My younger daughter has graduated, our video shoots for the Clinical Interviewing text are “in the can,” my time with the grandkids has passed, and the family reunion is over. Now, as the summer sun blazes, I’ve retreated to my standing desk and dived head-first into revising the 3rd edition of our Counseling and Psychotherapy Theories textbook. Later today, I’ll refresh myself with a different sort of dive into the beautiful and frigid Stillwater River.
As I work on revising this textbook I’ll be posting a series of “Theories Highlights.” They will be short excerpts from the forthcoming 3rd edition. Here’s the first one. As always, I’d love feedback if you feel like sharing.
From Chapter 1:
Definitions of Counseling and Psychotherapy
Over the years, many students have asked: “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”
This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees, but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and the psychiatric nurse practitioner credential. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. If time permits during these discussions, we also share our thoughts about less-confusing topics, like the meaning of life.
Sorting out differences between mental health disciplines is difficult. Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power the differences are irrelevant” (p. 165). Haley articulated the reality that many different professional tracks can lead you toward becoming a successful therapist, despite a few ideological, salary, status, and power differences.
In this section we explore three confusing and sometimes conflict-ridden questions: What is psychotherapy? What is counseling? And what are the differences between the two?
What Is Psychotherapy?
Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), referred to the treatment she received as “the talking cure.” This is an elegant, albeit vague description of psychotherapy. Technically, it tells us very little, but at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: Talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing. This definition isn’t satisfactory as a research definition, but it provides an elegant historic and foundational frame.
As we write today, heated arguments about how to practice psychotherapy continue (Baker & McFall, 2014; Laska, Gurman, & Wampold, 2014). This debate won’t soon end and is directly relevant to how psychotherapy is defined (Wampold & Imel, 2015). We explore dimensions of this debate in the pages to come. For now, keep in mind that although historically Anna O. viewed and experienced talking as her cure (an expressive process), many contemporary researchers and writers emphasize that the opposite is more important—that a future Anna O. would benefit even more from listening to and learning from her therapist (a receptive process). Based on this perspective, some factions in the great psychotherapy debate believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).
We have four favorite (and different) psychotherapy definitions we’d like to share:
- A conversation with a therapeutic purpose (Korchin, 1976).
- The purchase of friendship (Schofield, 1964).
- [A] situation in which two people interact and try to come to an understanding of one another, with the specific goal of accomplishing something beneficial for the complaining person (Bruch, 1981).
- When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).
What Is Counseling?
In some settings, an evaluative or judgmental distinction is made between counseling and psychotherapy. Alfred Adler, whom we’ll get to know more intimately in Chapter 3, might say that counseling has an inferiority complex with respect to its older sibling, psychotherapy (Adler, 1958). Or, perhaps it could be that psychotherapy has a superiority complex toward its younger rival, counseling. Either way, at some point you may notice or experience people passing judgment on the relative merits of psychotherapy and counseling.
Counselors have struggled to define their craft in ways similar to psychotherapists. Consider, Kottler and Brown’s (2008) perspective:
Counseling is indeed an ambiguous enterprise. It is done by persons who can’t agree on what to call themselves, what credentials are necessary to practice, or even what the best way is to practice—whether to deal with feelings, thoughts, or behaviors; whether to be primarily supportive or confrontational; whether to focus on the past or the present. Further, the consumers of counseling services can’t exactly articulate what their concerns are, what counseling can and can’t do for them, or what they want when it’s over. (pp. 16–17)
As with the term psychotherapy, a good definition of counseling is hard to find. Here’s a sampling:
- Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior (Burke, 1989, p. 12).
- Counseling consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems (Krumboltz, 1965, p. 3).
- [Counseling is] an activity…for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems (Kottler & Brown, 1996, p. 7).
We now turn to the question of the differences between counseling and psychotherapy.
What Are the Differences Between Psychotherapy and Counseling?
Years ago, Patterson (1973) answered this question directly: “There are no essential differences between counseling and psychotherapy” (p. xiv). On this issue, we agree with Patterson and Corsini and Wedding (2000), who wrote:
Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do. (p. 2)
This statement implies that counselors and psychotherapists engage in the same behaviors—listening, questioning, interpreting, explaining, and advising, but may do so in different proportions.
For the most part, the professional literature implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed. For example, some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less. Additionally, although it used to be that counselors worked with clients who displayed less severe problems and psychotherapists worked with patients who display more severe problems, now, perhaps because obtaining services from master’s-level counselors or social workers is less expensive, counselors often work with lower income clients whose financial stress interacts with and complicates their personal and family problems.
A Working Definition of Counseling and Psychotherapy
At the very least, there are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. And sometimes we use the word therapy as an alternative.
For the purposes of this text and to keep things simple, we offer a 12-part general definition of counseling and psychotherapy (in case you weren’t sure, this reference to keeping things “simple” is an example of sarcasm). Counseling or psychotherapy is:
(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically-based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.
We should note that, although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit for any self-administered forms of therapy, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance-state.