During a workshop at the end of last year, ICHAS lecturer John Hickey had an in-depth discussion about counselling and psychotherapy. He focused on what’s the difference between the two, the careers you can develop and what recent legislative changes mean for all involved in the professions.

Counselling and Psychotherapy in Ireland

From an Irish perspective, would you believe that the counselling sector itself is quite unregulated? We do have professional accrediting bodies, of which there are quite a number of them. What I’ve noticed over the years is where you can complete your contribution. 

The personal therapy that we need to do as part of our own process seems to be getting a little bit more streamlined. But currently, all the professional bodies that will accredit therapists and psychotherapists at the moment, they’re technically charities, there isn’t a state run registry body, which to be quite honest with you, is a disgrace at this stage. 

Now, this process has been happening for the past 15 years, at least, with the psychological therapist forum. With all those accrediting bodies,they are coming together and trying to find a way through the politics, the red tape and the different criteria that they would each have as an accrediting body and oversee all of this. This very difficult process is a state body known as CORU, which some of you might be very familiar with. 

CORU are a regulatory body who currently have the likes of social workers and social care workers of physiotherapists, optometrists, radiographers, they have all of those professions under their remit. They’re the overarching body of all those professionals mentioned, have to apply into, to become registered with and approved by. That’s happening at the moment as well, with psychology, and counselling and psychotherapy. 

For example, in about three years time, even though I’ve been practising for 20 years, I’d have to apply to CORU for them to credit me and approve me as a therapist. So we will have state regulation which is great. 

Interestingly CORU about two years ago protected the titles of counsellor and psychotherapist, which meant that CORU thought there was a distinct difference between those titles. Whereas up to this point, the words counsellor & psychotherapist were very interchangeable, in the language of counselling. So you might say  “Look, I’m going to see my therapist or I won’t see my psychotherapist, I’m going to see my counsellor”. 

It’s very interchangeable language. But it’s interesting, the court will now have separated those two titles. 

What we need to make sure of is that CORU is going to say, look, you have to have a minimum standard of education, possibly to level eight, on the national framework of qualifications, to become a registered counsellor with us. We think they’re going to then say, you have to have a minimum of a level nine, or a master’s qualification on the national frame for qualifications to become a psychotherapist. That’s where we think they’re going to picture. So you can see now that distinct difference that’s starting to sort of develop and unseparated.

That’s the current situation as it stands in Ireland, and it’s a very good thing that regulation is coming in. We’re actually separating the titles of counselling and psychotherapy. 

Now the profession is intense without a doubt. It’s an enjoyable journey, but it’s a long journey as well. You will probably take the scenic route to become an accredited counsellor or indeed an accredited psychotherapist who does a lot of personal development, increased self-awareness, improvement of communication skills on top of that, and the academic requirements as well. 

Plus, there are the arrows you have to walk towards your accreditation. Sometimes I wonder when I see TV programs or may read news articles and things like that it portrays the therapist as just maybe asking and how does that make you feel? We’re boxed into a certain way in the media. But let me tell you from my experience, it is a very enjoyable, but difficult journey through the process to get to where you want to be. It actually has to be both enjoyable and challenging because we work with such a broad range of presentations, that really, we need to get to know ourselves quite a deep level, before we can actually reach out, and hope to help other people. 

So there’s quite a process involved, let me put it that way. There’s a theory that you’re exposed to such as self-awareness and self-development. There’s practice placement that you have to go on, there is personal therapy that we would ask you to get involved in as well. 

So it is quite demanding as it should be a demanding course if you choose to take it on, but it is extremely rewarding. Some people who take on undergraduate level study, with thoughts of becoming a counsellor, may change their mind through the course. But the learning that they receive, really, really helps them in other areas of life to not only their own personal lives, but in areas such as sales, marketing, PR, social care, obviously, anything that has to do with working with people and listening to them, talking to them, interacting with them, it can be a huge benefit in a lot of sort of different areas of life. 

So you will find from an educational perspective, anything that I learned, I don’t just apply it to the clients that I work with, or the supervisors that I work with, I apply it in and across my personal life as well. That’s been of great benefit to me, over the years, too. So you do absorb an awful lot. I think as you go through an academic program, many will be thinking what if they get into this as a career or I want to work with people, I care about people. But will I make a living from it? 

There are some Subtle, Distinct Differences Between Counselling and Psychotherapy

To begin with, counselling is a short-term solution for presenting issues that can be quite action and behaviour focused. We can focus on the secondary processes as opposed to the primary root or primary core manifestation, which psychotherapy would eventually do. By the way, psychology and psychotherapy can be seen as a longer process as opposed to counselling, which generally can be a shorter-term process. The terms counsellor and psychotherapist are often used interchangeably and have many similarities. But there are some important differences as well. 

