Some say psychotherapy and counselling are different. But if the approach is non-directive they are technically the same thing. In fact you could also call it coaching. The input is the same. Do you want to get better? Call me a therapist. Do you want to feel better? Call me a counsellor. Or do you want to do better? Call me a coach.
What is the difference between a counsellor, psychotherapist, psychiatrist, and a psychologist?
A psychotherapist provides ‘talk therapy’ of one sort or another, although some therapies might feel like there is not much actual talking at all – just forms and exercises. (I once attended a world-class CBT course but was horrified that they didn’t want to actually talk with me). There are two main kinds of psychotherapy: the directive approaches, and non-directive (or person-centred) psychotherapy. A directive clinician will play the role of expert. This therapist will ask questions so he can classify you as X or Y, and will then tell you what to do. He will say to you what he says to everyone who they have placed in the same category, perhaps using the medical metaphor of ‘illness’ to label your state and to give them confidence and gravitas. He will encourage your dependence on his expertness. A psychoanalyst is a kind of directive psychotherapist, in the tradition of Freud and Jung.
The non-directive (person-centred, or Rogerian) psychotherapist will help in a very different way, by providing a non-judgmental, open-ended and empathic attitude of understanding for your instincts and inner voice. They will do this from within your own frame of reference, rather than impose their own (e.g by taking control of the conversation). They will allow you, the client to decide which direction is most important, which elements of your experience are most troubling to you.
A person-centred clinician will not judge the things that you say or do, because these are not yet sufficiently aligned with your instincts and inner voice. They will treat your personal agency with the utmost respect: if you can feel more open and confident amid your own experience – your thoughts and feelings – you can decide your own way forward. Indeed a person-centred therapist would say that such confidence is the same thing as well-being. They will help you to have more faith in your instincts and less faith in your ideas about yourself. This allows you to reorganize your personality so that it is more in line with your temperament, and less pressured by conditioned responses, in a way that leaves you truer to yourself.
And here’s the kicker: non-directive therapy is as effective as any other, yet without the loss of personal agency. All those exams and certificates in this or that ‘illness’ and its related ‘treatment’ don’t actually provide a better end result. The work is done by the therapeutic relationship, not by the crystal-waving or form-filling. This was Carl Rogers’ great insight, based on analysis of thousands of hours of therapy: given the right therapeutic conditions the client’s personality will experience the growth that has hitherto been frustrated.
Why have I divided therapy into directive v non-directive? Because it seems clear to me that this is most obvious way to carve nature at the joints. Both approaches are equally effective, and there are vast numbers of therapist of each type. Both are mainstream and well-proven. But fundamentally one works from the outside-in, drive by how the clinician sees things, while the other works from the inside out, from within the client’s own frame of reference (it was Rogers who said ‘change comes from within’). One is rationalist, the other is empirically driven, requiring only one axiom: faith that every living thing is always and only working to become itself. There are many other differences, and these differences are also as radical.
That is why a visiting alien would, I feel, divide the world of therapy between the directive approaches and the non-directive (Rogerian) approach.
A counsellor is, if person-centred, the same as a psychotherapist. Counselling is simply another word for non-directive / client-centred or person-centred psychotherapy. So a counsellor is a type of psychotherapist. And it is as effective as other leading approaches to psychotherapy. Jordan Peterson, the famous psychologist, has described person-centred therapy (counselling) as ‘one of the most intellectually compelling and practically useful theories of personality’.
You might hear the new term ‘psychotherapeutic counsellor’ (as if there is any other kind of counsellor?!), which has emerged as an expression of the directive therapists’ attempts to place themselves above the non-directive ones, due to the misplaced belief that more scout badges = better therapists – more of which below.
And there are some people who call themselves counsellors but don’t provide non-directive therapy. These people should perhaps call themselves something else. They are not the heirs to Carl Rogers and the person-centred approach to psychotherapy.
The term counselling was only invented because at that time psychologists were not legally permitted to call themselves psychotherapists. In person-centred terms there is no meaningful distinction between a counsellor, therapist or coach. It is all the same input, the same skill set, and non-directive therapy / counselling is based on the idea of personal growth rather than on the ‘medical model’ – an engineering-like approach focussed on a perceived deficit between the patient’s symptoms and whatever is deemed objectively ‘normal’.
A psychiatrist is a medical doctor who describes your state as some kind of disease so they can prescribe medication or do something else to you (what they would call ‘treatment’). Like most clinicans, the psychiatrist is directive, i.e. medical, i.e. not person-centred. The psychiatrist will act as if she is the expert on you, and insist that you go along with this – hence the value they place on the medialized metaphor of mental ‘illness’. All for your own good, of course. You are not really seen as a person, but a ‘case’. Because you now officially have an illness, and illnesses can be treated, is not necessary to understand you as a person, to respect your human need for self-determination, or help you to find a more comfortable perspective on your own experience, and the strength that this brings. She will impose her own frame of reference on yours, which will risk you losing faith in your own sense of agency: ‘I have an illness!’ doesn’t take us much further than the medieval ‘I have a demon!’. Like an engineer, she is trying to work out what needs to be fixed and then she will fix you, declaring you healed, or at least ‘treated’. But if the medications put a smile on your face and get you back into the factory, she is content. Next please!
