Tag Archives: psychotherapist

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What’s the difference between psychotherapist, psychologist, psychiatrist, psychoanalyst and counsellor?

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I lost count of the times I’ve been asked: ‘so what’s the difference between a psychotherapist, psychologist, psychiatrist, psychoanalyst and counsellor?’ The combination of professionals for comparison of course vary from enquirer to enquirer, but this is nonetheless a valid question.

However, despite some overlapping similarities in the work, not all ‘shrinks’ are the same. There are in fact fundamental differences between mental health professionals when it comes to training, theoretical orientation, approaches, techniques, professional registration and many other aspects.

So in this post I would like to address some of the similarities and distinctions that permeate the work of psychotherapists, psychologists, psychiatrists, psychoanalysts and counsellors, in the hope of clarifying this all but uncommon confusion. I refer here to the context of the United Kingdom, so the descriptions may vary from other countries.

– Psychiatrist: psychiatrists are professionals who went to medical school and then did a post-graduate specialist training in psychiatry, developing the skills for the diagnostic and treatment of mental disorders. So from all the professionals listed in this post, psychiatrists are the only ones who are medically trained doctors. Psychiatrists assess patients to ascertain whether their condition is a consequence of a physical illness, a combination of mental and physical or strictly a psychiatric one. They are able to prescribe medicine to help regulate symptoms related to mental illnesses (i.e anxiety, depression, schizophrenia, bi-polar disorder, etc), as well as sometimes make use of psychological interventions (such as Cognitive-Behavioural Therapy – CBT) for treatment. They can also refer people for psychotherapy or counselling if they believe the patient may benefit from such approach. Psychiatrists often work in institutional settings (such as psychiatric wards), and as consultants in the health service or in private practice.

– Psychologist: psychologists are professionals who underwent a degree in psychology, followed by a doctorate degree of their choice in a field within psychology (i.e forensic, counselling, clinical, educational, occupational, organisational). These professionals are not medically trained, and therefore are not able to prescribe medicine. Psychologists assess, diagnose, treat and study mental processes and behaviours. Not all psychologists provide mental health care, but those who work with patients can help by offering a range of evidence based treatments, from cognitive-behavioural therapy to counselling. They also provide psychological evaluations, using psychometric tests, direct observation and structured interviews.

Psychotherapist London– Psychotherapist: a psychotherapist is someone who underwent a post-graduate training in psychotherapy, specialising in the work with those struggling with emotional, psychological, relational and other mental health related issues. Psychotherapy is a talking therapy, so no prescription of medicine is involved. Psychotherapists help patients understand themselves better, their feelings, relationship dynamics, their past traumas and experiences as well as current difficulties. Psychotherapy consists of attending weekly sessions (once or up to 3 times a week) of 50 minutes, where the therapist will help the person understand and work through their struggles. Whilst there are different approaches (i.e integrative, psychodynamic/psychoanalytic, transactional analysis, etc), psychotherapy generally looks into how the person sees themselves, experience others and the feelings derived from such interaction. The process can also vary in terms of duration, going from brief to long-term or open-ended.

– Counsellor: counsellors are professionals who did a post-graduate counselling course, training them to provide talking therapy to people struggling with emotional and relationship issues. Counselling and psychotherapy are often regarded as the same thing, and it is an ongoing controversial debate whether they are. In my opinion, they are not one and the same. Although counselling and psychotherapy share many similarities in terms of the setting, the approaches, the fact that they are both talking therapies and so on, they differ both in the training requirements and the ability to work with cases according to degrees of complexity. Psychotherapy trainings (particularly in psychoanalytic psychotherapy) tend to be longer (up to 4 years), requiring more patient contact, supervision and personal therapy. Counselling courses have been more demanding in the recent years, but there are still courses that can be completed in 1 year. This has an effect on the sort of work that counsellors and psychotherapists can do, and what sort of issues they are prepared to work with. So counselling, generally speaking, tends to be more focused and work towards overcoming symptoms and issues (such as depression, anxiety, stress, trauma), whilst psychotherapy tends to be a longer and broader process, often working with more thorough and complex cases (i.e personality disorders, bipolar affective disorder, severe depression, etc), with the focus in understanding and working through the function that symptoms, disorders and issues acquire for the whole of the patient’s personality. Of course, this is not a definitive distinction between counsellors and psychotherapists, and there are many exceptions and variables. I once read that whilst counselling works towards helping the person overcome the obstacles that prevent their development and personal growth, psychotherapy aims to help the person re-organise their internal world, their personality. Two different scopes, but each with its own validity, usefulness, recognition and field of work.

