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Differences and similarities between counselling and Psychotherapy
This essay will critically consider the points of similarity and differences between counselling and psychotherapy. After briefly considering what counselling and psychotherapy are, it will firstly outline the broad arguments for the differences between the two and evaluate the validity of these assertions. Then it will look at the points of similarity, again critically considering these various points.
Psychotherapy can perhaps be defined as the process in which a therapist helps the client in the process of re-organising their personality. The therapist also helps the client integrate insights into everyday behaviour. Counselling may be seen as a process of helping clients overcome obstacles to personal growth. According to the professional body for counselling and psychotherapy in Scotland, COSCA: ” Counselling and psychotherapy are ways of responding to a wide range of human needs. Counselling and psychotherapy provide opportunities for those seeking help to work towards ways of living in more satisfying and resourceful ways. ” (2004:1). Though this definition puts counselling and psychotherapy under the same umbrella it also goes on to say that both are constantly changing fields of practice. Therefore that it is not possible to have a definite fix on what they are.
The issue of similarity or difference is certainly one that attracts much debate. Some insist that psychotherapy and counselling are very similar, even identical. Others think that they are very different or at least differ fundamentally on certain points. So we have a situation that appears to elude universal definition. Christine Webber (2005) points out one very practical source of confusion: ” Sometimes therapists advertise in both the counselling and psychotherapy sections. And if they also have a qualification in hypnosis they often put themselves into the hypnosis section, too. So one therapist can be listed under all three headings i. ”
Also to make matters even more complicated is the problem that psychotherapy as a word may be off putting to some people. Therefore, regardless of what they actually do in practice, a therapist may simply call himself or herself a counsellor as it is a more neutral term. James Chriss has noted: ” If people feel that “psychotherapy” is too pretentious a word to apply to what they do, they describe what they do as counselling, and so we have student counsellors, marriage guidance counsellors, Samaritan counsellors, alcohol counsellors, drug counsellors… ” (1999). But this problem of labelling reflects the uncertainty at the heart of the debate. If there was no uncertainty then there would be no need for multiple labels. We do not see general practitioner doctors also under multiple listing do we? (Such as ‘magician’ or ‘quack’ perhaps?).
Perhaps we should begin with looking at the historical differences between counselling and psychotherapy. Psychotherapy has roots in Freudian psychodynamics, so that a medical aspect to the training was involved in the past, which lends it an air of respectability. The training period was also normally long, and involved working with real clients under supervision. Also of a long period of self-analysis was required. Both in working with clients and the analysis of the psychotherapist themselves focused mostly on in-depth consideration of past issues. Petrushka Clarkson notes: ” The psychodynamic past to psychotherapy still exerts an influence on the debate, and consequently on perceptions ii. ”
Therefore these characteristics from psychodynamics still affect the way psychotherapy is viewed. Of course it can be said that nowadays courses of counselling also require a long period of analysis on the part of the therapist in order to qualify and these too often involve working with clients under supervision for a certain initial period. Never the less it is still imagined of counselling as something that you can begin to do after a shorter period of training and less in-depth self-analysis.
The training courses for counselling and psychotherapy often seem to reinforce this as psychotherapy courses are normally at a postgraduate level, so that an individual needs to have a degree already. And the level on counselling courses is often a little less academic than on psychotherapy courses. This difference is sometimes reflected in counsellors receiving less pay than the psychotherapists that they work along side in such places as hospitals. According to the charity Counselling this all adds up to a situation where: ” Counselling tends to be seen as the poorer relation to psychotherapy iii… ” .
In addition the academic and professional standing of counselling has recently increased, as Rowan Bayne, Jenny Bimrose and Ian Horton note: ” There has been a massive increase in the number of students on counsellor training courses, the numbers of courses available, and interest in BAC Course Recognition, as well as the establishment of undergraduate and postgraduate courses in counselling and psychotherapy, and the establishment of Chartered status for Counselling Psychologists. ” (1996).
