Psychotherapy under the magnifying glass

What is the difference between counselling and psychotherapy?

Working with mental distress can mean we have to be very careful of our language. Use of certain words in certain contexts can be the breakthrough we’re looking for, or it can cause the damage that ends a course of therapy.

For a profession so sensitive to language, why does the use of the terms ‘counselling’ and ‘psychotherapy’ cause so much confusion? In this post, I want to look at the history of these two terms. But first, there’s something we need to clear up;

Counselling and psychotherapy are the same thing

For years there has been much confusion around this, and it is important to clear up that in the UK there is no distinction between counselling and psychotherapy. This is the view of many professional bodies, academics and practitioners.

Why are counselling and psychotherapy both used to refer to the same thing?

So why do we have two terms? The answer here is history. Psychotherapy and counselling have their different histories but share a similar present.

The history of psychotherapy

Compared to other sciences, psychology is very young. Psychology, as we recognize it today, has only been practised since the 19th century. When Sigmund Freud (1856-1939) combined his understanding of neurology with hypnotism (or mesmerism as it was also known) and philosophy, the term he coined was psychoanalysis. This label makes a lot of sense. ‘Psyche’ is the Greek term for the human spirit, and in psychoanalysis, this is being analysed by the therapist. The psychoanalysts were some of the first to believe in a ‘talking cure’ within a medical framework, and so, it could be argued, is a key origin of talking therapy.

Here is a great 3 minute video that talks you through Sigmund’s psychoanalytic theory.

Early psychotherapy was born in Amsterdam in the late 19th century, just as psychology as a science was beginning to flourish across Europe and the States. The first psychotherapists, Van Renterghem and Van Eeden, described psychotherapy as ‘the cure of the body by the mind, aided by the impulse of one mind to another’ (MacLeod, 1998). This is important; it defines the role of therapist, connects physical and mental health and places ‘psychotherapy’ in the context of medicine and science.

The history of counselling

Counselling has a very different history. Counsellors existed in educational and work contexts as early as the 1920’s. Their role was to help guide students and employees that were struggling at work or facing decisions that counsellors, with training and understanding, could help them make, such as what to study at university.

Counsellor numbers and demand for psychological support exploded in the US and UK after World War II. In the UK, the Relate organisation was founded to address the damage the war had on many marriages. Counsellor training was made available to the public outside of the context of medicine or universities. In America, Carl Rodgers (1902-1987) established Person-Centred Counselling. Rejecting some of the more elitist elements of Freud’s analysis model and giving the client more control moved talking therapy away from the medical and academic world.

Counselling became more accessible for clients as more therapists were able to train outside of privileged institutions. However, it has been suggested that moving away from the medical model meant that Rodgers was not able to use the title ‘therapist’; this was a protected title in the US. Therefore Rodgers elected to use the term ‘counsellor’.

And so to the present day…

History would suggest to us that ‘psychotherapy’ is allied to ideas of medicine and science, whereas ‘counselling’ is somehow more related to holistic care and ideas. But this is just language. Medical and academic institutions are comfortable in using the two terms interchangeably most of the time, and as counselling and psychotherapy have developed from 1950’s onward, they have often done this together. ‘Psychotherapists’ are increasingly challenging the medical understanding of mental health, and ‘counsellors’ are quite comfortable working in academic and medical contexts. The language suggests a difference, but the practice is almost totally indistinguishable.