What’s the difference between counselling and psychotherapy?

I’m often asked what the difference is between counselling and psychotherapy, so I thought I’d offer my take.

The short answer is that today there is a great deal of overlap between the two. In my view, what matters far more is how a therapist works than whether they call themselves a counsellor or a psychotherapist.*

Psychotherapy emerged from Western medicine in the late nineteenth century and became associated with doctors such as Freud and Jung, who used psychological methods to treat emotional suffering. Counselling, by contrast, grew out of pastoral care, education, vocational guidance and social work.

Then along came Carl Rogers and the humanistic psychology movement of the 1940s - 60s. Rogers used the terms counselling and psychotherapy pretty much interchangeably, believing the same principles underpinned both.

As counselling became established as a profession in the 1970s, some still commonly held, but never universally accepted, distinctions emerged, namely that counseling is short-term, focussed on a current problem, and psychotherapy is longer term focussed on unconscious and developmental process. You may be familiar with the saying “If you have a problem see a counsellor, if you are the problem, see a psychotherapist”.

However, this doesn’t really reflect how many counsellors practice. Many of us, myself included, offer open-ended, relational work that goes deeply into a person’s inner world - work that, according to the meme, would probably be labelled psychotherapy.

If I were looking for a therapist, I’d be more interested in their training, experience and therapeutic approach than whether they describe themselves as a counsellor or a psychotherapist.

In the UK, both counselling and psychotherapy qualifications are assigned a level within the national qualifications framework. Most core psychotherapy trainings are at Level 7 (Master’s level), whereas counselling trainings are more varied. Some counsellors are working with a Level 5 diploma, while others complete more advanced Level 6 training.

I’d also want to know whether they belong to a recognised professional body, such as the BACP or UKCP, and receive regular supervision.

But initial qualifications are only part of the picture. Most therapists are committed to ongoing professional development throughout their careers, often undertaking substantial additional training in areas such as couples therapy, working with children and young people, or specific therapeutic approaches like Internal Family Systems (IFS), EMDR, or depth psychology.

To add to the confusion, the word accredited means different things in different organisations. Within the BACP, accreditation is an additional status that practitioners can apply for after gaining significant post-qualification experience. The UKCP, meanwhile, registers psychotherapists who have completed an approved training route. Because the two organisations use different systems and terminology, it’s not always helpful to compare titles directly.

Ultimately, a therapist’s experience, way of working and the quality of the therapeutic relationship are likely to be far more important than whether they call themselves a counsellor or a psychotherapist. 

If you’re looking for a therapist, here are some questions worth considering when wading through profiles:

• What core training have they completed, and to what level?

• Which professional body are they registered or accredited with?

• What additional training or areas of specialism do they have?

• How do they typically work? (For example, short-term or open-ended, structured or exploratory)

• What therapeutic approach or approaches do they draw upon?

• What ongoing supervision and continuing professional development (CPD) do they undertake?

And when you meet a therapist, by far the most important question is this:

Do I feel understood, comfortable and able to imagine building a trusting relationship with this person?

If the answer is ‘yes’ to this last question, there is a good chance the therapy will be helpful.

* The terms counselling and psychotherapy are not protected terms and can legally be used interchangeably. There is an ongoing debate around whether they should be protected which is beyond the scope of this post.