However Bayne et al go on to mention that not everyone thinks this move is a positive development. They cite Illich et al. (1977) regarding more professional prestige for counselling who thought: ” …that such a move fosters restrictive practice, stifles initiative and is motivated by money, status seeking and bargaining power, which in turn are out of line with the values of counselling… ” (In Bayne et al, 1996). In addition greater academic requirements also mean greater cost to the person training, and therefore people from poorer sections of society may have less chance to become a counsellor. One of the advantages of the situation of having counselling courses as short, cheaper and more accessible courses is that they are very inclusive. Working mothers, part time workers, the unemployed etc can normally find some way to take some form of counselling course. But the move towards ‘respectability’ and professionalisation is likely to make such courses longer, more expensive and harder to get into.
The degree of training which psychotherapists and counsellors receive is another area of note. The UKCP system is that an individual must have completed postgraduate level course in psychotherapy that lasted at least 4 years (part time). The BCP is even more thorough. It requires one year of personal training (5 days a week at 50 minutes each session). This is followed by three years of theoretical and clinical seminars (three times a week), and this is done simultaneously with up to two years of supervised psychoanalysis of two patients (again 50 minutes each, 5 times a week). Only on successful completion of this process can the person apply for associate membership in the British Psychoanalytical Society. Full membership is not granted until after completing the Institute’s two-year post-qualification course. In addition, this process is usually not even started until the applicant is already well qualified in a related discipline.
Contrast this to certain courses in counselling where the training is shorter and less intensive. The Diploma in Person Centred (Rogerian) Counselling & Psychotherapy at Warwick University can be done after a one year introductory certificate. It is noted as being: ” A higher qualification for those wishing to enter the counselling profession iv. ”
The diploma lasts for just 2 years in which the student is required to carry out only 15 hours of personal therapy (the BCP requires more than 200 hours in just one year!). The diploma also requires only 100 hours of supervised counselling practice (BCP is more than 500 hours). This course is at a reputable University, and may be a very good one. However, many counselling courses are run by smaller, private organisations, and some of these seem to put ease of qualification before quality of work. A certain college advertises a course of only 3 to 6 months, of home study, and claims: ” This course qualifies you as a counsellor allowing you to set up in practice v… ” .
This is a claim that on the face of it seems almost laughable when compared to the rigorous process of qualification for the BCP psychoanalysts (this may explain why there are only just over 400 of them compared to around 23,000 members of the BACP). So although the attributes gained during training are universally seen as important, there is, according to Cosca (2004): ” …no consensus about the most effective methods for fostering and assessing these attributes. Consequently all training courses include elements that aim to develop self-awareness but the amount and proportion of time devoted to this, as well as the format, vary. ”
However, there are also plenty of ‘psychotherapy’ courses that are available as short, rather inadequate looking efforts, not just ones for counselling. The same college offers a ‘Psychotherapy Diploma Course’ that lasts for only 6 months home study. It claims: ” This course would greatly help those enormously who wish to set up in private practice vi… ”
Therefore it can not be clearly held that psychotherapy training always differs from counselling in terms of length and depth.
Even within the world of psychotherapy there are points of disagreement. Ann Casement, the Chair of the United Kingdom Council for Psychotherapy (UKCP) in 1997, indicated that she saw little difference between that body and the other psychotherapy body in the UK, the British Confederation of Psychotherapists (BCP) vii. However Joscelyn Richards, Chairman of the BCP (1999) disagreed and insisted that there were considerable differences in terms of the level of training and supervision acceptable in the two. In addition she noted that in her opinion: … ” the UKCP saw psychotherapy as a linear extension of advice, guidance and Counselling rather than involving a different order of complexity and intention as understood by the BCP. ” Therefore there remains considerable disagreement within the world of psychotherapy as to levels of training needed and the connection with counselling.
However, it should be said that perhaps sometimes short-term training might well be more useful than it seems. Hypnotherapy is a case in point. The basic skill may be learned quickly by someone sufficiently focused and suitable. Therefore long training may be unnecessary. The London College of clinical hypnosis (LCCH) runs a Diploma in Clinical Hypnotherapy that runs for a year of part time (but intensive) study. They claim that: ” Properly taught, the ability to induce hypnosis is easy to acquire. However, it takes a long time to learn how to use this skill effectively within a therapeutic framework viii. ” This indicates that the element that takes time is the ability to use the skill well to help clients. So perhaps the main aspect that such short courses fall down is not the skill, but the lack of a long period of supervised therapy of clients.
