Counseling and psychotherapy are often used interchangeably, which can be confusing to people seeking help. Most of us who work in the field tend to use the two terms a little differently. Counseling is usually used to refer to getting help for less severe problems or for situational issues. Psychotherapy is usually used to describe a process that relies more on the relationship between therapist and client to lead to deeper or more lasting changes.
One way to look at it is that psychotherapy is treatment for a disorder. In that situation, there are symptoms that are interfering with a person’s overall functioning, and therapy is designed to relieve the symptoms and improve functioning. Counseling, on the other hand, is intended to foster personal growth, help a person make a decision, assist with future planning (for example, about a career decision), or attain greater happiness. It may also help a person to figure out how to resolve a troublesome situation, such as a workplace problem or an unhappy relationship.
At the risk of creating too much complexity, I would offer the following additional comparisons between counseling and psychotherapy:
|Problem types or issues or Diagnosis
|Situational stresses, mild relationship problems (Communication, decision making), parenting, job issues, career goals, Adjustment disorders, Dysthymia
|Mental health disorders: Anxiety, depression, post-traumatic stress, substance abuse disorders, personality disorders, panic disorders
|Client’s Level of Functioning
|Moderate to high
|Moderate to low
|Good family functioning, good support, low to moderate stress
|Family dysfunction, lack of support, high stress
|Measure of success
|Problems being resolved
|Symptoms being decreased
Yet another way that I often suggest to my students to distinguish counseling from psychotherapy is based on my Adlerian framework, which sees a person’s behavior as flowing from their “style of life.” This concept is a way of referring to a person’s relatively stable personality “blueprint,” which is made up of basic beliefs about the self, other people, the world, the future, and how the individual must act in order to feel significant and to belong.
Counseling does not attempt to change this basic blueprint; it may help a client to become more aware of his or her life style beliefs and assumptions, and to make adjustments to situations by attaining more flexibility in the application of the beliefs and goals in the life style.
Psychotherapy is more likely to involve trying to change some mistaken beliefs and goals that are part of the style of life itself. This means un-learning some basic ways of seeing or interpreting the world, and learning new ones.
For example, a person who has a basic sense of inadequacy as a person (“I’m just a loser”) needs to change this basic belief, and that usually requires the encouragement and therapeutic alliance found in psychotherapy. Another example would be a person who has an avoidant style of life (who seeks to avoid situations where failure could result). This person may need to learn to change that basic goal, and learn to view failure as a natural part of life – at times necessary and even constructive.
Of course, there is a great deal of overlap between all these characteristics. The line between counseling and therapy is seldom clear. When I am working with a client,we may be engaged in counseling at some points and psychotherapy at other points, as the work moves between symptom relief and personal growth. Often, psychotherapy and counseling may blend, with both taking place in the same session.