Two Different Paths

Psychotherapy and Counselling are two terms that are often used interchangeably today. But, this was not always the case. This article aims to show the similarities and differences between psychotherapy and counselling through the story of how a singular mission spread into two unique and distant pathways, and how this mission brought them back together in reunion. What started as a divergence in pathways, has turned into a convergence of the two ideas into a more holistic approach to mental healthcare.

Let the journey begin…

The Origins

Psychotherapy is currently defined as the application of treatment methods to treat psychological disorders and alleviate distress. Historically, however, the word psychotherapy comes from the Greek words psyche, meaning soul or mind, and therapeia, meaning healing or treatment. Put together, the original meaning of psychotherapy is the treatment of the mind or the healing of the soul. From this, we can recognise an emphasis on the treatment and healing process.

Counselling, today, is defined as a professional and supportive relationship that empowers individuals, groups, and families to pursue their goals for mental health, wellbeing, education, and careers. The word counselling originates from the Latin consilium, which means to advise or consult. Here, we recognise an emphasis on forming and maintaining a unique relationship dynamic that promotes growth and development.

By comparing the two definitions, psychotherapy and counselling today are similar in describing services aimed at improving the client’s psychological state. Where they differ is that psychotherapy describes a healing process, that is, administered while counselling describes a supportive, trusted, and empowering relationship. This difference is also reflected in education and training.

Psychotherapy and counselling courses may have several overlapping modules; but, psychotherapy courses tend to focus more on learning and practicing a specific psychotherapeutic modality – treatment methods and how to apply them in various cases. Counselling courses, on the other hand, tend to focus more on practical and interpersonal skills such as active listening, empathic responding, and reflective practice – skills that counsellors need to create and hold a supportive, trusted, and empowering space for the client.

Coming Together

The term “psychotherapy” did not enter common usage until the late 19th century through the works of Sigmund Freud and his psychoanalytic theory. However, the treatment of mental illness can be traced back to the ancient Greeks. It was Hippocrates, namesake of the doctor’s Hippocratic oath, who argued that mental illness originates from the brain and should be treated in the same way physical illnesses are treated. It was Hippocrates who coined terms such as Mania, Melancholy, Paranoia, Panic, and Hysteria and classified them as mental disorders. Before that, mental illnesses were believed to be the work of evil spirits, curses, or signs from the divine.

During those times, the treatment would involve exorcisms or drilling holes in the skull to banish or release the spirits from the person. Fortunately, psychological treatments have evolved with the times. Today, there exist over 400 different psychotherapeutic modalities, strictly supported by empirical evidence, that view psychological disorders through different lenses and approach treatment in their own, unique way; all working towards the same destination – an improvement in psychological health and well-being.

Counselling, as a profession, also came to light in the 19th century and has roots in Sigmund Freud’s Psychoanalytic Theory. The underlying nature of counselling, however, is as old as humankind. The notion of sharing our burdens, hearing the troubles of others, and discussing solutions can be traced back to prehistoric tribes who would gather around their fires to sit down and share stories and dreams.

Ancient civilisations would look to priests, philosophers, and community leaders for guidance to navigate life and make important decisions. Still heavily influenced by the psychoanalytic and behavioural theories of the time, counsellors took on more directive roles – the counsellor was the expert who would advise the client on what to do.

It was not until the works of Carl Rogers, in the 1940s, that the practice started to make a major shift, challenging the status quo by introducing the idea that it was clients who know themselves best and who possess an innate drive to achieve their fullest potential. Rogers believed that the client is the expert and should determine the direction and flow of therapy. The practitioner would, instead, take on a supportive role in helping the client explore their experiences through reflection and clarification. Given this space, the client can discover their answers and develop their internal resources. This laid the foundations of the Client-Centred Approach – later to be known as the Person-Centred Approach when applications of this theory were found beyond the context of therapy.