One of the differences often cited is that psychotherapy involves working in greater depth than counselling, that clients see their therapist more frequently and for a long period of time. By contrast counselling takes place over a shorter period of time. Counselling cites the opinion of trainer Petrushka Clarkson who thinks that counselling can be short term or long term but: ” Psychotherapy… is about ‘deconstruction, and ‘reconstruction’ of the clients self-concept, a process likely to be lengthy and at a greater depth than counselling might explore ix. ”
Again this image of length in psychotherapy is derived partly from the techniques of psychodynamic therapy, so that the process can last months, even years, and take place more than once a week. As with the training process the BCP indicates that the frequency can be very high: ” Psychoanalysts work with patients intensively (fifty-minutes a day, five days a week) and less intensively (fifty-minutes a day, one, two, three, or four days a week) x. ”
In contrast someone may go to see a counsellor for just a few sessions, perhaps even just once if the issue is successfully addressed. This is because counselling is often carried out for more ‘situational’ issues, such as the death of someone close, unexpected unemployment, relationship problems etc. Where as Jo Ellen Grzyb (who advertises herself as both a counsellor and psychotherapist) in an interview for the BBC noted: ” Psychotherapy is a lot more like archaeology – I’m looking at the causes and the roots for what’s known in the jargon as psychopathology – the behaviours that you keep repeating over and over and over again that actually get in the way. xi ”
Therefore counselling is seen to be about short-term help, and psychotherapy about longer term. Connected to this is that the focus is on the past causes of the issues in the case of psychotherapy, and the on the present issues in counselling. Also that psychotherapy is concerned with some type of deeper personality change; but counselling is concerned with helping individuals develop their full coping potential in regards to some particular issue. However, this too is not as clear cut as it once may have been. Cosca indicates that some argue: ” …that the intensity and depth of therapeutic work can be just as great in counselling as in psychotherapy. ” (2004:4). In addition some psychotherapists may offer brief therapy and some counsellors may work with the same client for years.
The setting of the treatment is also thought to be different between counselling and psychotherapy. A counselling session often takes place in a number of non-medical settings such as an office or small therapy centre, or even in the therapists flat. Where as Psychotherapy is often thought of as taking place in a more medical setting, perhaps a clinic or hospital. Again this is not so clear cut, as counselling increases in respectability it can also be found in hospital settings, and psychotherapy can also take place in settings like the therapist home.
Professor Paul S Morgan-Ayres makes the further point that, for him at least, counselling is more suited to clients that are open to speaking. Psychotherapy is better for those who find it difficult to open up, so that the therapists take more of an active role in guiding them. He notes: ” As the client becomes more able and used to talking, the process may change in to a more client centred approach xii. ” Counselling, according to Morgan-Ayers, is a process in which the therapist is there as a ‘tour guide’ for the client, refocusing them in a process that they are otherwise quite good at exploring themselves. Therefore: ” The counsellor speaks very little and gives the client plenty of space to offload and talk themselves into self-knowledge xiii. ” . It could be said in contradiction to this that Freudian psychoanalysis often places great emphasis on the therapist not interrupting the client. So therefore this difference may not always be the case.
