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: 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.