Coming Together

Today, there is little distinction between psychotherapy and counselling sessions. Both generally operate within the same outline – the issue is discussed, therapeutic goals are set, and the journey is plotted out. The experience of a session, however, can differ significantly between practitioners. Here we will look at differences in educational backgrounds and practice contexts and how they influence the experience of a therapeutic session.

Practitioners primarily trained as psychotherapists tend to have a longer educational background in psychology. This makes them more inclined to the scientist-practitioner model. This translates to a greater respect for the method, a more directive touch, and greater attention to measuring treatment outcomes.

Practitioners primarily trained as counsellors tend to have a wider history of experience. Many Master’s courses in counselling today see students from various occupational backgrounds coming in to study the art of counselling. A tremendous benefit that has come of this, is that counsellors-in-training share a greater pool of experiences and wisdom that come from this diversity. This translates to a greater appreciation for individual differences and a greater respect for the innate wisdom of every human being. This perfectly complements the person-centred and relationship-oriented approach of counselling.

Context also has a huge influence on how practitioners approach the session. Counsellors or psychotherapists who work in government organisations, such as Hospitals, Family Service Centres, and Schools may be more focused on the treatment and more outcome-oriented. This is usually because they have high caseloads and are under immense pressure to report positive outcomes. As a result, investment in the relationship may sometimes fall short. In a Private Practice, on the other hand, the client’s experience and the therapeutic relationship play a greater priority – these are the greatest predictors of therapeutic success.

There is a finding that psychotherapy tends to be more long-term while counselling sessions are more short-term. This finding, however, is slightly skewed because it includes clinical patients undergoing psychotherapy with Clinical Psychologists for more serious and chronic issues. Schizophrenia, Bipolar Disorder, Borderline Personality Disorder, and Obsessive Compulsive Disorder are examples of complex psychological disorders that require long-term psychotherapy to help patients cope with the condition.

That being said, School Counsellors also work with many neurodivergent children and adolescents facing disorders such as Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Tourette’s Syndrome. These disorders are also considered to be complex and require long-term therapy to manage. In this case, the duration of therapy becomes more of a question of condition severity than the nature of the practice.

Another factor that impacts therapy duration is the modality. Psychoanalyst, for example, pride themselves on the depth at which their sessions go. This can usually draw out the treatment duration over several years. Cognitive-behaviourists or Solution-Focused practitioners, on the other hand, pride themselves on being quick and efficient. This means that the number of sessions can be cut down. In this case, the duration of therapy is not dependent on whether it is counselling or psychotherapy, but rather on what modality the practitioner subscribes to.

We can see how, like the history of the practices, psychotherapists and counsellors started from a similar mission to help, but took different pathways that ultimately came together to provide a more holistic approach to mental wellness.

What This Means For Us

In summary, there are terminological and historical differences between psychotherapy and counselling. This created a divergence between the practices for decades. The two practices have begun converging towards a common understanding. Ultimately, the difference between psychotherapy and counselling lies in the training and orientation of the practitioner, as well as the context in which the practitioner practices. It is, therefore, highly recommended that people seeking therapy enquire as much as possible about the practitioner and try a few different ones to find the practitioner best suited to their needs.

At Hirsch Therapy, for example, we use an integrated approach that combines the best of both worlds. We lay the foundation by building a strong therapeutic relationship with the counsellor-inspired Person-Centred Approach; substantiated by the strong pillars of empirically supported psychotherapeutic modalities. In our opinion, a strong therapeutic relationship helps our clients feel safe to explore their thoughts and emotions on a much more profound level. When people have this space, they find the internal resources needed to overcome their challenges – internal resources that last a lifetime. We then use a strong grasp of psychotherapeutic modalities as supplementary guiding tools to bolster and cement the progress.

If you have any further questions at all, please feel free to get in touch with us. Hirsch Therapy offers a free 15-minute online consultation where you can ask any question and clarify doubts. We are always happy to share more.