Should you see a coach, counsellor, therapist, psychologist or psychiatrist?

Demystifying the terminology + an apology

You may have noticed in a previous post that I referred to the fact that I’m training to be a therapist. This isn’t strictly true as I’m studying to be a counsellor, not a psychotherapist, however the term “therapy” is commonly used to mean both counselling and psychotherapy, which can be unnecessarily confusing for many people.

In Australia where I live, ‘counselling’ and ‘therapy’ are relatively interchangeable terms and I would hazard a guess that the average person doesn’t know the difference between the two. Today I’m going to be giving you some more information on each of these roles, describe the basic differences between the different types of mental health support you can access, and also explain why using the correct terminology is important, even though a lot of these roles are very similar.

Counselling

Counsellors cannot diagnose or prescribe, and they shouldn’t even really be giving advice. I know, right?! A counsellor should not be giving you advice, per se - their main role is to act as a listening ear and help guide you towards figuring out the answers for yourself. They may use worksheets or certain therapeutic techniques to delve a little deeper, but everything should be done with the intention of guiding you towards greater self-understanding, not just handing you all the answers. Counsellors can also act as a ‘companion on the counselling journey’, a supportive person who walks with and alongside you towards a happier and more fulfilling life.

Counselling is therapeutic, but it is not therapy. Counsellors can work in ‘general practice’ or they may choose to specialise in their area(s) of interest, for example: relationship counselling, child counselling, youth counselling, career counselling, financial counselling, etc… It’s also worth noting that in some countries it’s possible to work in the dual role of counsellor and psychotherapist.¹

Some counsellors can practice and register as counsellors and psychotherapists. This is only if they have trained in psychotherapeutic counselling. In the UK ‘Psychotherapeutic counsellors who can demonstrate that they have achieved UKCP standards for adult psychotherapy may be permitted to call themselves psychotherapists.’ [link]

Counselling is not coaching in the sense that counsellors tend to look back over a person’s life and address issues from the past, whereas coaches tend to be more future-focused and motivational-based. Coaches are not trained or equipped to deal with any sort of mental health issue or anything above and beyond simply providing motivation and encouragement. A coach should not be giving you mental health advice or support.

Both coaching and counselling are unregulated industries in the UK and Australia, meaning that anybody can call themselves a coach or a counsellor without any experience, training or qualifications - however this does look to be changing in the future, so watch this space!

Whether you should see a coach or a counsellor depends on what you need support with. Someone struggling with motivation may work best under the guidance and accountability of a coach, but they could also have undiagnosed (or poorly managed) ADHD, which a coach can’t do anything about (unless they’re an ADHD Coach²).

Psychotherapy

“Therapy” is shorthand for psychotherapy. Sessions are facilitated by a trained psychotherapist and usually take place on a longer-term basis than counselling (which could be one-off or only a few sessions). It’s not uncommon for people to attend therapy for months or even years, although there is some discussion within the industry as to how ethical it is for therapists to keep the same client indefinitely.

Psychotherapy has a reputation for digging up skeletons from the past and addressing childhood trauma or abuse, but in reality there are lots of reasons as to why you might want to see a psychotherapist. You might have already had a few sessions with a counsellor and realised you want a longer-term therapeutic relationship in which to explore some deeper-rooted issues, or it could be that you simply wish to have the opinion of someone with more experience, knowledge and training.

Whatever your reason for seeing a psychotherapist, you shouldn’t feel ashamed. There is much more of an open culture around therapy these days and in some circles/cultures/social groups it’s almost unusual if you don’t have a therapist. On the other hand, don’t feel bad if you can’t afford therapy - I’m not currently in therapy, largely for financial reasons, but personally I find journalling an effective and low-cost substitute. Journalling is a self-reflective practice which is what counsellors and therapists teach you to do.

What about psychologists and psychiatrists?

A psychologist is a trained health professional who can diagnose mental health disorders as well as neurological conditions such as autism and ADHD. It’s not uncommon for psychologists to specialise or practice in their areas of interest. You can usually refer yourself to see a psychologist (known as self-referral).

A psychiatrist is a medical doctor who has studied psychiatry at postgraduate level. Psychiatrists have A LOT of training and knowledge, and this is great if you’re seeking assessment, treatment, or medication for a mental, emotional or behavioural condition. Psychiatrists can not only diagnose and treat conditions but they can also prescribe medication. You usually need a referral from a GP to see a psychiatrist, but it’s worth contacting the psychiatrist’s office to ask what the requirements are.

Psychiatry has a reputation for sending people to mental health hospitals, but whilst such places do exist (there’s one under two hours from where I live) the majority of people who see a psychiatrist are at no danger of being admitted to a mental health hospital. If you see a psychiatrist it doesn’t mean you are “mad” or have “lost the plot” - it could be that you are simply seeking more information, help or advice, or it could be that you are seeking medication for a condition such as ADHD.

The thing to remember here is that coaches, counsellors, psychotherapists, psychologists and psychiatrists have differing levels of training and experience. It’s possible to become a trained counsellor within a few months; psychiatry training typically takes at least five of study on top of a general medicine degree. And as mentioned earlier, coaches are not health professionals, however coaches definitely have their place in this space.

In regards to counselling and psychotherapy, using the correct terminology is important because they are two separate disciplines, even though in many ways they are very similar. I am guilty of using the term “therapy” to describe counselling, but that’s mainly because the majority of my audience is US-based and I felt they would better understand what I was talking about if I used the term “therapy”. But I’ve since realized that counsellors in America have to hold a graduate degree, which is not a requirement in Australia or the UK. So apologies if I have unintentionally misled anyone (and any Americans reading this, feel free to correct me if I’m wrong about your education system!).

From now on I’ll probably be referring to myself as a trainee counsellor rather than a trainee therapist - it may be a small distinction, but I feel it’s an important one. Til next time - J x

1. For more information see here.

2. ADHD Coaching is gaining momentum in the UK, US and Australia. There is some criticism on how effective it is, but I think it depends on the person (fyi I have not received ADHD coaching so cannot personally vouch for the effectiveness of it).