Despite the assertions above there are many that maintain an opposite opinion. Donald Arbuckle argues that: ” …counselling and psychotherapy are in all essential respects identical ” (1967). One of the most obvious things that need to be considered regarding the similarities between counselling and psychotherapy is that the kinds of issues that draw people to use counselling and psychotherapy are often very similar. Also that the aims of both are similar: both can be seen as an attempt to allow the person to build up resources to live in more healthy, meaningful and satisfying ways, and to develop self awareness. Also a high degree of respect for the autonomy of the client is a basic principle in both counselling and Psychotherapy. With an understanding that the clients bring with them the potential needed to successfully achieve their aims. (COSCA, 2004)
However, contrary points can be found for all of these. If, as stated, psychotherapy deals more with deeper, long term problems and counselling with more situational and shorter term issues, then clients do not go to these differing fields for exactly the same specific reasons, only because of the same general motivation. Also it is perhaps only at the very general levels that the aims of differing elements of counselling and psychotherapy are the same. Taking it a step further we can see that different varieties have often quite different aims. Gestalt therapy for instance: ” seeks to promote a person’s awareness, support creative choice and encourage responsibility in a person’s effort to realise a meaningful and fulfilling life xiv. ”
This appears to be a more wide ranging and deeper aim than that of counselling reported here: ” Help the person focus on ways to manage their difficulties a little or a lot better xv. ” This relates to the point considered before that counselling is more focused on situational problems, and therefore its aims are likely to be more limited than psychotherapy.
Psychoanalysis in particular has sometimes been criticised for concentrating to much on the process and not enough on the aims. Molnos (1998) notes concerning goals in psychoanalysis:
” At one extreme of this continuum there are those psychoanalysts and psychotherapists who consider goals to be an arbitrary matter and see goallessness as technically essential to analytic work. At the other end of this spectrum those practising forms of Brief Dynamic Psycho-therapy tend to be concerned with setting specific and explicit therapeutic aims to be attained at the end of the therapy xvi.
One other area of similarity is that both counselling and psychotherapy involve clear contracts between the therapist and the client as to what the aims are and the roles involved. These have been summarised by Professor Paul S Morgan-Ayres as:
- ” An Assessment to ascertain whether the therapist can help you / have a good chance of helping you.
- That the therapist does not lead you to believe in some sort of magic cure and that you realise that they are there to help you change yourself.
- That you have explained to you what is proposed before the therapy commences so that you are giving informed consent to the therapy.
- That any person under 16 years has a parent’s permission and signature.
- That confidentiality is discussed and the therapist’s position is made clear.
- That the therapist is registered, insured and monitored xvii. “
Another point of similarity mentioned by COSCA is that both counselling and psychotherapy require the therapist to have highly developed skills. Their paper on the subject mentions: ” Consequently, counsellors and psychotherapists undergo lengthy training, often lasting several years. Their work is always supervised by another practitioner who helps them to process and reflect on the issues of concern to their clients. ” (2004: 2). However it has already been considered that different routes involve considerably different levels of difficulty and length of training and supervision.
Counselling notes that: ” The BACP tend to see both disciplines as so similar that debate about differences becomes rather redundant. It is undeniable that many similarities do exist between the two xviii. ”
It does appear that the argument for similarity is winning the debate. A survey in 1993 indicated that over 50 per cent of the members of the then BAC used psychotherapeutic models of counselling. Membership of the BAC and UKCP often overlaps, as does that between the BAC and the British Psychological Society (BPS). Bayne et al note a growing tendency: …these bodies might not fight but might confederate through a process of rapprochement, in what appears to be an unstoppable momentum towards the professionalisation of the disciplines ” (Bayne et al, 1996). This process can be seen already. Jo Ellen Grzyb noted that when she began as a therapist her organisation was called the ‘British Association’ but that later the name was extended to the ‘British Association for Counselling and Psychotherapy’. Grzyb reflected: ” So magically suddenly we’re all psychotherapists xix. ”
Perhaps then, in conclusion, as the BACP they insist: ” It is not possible to make a generally accepted distinction between counselling and psychotherapy xx. ” The BACP go on to say that perhaps the differences can only really be found at the level of the individual therapists daily practice, not at the wider level of definable principles. In practice a professional calling themselves a psychotherapist my deal with deeper psychological problems in one setting, such as a hospital; but may in their own private practice see clients with more ‘situational’ issues. The work in that setting may be far more similar to that often seen as the domain of counselling. The BACP also insist that although counsellors may work on very specific everyday issues in setting like work or school, that in private practice they may offer: ” …therapeutic work which in any other context would be called psychotherapy xxi ” .
It appears that the trend, despite noticeable dissenters such as the BCP, is for recognising the similarities between counselling and psychotherapy. This trend is reflected in the increasing pressure towards joint bodies representing both fields of practice.
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