In general, a counsellor might be recommended for specific issues and situations such as addiction or grief and can take place over weeks or several months. That’s not to say that someone might not benefit more or even better from deeper psychotherapeutic work in the area of say addiction. But generally speaking, the process of counselling can be very effective. 

Psychotherapy, in contrast, tends to explore the past issues that might be contributing to present-day issues. It often takes place continually or indeed intermittently over a period of years sometimes. 

In actual practice, however, there is a great deal of overlap between the two types of therapies. One of the most consistent pieces in all of these two disciplines, if you want to call it that, is the personhood of the counsellor/psychotherapists themselves, as in who that individual is. 

So let’s say you could be the most competent and qualified psychotherapist in Ireland, but you may not have the ability to generate a good, deep therapeutic relationship with your client. So it’s the person that’s providing the therapy or the psychotherapy, that is so important.

Now the same therapist may provide both counselling and psychotherapy, psychotherapy generally requires more skill than counselling is conducted by professionals trained to practice psychotherapy, such as a trained counsellor who goes on to become a trained and qualified psychotherapist, or indeed, a psychiatrist or social worker. 

So, generally many psychotherapists might actually be also practicing psychiatrists as well. There’s a deeper and a further level of education. Now that a psychotherapist is qualified to provide counselling, a counsellor may or may not possess the necessary training and skills to provide psychotherapy. With that said, a therapist may provide counselling with specific situations, and a counsellor may function in a psychotherapeutic manner.

Technically speaking, the word counsellor means advisor, that’s been there for hundreds of years, counsel involves generally two people who can, of course, involve families or couples, etc, etc. working together to solve a problem. It’s a term that’s used in conjunction with many types of advice, giving financial, spiritual guidance, etc. To the very broad term in, in essence, we counsel, we advise now. The term counselling may also be used to refer to what occurs in a relationship with a psychotherapist. 

It’s rare, but generally, clients who would come to me just looking for support, guidance, understanding, whatever it might be. They won’t necessarily know I’m a counsellor or a psychotherapist. Someone has done their research and their homework and they want something quite specific to treat their presentation or manifestation. But generally, clients won’t really understand or know the difference between a counsellor and a psychotherapist. 

The more that regulation is advertised and as the public becomes more aware of it will actually increase public awareness, which is a good thing as well. 

In the context of mental health counselling, it is generally used to denote a relatively brief treatment that is focused primarily on the behaviour of the individual. It often targets a particular symptom or problematic situation and could offer guidance, advice, suggestions, your gentle depth work and advice for dealing with it. As opposed to psychotherapy, which is a little bit deeper, both in depth, relational depth, and also timewise. It may go further back in the client’s history. 

The counsellor offers guidance and support as the individual figures out ways to better manage life and adjust to change or indeed, adversity in their life. There are many types of counsellors, marriage guidance, family therapists, grief counsellors, addiction, substance abuse, etc. and indeed many more. 

What you’ll find is that for many people, counselling is such a broad term that from an educational perspective some people have a really strong interest in maybe working with adolescents or working with in the areas of say addiction or youth. 

Students need a broad understanding of the world of counselling and psychotherapy, but they need more specialist training, and education when it comes to working with specific subgroups. There are many, many types of specialists working with eating disorders and addiction, grief and loss and so on.

Now, psychotherapy, on the other hand, is generally a longer treatment that focuses more on gaining deeper insight into chronic physical and emotional problems. It focuses on the person’s thought processes, and how these may be influenced by past events, such that caused problems in the present. 

Sometimes a person might actually know, they’re engaged in a particular type of behaviour, or they find themselves becoming maybe quite emotional in some way and they don’t understand what’s happening to them. Sometimes the job of a psychotherapist would be to gently and in a very structured and safe way, bring them back to perhaps early childhood, adolescent young adulthood. To see, can we find out the sort of the personality development, how the persona has developed over time, and perhaps what’s happened or occurred within that person’s life, to bring them to this present moment, and the acting out or feeling a particular way? 

Often in psychotherapy, a lot of material that’s repressed or denied, or minimised, or has been projected onto something or somebody else, for many years, and psychotherapy hopes to open up that understanding for the client of why they are this particular way. 

A lot of material can be embedded within the subconscious mind. It’s hidden from our everyday awareness. Now, Freud would have been a very big believer in the subconscious or unconscious mind. His job was to try and take material from our unaware stage into our awareness. Now many of Freud’s theories have been disproven, but he still has a big influence in the whole area of psychotherapy. 