– Psychoanalyst: a psychoanalyst is someone who is already a qualified and experienced professional in their field of work (i.e psychiatrist, psychologist, psychotherapist, social worker), who then undergoes a long (no less than 4 years) and intense training that combines learning psychoanalytic theory, working with patients in 5 times a week analysis under supervision, and attending personal analysis also 5 times a week. Psychoanalysts work with people who wish to have an experience of analysis, meeting 4 or 5 times a week for many years, with the aim of unravelling and discovering unconscious dynamics that affect the way the person behaves, feels and relates to others. Psychoanalysis traditionally makes use of the couch, where the patient lies on as the analyst sits behind, interpreting what is unconscious in what the patient communicates throughout the session. Psychoanalysis can help people that are willing to explore their internal world, and also those who present more complex personality issues. Psychoanalysts can also offer less intense psychotherapy.

All of the practitioners mentioned above are part of a helping profession, and as such they can offer great help to those who suffer from the mildest of struggles to more difficult and complex issues.

I hope this simple article shed some light onto some of the similarities and differences between psychiatrists, psychologists, psychotherapists, counsellors and psychoanalysts.

 

Allan Gois – Psychoanalytic Psychotherapist – Psychotherapist in London

 

 

 

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What happens in a consultation (assessment) for psychoanalytic psychotherapy?

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People often assume that when they go see a psychotherapist for the first time, they are already in treatment. However, soon enough the person will learn that before the therapy starts, a consultation takes place in order to assess the needs of the person and help them think, together with the therapist, whether psychotherapy can in fact help them with whatever problems they need to work through.

There are important questions that both therapist and patient need to ask themselves before embarking in the psychotherapeutic process. And this is why an initial consultation for psychotherapy is so important. The consultation is not only for therapist and client to have a sense of each other and to see if empathy and connection springs, but most importantly for the client to have a feeling of how the future therapy will unfold, and if he or she has enough resources to endure mental pain, uncertainty and unsettling feelings and the necessary robustness to face some disturbing aspects we all have within ourselves without breaking down.

A consultation for psychoanalytic psychotherapy happens over a few sessions (normally between 2-4 encounters), and this is so there is enough time for the therapist and client to have a feel of how they work together. It is also an opportunity for the psychotherapist to gauge the mental state of the client and to decide if psychotherapy or counselling is the best approach, if the help the therapist has to offer is enough for the needs of the client.

So I’ve put together a list of elements that are considered in the process of assessment for psychotherapy:

1- Connection. In the consultation stage both patient and therapist will get to know each other a bit better and feel if there is a connection there. This is important so the pair will know if they feel comfortable enough to work together. This connection has to do with empathy and trust. It is normal to be anxious in the beginning though, and it can happen that this connection will take place over time. Nonetheless, the therapeutic relationship is the springboard on where the therapy takes place, and so the connection between psychotherapist and patient is an essential question to be regarded and thought about. It is important though to go through the whole process before making any decision. The consultation is an ideal place to discuss any particular feelings or reactions that the patient might be experiencing in the here-and-now of the meeting, and this will help the pair to think about how it is to work together.

2- Information. During the consultation the patient will be free to share whatever information they feel relevant to help the psychotherapist understand what brought them to seek help. The therapist may ask a few questions to clarify and further explore what the person is sharing. Some of the information gathered throughout the assessment should include: personal history, family history, illnesses (mental or physical) history, current and past relationships, relationship with parents and siblings, work and living circumstances, etc. This list is not exhaustive, and the more information the better. The consultation is also an opportunity to clarify any queries in relation to the psychotherapy process.