A clinical psychologist is much like the psychiatrist, only without the drug-pushing. He is medical so will adopt the same, directive, engineering-like ‘assess and treat’ approach as the psychiatrist. You will be given forms to complete, and as a result might well not feel heard. Like the psychiatrist, the clinical psychologist will act as if he is the expert on you, and insist that you go along with this. Like the psychiatrist he is ‘directive’ in terms of insisting you play the game of pretending that he is the expert on you. Like the psychiatrist, he has studied hard for years, accumulating many scout badges, and needs you to acknowledge his superiority by surrendering your own agency to him. Like all directive clinicians he will lay expectations on you: fill out this checklist, do the exercises I show you, do your homework, sign this form saying you won’t try to kill yourself. Your agency will therefore not be nurtured, but your dependence will.
Clinical psychology, like the rest of the medicalised sector, and directive therapy in general, is rationalist. Like the other medial approaches it is manual-based, imposing a standardised, impersonal, ‘if-this-then-that’ commonality of approach that can make the client feel they are being fed through a sausage machine.
The best talking therapy, on the other hand, is mainly empirical, and unique to you. It is driven by a here-and-now based, ‘if-this-then-what’ attitude, based in understanding rather than categorization. This models the openness that signifies personal growth. This capacity to accept my present moment and to ask how I want the next moment to unfold is the mechanism of wellbeing. I sometimes describe a psychologist as the scientist who tends to be precisely wrong about the person, and a therapist as the artist who tends to be sufficiently right about the person.
The politics of therapy affects us all
As noted above, many therapists are still very tied to the idea that more scout badges = better therapy. They can’t imagine engaging with a client as equals, receiving whatever the client wants to say, or not say. It is so much easier to take control and classify you as… whatever, than to try to actually understand you, like the person who can name a bird but doesn’t know how to experience it. Rogers warned that the major underlying motive for many clinicians is often really just to prove how bright they are. And they will use you, the vulnerable client/patient, in this semi-conscious but selfish game.
So there’s a lot of reading to do if you want to become a directive clinician. But there’s more madness yet. Directive psychotherapy training takes longer than non-directive psychotherapy training for a reason that is very odd: the strange idea that a trainee therapist requires hundreds of hours of personal therapy, many times more therapy than is required by over 90% of clients! (One might wonder why someone so messed up would feel confident enough to embark on a new career). This bizarre requirement is a direct hangover from the ideas of Freud, over 100 years ago(!) But hey, we’re human, aren’t we? We feel good when we can afford something that others can’t.
We Rogerians take a principled, ethical stance against such behaviour. We would rather respect the vulnerable client’s autonomy than impose our picture of things on theirs.
But its not just about ethics. The science is hugely supportive of the person-centred approach, and its underlying assumptions about the importance of interpersonal and societal pressures upon the human’s need for self-determination.
It has been very well proven over a very long time that the ‘expert’ knowledge of the medical ‘assess-and-treat’ approach to psychological distress is based on flawed science. Diagnostic categories are increasingly acknowledged – even by mainstream psychiatrists- as not scientifically valid, so any related treatments and qualifications cannot automatically be regarded as helpful. It is also very well established that such expertise-driven, directive (‘therapist-knows-best’) approaches are no more effective than relationship-driven approaches. And the directive approaches run a much higher risk of inciting complaints and grievances: the therapist didn’t listen to me, the therapist misdiagnosed me, the treatment didn’t work…
Keep the science out! Keep the respect for human dignity out!
In many countries the term psychotherapist is a protected title, allowing those who hold such an exalted status to reap the financial rewards of being on the right side of what the economists call a ‘barrier to entry’ in the market. But who is the best person to decide who is a good clinician? The UK, in accordance with its tradition of classical British liberalism, in which the best person to decide what is best for you is you, has long held that the best judge is the consumer.
A medical doctor who has passed lots of exams might well be better than one who hasn’t, but therapy does not work like this. It is a verified scientific fact that therapy does not work like this. This is because the relationship is more therapeutic than any ‘treatments’. Yet life as a therapist involves a continual bombardment from those marketing some new training course, often involving a ‘big new thing’ that will be gone in a few years. Not only are most of these courses adding little to what a competent non-directive clinician can already bring to their client, the average therapist does not earn much, so only those with rich spouses are able to devote their life to such things.
