscious material and was built upon by figures such as Carl Jung, Anna Freud and Melanie Klein, who developed their own theoretical schools.
Analysis is an intense process of self-discovery and sessions are more frequent than most other therapies – sometimes (although rarely) up to five times a week. Lying on a couch is likely to be an option rather than a requirement these days, and the analyst tends to maintain a neutral position, saying little apart from interpretations. An analyst wouldn't share his or her experiences or work flexibly with cancellations.
Psychology studies how and why humans (and also animals) behave as they do. Psychologists work in many different areas depending on their particular field of expertise, but if you were being treated by a psychologist for mental health problems, this would usually be a clinical psychologist or a counselling psychologist.
These psychologists use many of the same techniques and theories that a psychotherapist or counsellor would use. However, they tend to rely more on theories and techniques that have been studied scientifically, which can also be carried out over a fairly short period of time (because ultimately there is a limit on resources in the NHS, for whom many work). For this reason Cognitive Behavioural Therapy (CBT) is often used and is now well-known.
It is also important to know that only GPs and psychiatrists are able to prescribe drugs such as anti-depressants, or diagnose serious mental disorders. Counsellors, psychotherapists and psychologists can only do so if they have a relevant medical training as well. A good talking therapist should know when a referral to a medically trained mental health specialist is appropriate.? A psychiatrist is a medical doctor who has specialised in working with the acute end of mental health problems – such as psychosis, bipolar disorder, personality disorders, severe depression and anxiety disorders. They can prescribe drugs (such as anti-psychotics and anti-depressants) along with recommending talking therapy if they think their patient is well enough to engage in psychological work. Then again, if he or she has trained as a psychotherapist, they may use talking therapy instead of or alongside a drug intervention.
Coaching refers to a type of supportive relationship which isn’t generally described as therapeutic. Coaches often specialise, describing themselves as “executive/business/personal/life/relationship” coaches.
A coach tends to work in a goal-oriented way, with sessions following set agendas, including homework. They don’t tend to explore the cause of emotional distress (eg looking into childhood) unless the coach has a counselling qualification too. However, the line between coaching and counselling can be blurred, and a new type of working is emerging in the UK called Personal Consultancy that fuses the two.
Where can I go for help?
A visit to your GP is always a good idea, and your surgery might have an in-house counsellor or links to local services. Unfortunately demand is high so expect a long wait, and because of funding pressures very few services are able to offer longer-term therapy. There are also many excellent organisations that offer support.