3- Mental state. An experienced psychotherapist will be able to gauge the mental state of the person through the consultation stage. It is important to assess if the person has enough mental robustness to dig deep without breaking down or falling apart. If there is a possibility that psychotherapy will harm the patient, it is a golden rule that it should not be pursued. Psychotherapy can be a painful and unsettling process, so if in the assessment the therapist perceives that the person is in risk of fragmenting or becoming too unstable, it is better not to pursue the treatment.

4- The treatment x the needs. Following from point 3, through the consultation the psychotherapist will discern whether what they can offer is enough to contain and meet the needs of the patient. Whilst once or twice-a-week therapy is suitable for many people, sometimes a patient may need not only more intense work, but also the involvement and care of other professionals (i.e. psychiatrists, GP’s). It is important to recognise whether what the therapist can offer is enough to contain the patient, and so this question must be thought about in the consultation process.

5- Trial therapy. A consultation is also a sort of trial therapy. The psychotherapist will make interventions and interpretations and see how the patient reacts to them. This is to gauge the level of insight and see what the client does with the therapist’s interventions. This aspect of an assessment is quite important, as both client and therapist will be able to have a sense of how the future treatment will feel like.

6- Diagnosis. Although psychotherapists will not deliver a medical diagnosis, he/she should be able to identify aspects related to whatever mental illness a client may present. Having said that, some patients will come to therapy without a clear need for it, perhaps pursuing greater self-awareness or because they want to undergo something specific and need some support for that. Nevertheless, in the assessment stage the therapist will be able to see some personality traits and dynamics of the mind, and use that to help the client identify their needs when in therapy.

7- Objectives. It is quite common that the objectives (or needs for therapy) worked on in the assessment stage will change or be lapidated over the course of the therapy. Many times what we think to be the current demand for therapy will happen to be but an expression of a deeper struggle in the mind. Part of the consultation is to talk about objectives and needs, but it is important to keep an open mind for the more unconscious demands of the mind.

It is clear that a good consultation is paramount for a good therapy to develop. I hope the points above helped to clarify what happens in an assessment or consultation for psychoanalytic psychotherapy.

Psychotherapy is a great commitment, but one with great benefits.

 

 

 

 

Allan Gois – Psychoanalytic Psychotherapist in the London Bloomsbury (WC1)

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London City Psychotherapist new website

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I’m delighted to announce a new website for my practice: Bloomsbury Psychotherapist London.

My traditional website – http://www.allangois.co.uk/ – will be up and running alongside, as I intend to keep them both.

Have a look and let me know what you think.

 

 

 

 

 

 

 

Allan Gois – Psychoanalytic Psychotherapist in London – Psychotherapist London Bloomsbury

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Job description of a psychotherapist

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I am always amused with people’s reaction when they find out that I am a psychoanalytic psychotherapist. One of the most common response is: ‘So, are you reading my mind’? ‘Don’t worry’ – I try to reassure – ‘I’m not Derren Brown’. However, a real confusion takes place when I try to explain to them what a psychotherapist actually does. Maybe they expect something pragmatic,  or perhaps it’s my inability to articulate what I do in not-so-philosophical terms, but people often look puzzled, as though they would never be able to understand how psychotherapy works and what the therapist’s role is.

So I decided to put together a description of what a psychoanalytic psychotherapist does. This is not, however, a list of practical duties and responsibilities, as one would normally find in a job description. These can be easily found on Google. Psychotherapists work with the whole spectrum of the human experience, and it would be perhaps very difficult to reduce it to mere pragmatism. So I will approach this from an emotional perspective, attempting to name some of the experiences that happen in the powerful encounter of two people who bravely venture into exploring the complexities of the mind.

 

Job description of a psychotherapist:

– Tolerating: the psychotherapist needs to be able to tolerate uncertainty, to bear the pain and confusion of not knowing rather than imposing ready-made or omnipotent certainties upon ambiguous situations or emotional challenges. This is what the psychoanalyst W.R. Bion, drawing from the poet John Keats, called ‘Negative Capability’. It takes a lot of experience and strength of mind to be able to withstand the anxieties that the patient will bring, and to stay engaged with conflicting feelings without wishing to resolve them in a magical way. Negative capability serves the purpose of helping the patient feel they can bring out their worst and that the psychotherapist won’t break down or react in a unthoughtful way. It can also help patients tolerate their own uncertainties and frustrations.