We’re focused on the person’s thought processes and how these may be influenced by past events. The past should not determine the future or the present moment today for that matter. The word psychotherapy addresses the root cause and core issue of current problems without lasting change, personal growth may occur. That can take some time. Depending on how long the person has lived, depending on the event or the events that they’ve experienced in their younger life. It can depend on how deeply they’ve repressed the emotions or the feelings associated with certain events. Also, the willingness the person has to be willing and collaborate in the psychotherapeutic journey. We can’t force or make anybody join us on that path to discovery. The person has to be willing to take the risk to step in and discover unknown material and sometimes quite unsettling material. 

The psychotherapist themself has to be very well educated, prepared, and be able to manage or contain the emotional cathartic episodes that may occur in the process. So you can see there’s a deeper process involved with psychotherapy. 

There are several different types of therapy that fall under the general heading of psychotherapy. From cognitive behavioural therapy, psychoanalytic psychotherapy and many more warranted there are many similarities between counselling and psychotherapy:

• Development of a healing, safe and therapeutic relationship between the therapist and the individual
• The effectiveness for a wide range of people, both adults and indeed children, and other similarities
• Understanding a person’s feelings and behaviours 
• Addressing issues with the goal of improving a person’s life

Some of the differences between counselling and psychotherapy, for example, can focus on present problems and situations, some very specific situations or behaviours could be quite short term and very much action and behaviour focused very much involves talk therapy, guidance, support and education, and may focus on this sort of the secondary process (the secondary process will be maybe the active thoughts or the active behaviours that I’m engaged in that are very visible to me), the overt behaviour, or the overt emotion as opposed to the primary (the primary processes are the ones that are a little bit deeper, a little bit more hidden, that need more time and exploration). 

Psychotherapy can focus on chronic or recurrent problems. Long term therapy cannot just be taught, it’s very much focusing on sort of feeling, and the experience of the client, in the moment, or in the past. So it’s not just the talking, we’re now going into more depth relational work here, we’ll get into focus very much on the experiential nature, or the subjective nature of the client’s experience.

That could be quite an in-depth focus on very deep internal thought processes, the core issues. And of course, we’ll focus them on the core or the primary focus, that’s where we want to get to with psychotherapy. 

Counselling is powerful, by the way, and it’s extremely effective. If we’re to use it as, say, an analogy of a cut on your hand, counselling might be putting the plaster over the cut. It might necessarily heal the wound but psychotherapy clears the infection using the stitches to close that off for good. 

When to Choose between a Counsellor and a Psychotherapist?

When choosing a therapist, it’s helpful to learn about the differences as well as the background of specific providers and the approach that they use. Sometimes the choice will come down to the personal preferences of the client, the logistics or the access or indeed, insurance that may cover a specific modality or speciality. 

The most important step however is to find a therapist, psychotherapist, or counsellor that you can trust. The level of trust a person has in their mental health care practitioner plays one of the greatest roles and part of the therapy will be successful or not. So of course, qualifications matter, expertise matters. But that will be diluted greatly if the therapist doesn’t have the capacity to generate a strong, trusting, safe connection with the order. If I go to a person who has fantastic qualifications, and I don’t get the feeling that I could trust myself to trust them with my own precious, intimate, sometimes very hidden material, well, then no matter what qualifications they have, that process won’t work for me. So be very conscious of that.

This is just a very brief overview of when someone may want to see a counsellor, it may be a better option than psychotherapy if you have specific issues or short term problems that you wish to address and you wish to learn some coping skills to help better manage stress and improve relationships. 

You might be coping with life transitions and adjustment, such as divorce, or indeed, grief. It could be in the area of addiction or you’re looking for someone who’s essentially a coach who can guide and support you, as you learn to recognise problems and formulate healthy solutions for yourself? 

Again, another key element in life is that we’ve had to do a lot of the work ourselves, the therapist will be there as a sounding board, the therapist will be there in a non-judgmental manner, the therapist will be there with a set of skills, and the therapist will be very objective. But we sometimes have to go and put most of the work in ourselves to change something around our thinking or our behaviour patterns.

A psychotherapist may be a better option if you have problems that are significantly impacting your life and indeed your relationships, including your relationship with yourself. If you’re trying to cope with past trauma, or if you believe situations in the past, maybe play a role in your current circumstances. If your present issues are chronic or recurring, you just can’t seem to cure them to stop them from coming back. Maybe you have a diagnosed mental health condition where you’ve seen a counsellor and your issues aren’t improving even though you’ve been actively working on solutions, it may be time to take maybe a step further. Maybe it’s time to go deeper here and try to open up and really find out what’s happening.

If you are interested in learning more about counselling and psychotherapy why not apply for the Certificate in Essential Counselling Skills.

You can also register for our online information evening which is taking place on Wednesday, March 23rd.

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