What’s the difference between counselling and psychotherapy?

I see them as one and the same. Sometimes counselling is thought of as short-term and psychotherapy as long-term, or counselling as solution-focused and psychotherapy as ‘digging deeper.’ In some countries you need a higher-level qualification to call yourself a psychotherapist (though not in the UK). But it is difficult to draw these lines in practice, or to pinpoint any difference in attitudes, goals and techniques between counsellors and psychotherapists. I tend to use the words ‘counselling’ and ‘therapy’ interchangeably.

Who is counselling for?

Counselling has the potential to help anyone struggling with difficult emotions, thoughts and behaviours. You may have a medical diagnosis, such as depression or anxiety. Or you may have noticed patterns in your life that you would like to change, such as romantic relationships ending badly, or strong and persistent self-critical thoughts. It may be that, even though you are normally happy and healthy, a recent experience such as a bereavement, job loss or trauma has left you struggling to return to your ‘normal’ self. In other words, there is a wide range of circumstances in which counselling can be beneficial – even life-saving.

How long does counselling last?

Ideally as long as you need it to. It’s difficult to answer that question because we all come to counselling with different problems and goals. It is possible to benefit from one session, although single-session therapy requires a specific approach and is not the same as presenting for counselling and dropping out after one session. My own counselling lasted just over a year and ended naturally. Organisations often offer time-limited counselling usually lasting between four and 12 sessions.

It’s wonderful when you can stay in counselling as long as you need to (for you and me both). It’s important to note, however, that circumstances are rarely ideal. Cost may be an issue for you, or life changes might cut your therapy short. The best thing we can do is communicate openly about your evolving needs as well as any barriers you might be facing.

What kinds of therapy are there?

There are many different kinds of therapy (these are called modalities), but they can be divided into three categories. Psychodynamic therapy focuses on unconscious processes and the link between early experiences and our present thoughts, feelings and behaviours. Cognitive-behavioural therapy (CBT) is based on identifying and challenging unhelpful thoughts and behaviours so our feelings can change. It is quite structured and relies on tools and exercises you can do in between sessions. The aim of person-centred therapy is to create a safe space where we can access our inner resources. In other words, it’s about developing a strong relationship – a therapeutic alliance – with another (trained) person so we can hear and understand ourselves better, see the world more clearly, and accept ourselves as we are so that we can change.

What is your approach?

I’m a person-centred counsellor, but I take a pluralistic approach: I believe that different people may benefit from different types of therapy at different points in their lives. This means three things in practice: 1., That I try to be as flexible in my work as I can, prioritising your needs. So if you tell me that you would like to do an exercise to help you confront one of your fears, I will do my best to accommodate your request. 2. I aim to be open and honest about what I can and cannot offer you. So if you have specific needs that I feel I cannot meet, I may suggest that you turn to a professional working in a different modality. 3. I will invite you to reflect on and express what is and isn’t working for you so that we can make changes if required, and make sure you’re getting what you need from your therapy.

As Irvin Yalom wrote in The Gift of Therapy, “The therapist must strive to create a new therapy for each patient.” I do think that’s the best way.