What is Psychotherapy?
Whether it’s because you are experiencing mental health issues, have gone through a difficult life event, or just want some space to focus on your own growth, it can be overwhelming when you’re presented with the abundance of different kinds of support you might be able to access.
Counselling? Therapy? Psychotherapy? What do they all mean and what do you choose? And that’s before you even get into the different therapeutic modalities. And what does therapeutic modality even mean?
The UK Picture
The answer to these questions actually depends a little bit on the country you're in. I'm talking from the perspective of a counsellor and psychotherapist trained and based in the UK. I know that this is different in the US and across the globe.
In the UK then, counselling, therapy and psychotherapy all mean basically the same thing. There are slightly different cultural connotations that come with each word, for instance counselling is often thought to be more surface level and potentially shorter term, meant for less complex or long standing mental health issues. There is an image of counselling being “just talking” about things. On the opposite side, psychotherapy conjures images of long term, intensive work that might delve deeper into a person’s past experiences and traumas.
In reality, in the UK, whether a practitioner calls themselves a counsellor, a therapist or a psychotherapist is generally down to that individual practitioner's preference and different traditions in different therapeutic modalities. Therapeutic modalities can be thought of as collections of different theories, outlooks and practices that define the way that a particular group of practitioners approach their work. It could be referred to as “types” of therapy.
Traditionally, person centred practitioners have been called counsellors, as the modality is generally known as person centred counselling. Psychodynamic practitioners have generally called themselves therapists or even analysts, following in the tradition of Freud. CBT practitioners, whose roots lie in behaviourism and cognitive psychology, generally stick to therapist.
However, none of these modalities are intrinsically more suited to working with “complex” mental health issues and all can be suitable for different clients at different points in their lives. There are studies that suggest that certain modalities can be slightly more effective for specific groups of people with specific issues, however, even these differences tend to be quite small.
Who can call themselves a therapist?
At this point, I feel that it’s relevant to point out that the terms “counsellor”, “therapist” and “psychotherapist” are not protected titles in the UK. This means that, unlike a title like doctor or nurse, anyone can call themselves a therapist without necessarily having a qualification or any experience. As you’d imagine, this can lead to real damage to clients of these unqualified practitioners.
I’ll go into the kinds of qualifications that exist for mental health practitioners in the UK in another post, but, in short, you want to make sure that they’re registered or accredited with a recognised professional organisation. The common ones are the BACP, UKCP, NCPS & HCPC (specifically for art therapists and practicing psychologists, which are actually protected titles).
How do I know what to look for?
Figuring out what to look for, then, when you’ve got so many different options and it’s not always clear from the outside what the differences are between individual practitioners can be daunting.
Thinking about what you want the focus of your work in therapy to look like can be a good starting point. If you’re looking for a non-judgmental space to explore your issues alongside a trained professional, but without them telling you what to do, then person centred counselling may work best for you. If you want to look closely at your childhood and the patterns that have followed you into adulthood that may no longer be working for you, then psychodynamic therapy might be a good place to start. If you’re looking for structured strategies and skills you can apply to your day to day life to improve how you feel then you might find CBT helpful. There are also so many other different types of therapy that I’ll explore in a different post.
However, current research shows that the thing that has the biggest impact on the success of therapy is the quality of the therapeutic relationship between the therapist and the client. Therefore, when you’re seeking out support for your mental health, I’d suggest focusing more on whether you feel comfortable with the practitioner, rather than whether they call themselves a counsellor, therapist or psychotherapist. This may mean that you decide a few sessions in (or sometimes even quicker) that a particular practitioner isn’t going to be a good fit, and it’s absolutely fine as a client for you to say that and look for someone else. A good practitioner will also notice if they feel they’re not the best fit for you and they may give you referrals to other practitioners who could be a better fit.
In Conclusion
There are very few easy, straightforward answers when it comes to mental health. Trying to find the exact right approach can leave you feeling stuck when there isn’t really a right answer. I find it’s usually better to focus on figuring out what’s helpful for you, as opposed to right for someone like you. Don't get too bogged down in whether someone calls themselves a counsellor, therapist, or psychotherapist. Instead, focus on finding a qualified professional with whom you feel heard, respected, and safe.