– Not knowing: although the patient may think that the psychotherapist ‘knows it all’, the therapist works from an unassuming and not-knowing stance. Nothing is taken from granted, everything is open for understanding and analysis. The patient may wish for an instant answer or a solution to their suffering, but the psychotherapist is there to help bring out the truth from within the person, rather than imposing his own onto the patient. He is there to promote insights that will come from within.

– No memory, no desire: the psychotherapist is there to take in what the patient communicates with no memory and no desire, that is, with no preconceptions or prejudices and with no personal agenda. This promotes a space where the patient is free to say whatever comes to their mind, as the therapist is positioned in an open way, to receive what the patient is trying to communicate. This involves maintaining a thinking position, refraining from reacting to what the patient is bringing in order to help them understand how they are behaving and what kind of response they are inviting.

– Respecting autonomy: the role of the psychotherapist involves championing the patient’s autonomy. A psychoanalytic psychotherapist will rarely give advice or personal opinion, because the patient not only knows best, but he or she will need to develop ownership over their experiences in life. The therapist is there to help the patient make sense of such experiences, to understand implications and motives and to help bearing the feelings with the patient.

– Container: the psychotherapist has to be open to receive the patient’s most troubling projections and feelings. Being able to receive and accept the patient’s feelings is one part of the container function. The second part is to be able to help the patient make sense of their troubling experiences, to ‘digest’ what they are communicating and to give back an understanding that can help the patient to give meaning to their experience.

– Naming: the psychotherapist can help the patient find a name to feelings that had no name, that were experienced as dreadful and bizarre but were too difficult to be put into words. The therapist can help the patient to develop their own language to describe their experiences.

– Avatar: no matter how benevolent and helpful the psychotherapist wishes or tries to be, ultimately he is on the receiving end of what the patient will make him out to be. And, if necessary, the therapist will need to bear to be seen as cruel, distant, dismissive or in whatever ‘just like father/mother/partner/etc’ position they may be put, in order to help the patient to understand and live through the conflicting relationships they carry within themselves.

– Emergence and integration: the psychoanalytic psychotherapist is there to promote the emergence of what is unconscious to the patient, so symptoms and destructive patterns can lose their manifesting functions, giving way to understanding and self-awareness. The psychotherapist is also responsible for helping the patient integrate the healthier and the more destructive parts of him/herself, so the patient can become less defended against these conflicting parts of their mind.

– Reality checking: the psychoanalytic psychotherapist should be in a position to help the patient face a difficult reality they may be trying to avoid, be it within themselves or externally. The psychotherapist should not shy away from the truth, even when it’s too painful, promoting reality checking and then helping the patient bear the resulting feelings. A lot of people come to psychotherapy with an unconscious wish to resolve their problems without having to face reality. Some wish for a magical advice, others for a quick fix. In this sense, therapy can be a reality check in itself, as it can be a painful and lengthy process.

– Actions into thinking: the psychotherapist is there to help patients turn acting-out into think-before-you-act. Psychotherapy provides a space for exploration and thinking, in a sometimes painfully free way. But actions can sometimes be an evacuation for undigested experiences, and the psychotherapist is there to help the patient develop a sort of internal buffer, a thinking space that will allow them to give meaning to the urging impulse to act-out.

 

This is not an exhaustive list. Nor is it an ideal of a therapist. Psychotherapy is a process, an experience between two persons who work together to understand the most inner feelings, conflicts, difficulties and ways of behaving. And as every human experience, it’s filled with nuances and variations, the kinds that make life interesting and beautiful.

But perhaps after reading this clumsy post you find yourself still confused as to what a psychoanalytic psychotherapist actually does. Well, good! Perhaps it wouldn’t be a bad idea to try psychoanalysis for yourself, to personally go through some of the experiences I tried to describe here.

 

 

Allan Gois – Psychoanalytic Psychotherapist in London