Such realities have not deterred those in the business of selling spurious, fad-ridden training courses and endless personal therapy to fellow therapists. Leading professional bodies in the UK (including the UKCP, BACP and NCS) have recently agreed how the scout badge hierarchy is to be, what scout badges you will need, and who gets to call themselves what. What they did not do was to start by asking, ‘who are the most effective therapists, and why?’. And they didn’t ask how come non-directive therapists are as effective as those who use a scout-badge-driven, ‘assess-and-treat’ approach? Instead, for reasons that look really quite unethical, even corrupt (to some eyes), they have decided that only the ‘assess-and-treat’ / directive types of therapy are real therapists. Ignoring all the science, including the discoveries of Carl Rogers and many since, that the relationship does the healing. The certificates don’t do the healing. So it now is the duty of UK therapists to spend thousands of pounds and hours on supporting the cannibalistic and parasitic practice of selling more training and therapy to those who should not need it. It was also decided that to be a good therapist one must undergo (and of course pay for) hundreds of hours of personal therapy, regardless of whether or not this is needed. Which, ironically, does not fit at all with the assess-and-treat attitude underpinning the whole enterprise. Another painful irony is that therapists will get the therapy that might otherwise be available to the public. Endless discussions took place over many years leading up to these decisions, but these discussions were not well-attended by those who represent the huge number of person-centred/ non-directive/ Rogerian therapists/counsellors/coaches.
These sad developments might well lead to the creation of a new professional body to represent the interests of non-directive psychotherapists, if existing bodies like UKCP and BACP cannot demonstrate a sound understanding of the person-centred/ non-directive modality, and a willingness to act in the interests of all psychotherapists, including the non-directive ones. We never had an organisation to speak for us. Carl Rogers didn’t want that, and there are still no plans to set one up. So non-directive therapists are divided, but they have not been conquered. But its not just good therapists who are impacted here. Those who most desperately need therapy/counselling – those who can’t easily afford it – are left worse off than ever, as therapists increase their fees to pay for all the nonsense that they now have to go through. Do we need self-appointed, self-serving rent-seekers to declare who is, and who isn’t, a therapist? I say no.
This issue extends beyond the profession itself. If it truly takes 4 years to train a psychotherapist then very few will be able to afford it. We will never have many therapists who are not financially supported by The Main Breadwinner: i.e. the industry will become even more dominated by the wives of rich men. Perhaps other voices are also needed. Let me rephrase that. Other voices are definitely needed.
Can truth and human nature win in the end?
I gave up on ideologies when I eventually learned that two things always prevail over time: the truth and human nature. Our ideas come and go, and we are willing to try to twist our realities in order to feel that our ideas are the bigger thing. But such ‘Luciferian rationality’ always burns itself out. Or at least become unfashionable as the next faddish belief system becomes the new god, for a while.
It is largely this realisation that pointed me towards the non-directive form of therapy. The person-centred approach has been described as the purest form of therapy, so bereft is it of the rationalist ideologies and ‘conditions of worth’ that beset the sector and bedevil human growth and flourishing in general. A Rogerian holds faith (if faith is the word) only with the idea that the client, like any living thing, is always actualizing (becoming itself). It can only, and always, be doing this – attempting to flourish amid whatever the world is doing to it. And so the human gene looks to find optimal accommodation with the human meme. Even if this is asking too much, it will persist. Nature, playing the long game, looking for a chance to win in the end. And in actualising the organism is orienting itself as firmly as possible in its reality. Which is why the client’s truth, her acceptance and motivations are the most important thing in the room. Like I said, truth and human nature will win in the end.
In the meantime though, the client will have to tolerate being told what to do. And the therapy sector will need to forbear being subjected to being told what to read, learn, and impose on the client.
Giving up on the club-monkeys
So I have felt ethically compelled to regard the BACP as incapable of being my representative body. It is clear that they, and other bodies such as the UKCP and NCS, are more interested in selling the next fashionable fad to therapists than they are in asking what is best for the client.
I have other reasons for bad-mouthing the BACP, besides those outlined above. One example that sticks in the craw is when I lost a client because they were advised, by a court-appointed psychologist of all people, to see someone who ‘specialises’ in domestic abuse. Somehow this court psychologist was utterly ignorant about therapy/counselling, and even in the 2220’s seemed unaware that non-directive psychotherapy is as effective as the other kind. My client was distressed because he felt he was making good progress with me.
I contacted the BACP about this, in the hope that they are in the business of defending the interests of their members, and of their members’ clients. Yet the person I spoke to at BACP Ethics was also completely clueless about the person-centred approach, telling me, ‘well you wouldn’t do couples work if you weren’t specially trained in that, would you?’ Perhaps the real lack of training is with BACP staff(!). Why was she not aware that there are no specialist ‘assess-and-treat’ training courses in the person-centred approach? And why would there be as Rogers demonstrated that the therapeutic attitudes of the person-centred approach have proven both necessary and sufficient largely regardless of what the client/ patient brings or how they might be diagnosed.
There are many other horror stories about how the BACP has let down its Rogerian members, and their clients. We are waiting for a sensible organisation to take its place. Tick tock 🙁
Fair play in a crowded market?
My own opinion, for what it is worth, is that there are far too many people competing in this sector. Very few can actually make a living at it, although the universities continue to create vast numbers of under-utilised therapists.
I would prefer fewer, better therapists, who were each busy enough to be able to charge less. But this cannot be at the expense of non-directive, relational approaches which are just as effective as any other, and are much loved by the suffering public.
And I believe the best person to decide who is a good clinician will always be you, the client.