Psychotherapy and Counseling

The two terms are often used synonymously nowadays.  However, they really refer to different things.

In counseling we receive advice and guidance from an expert about some life issue.  Counseling is usually specific to some particular problem area, carried out by someone who has received special training in that area.  For example, counselors are available to consult for alcohol dependency, eating disorders, gambling addiction, vocational decisions, writer’s block, communication problems, sexual dysfunction, religious questions, etc.  We go to counseling to get expert advice.  Counselors come in many flavors, identified by the areas in which they are expert.  For example, there are alcohol counselors, nutritional counselors, pastoral counselors, vocational counselors, marriage counselors.  Counseling differs from the advice we get from friends and family because the counselor is presumably more expert and more objective.  It differs from the advice we get from self-help books in being more focused on our particular circumstances, since the expert can speak specifically to us, as opposed to the writer who must be more general.  Counseling may meet one’s needs in many circumstances.  However, it may also not work deeply enough to provide lasting solutions.

In psychotherapy we ask deeper questions and find deeper answers.  The psychotherapist must be more broadly and deeply trained than the counselor.  He or she must be, in Harry Stack Sullivan’s words, “an expert in human relationships.” Just as counseling is more personal and individual than self-help books, psychotherapy is much more personal and individual than counseling.  The psychotherapist advises less and questions more.  He or she forms a very deep understanding of the client, often the deepest understanding the client has ever experienced.  A patient and non-judgmental relationship is formed.  In such a relationship, in deeply honest discussion, what at first seemed to be the main problem may come to seem less central.  I may enter therapy thinking I don’t know how to meet the right people.  As talk deepens I may find that I have self-defeating patterns of behaving, or self-sabotaging motives that I had been very unclear about before.  I may enter couple therapy thinking if my spouse would just accept responsibility for hurting me, everything would be fixed.  I may find out instead that the other’s understanding of many important things has been very different than I had ever dreamed it might be.  In therapy we are greeted with understanding and develop understanding.  We are accepted, and form a depth of self-acceptance that we hadn’t known to be missing.  There will be work to do.  We may be asked to face an inward monologue of negativity.  We may be asked to take feelings seriously.  We may be asked to attend to the moment with fresh innocence, and without the safety of familiar, superficial scripts.  We may be asked to listen to the strange night language of our dreams.  We will be asked and encouraged to grow in our own particular directions.

Of course, in practice the distinctions between counseling and psychotherapy may blur somewhat.  Psychotherapists may see a need to give expert advice and counsel at times.  Counselors may elect to work more deeply and personally, as a psychotherapist would.  In this case, the client should understand that the counselor is stepping beyond his or her training, and the quality of the efforts will depend upon personal maturity and life experience. 

In general, if you are sure you want specific answers to specific questions, seek out a good counselor – or, depending upon the questions, a good expert in some other appropriate field.

On the other hand, if you sense that you need a deeper understanding of yourself, seek out a good psychotherapist.