What is psychotherapy? A conversation with Dr Seth Osborne
We know all too well how overwhelming it can be to search for information online. Even if you have an exact term you want to understand, the endless results can leave you lost. And if those first few results don’t give you a clear answer, well, it can make matters worse.
So, we spoke to counsellor and psychotherapist, Dr Seth Osborne, who sheds a little light on counselling and psychotherapy. He explains the differences between the approaches, the similarities, and what you may expect to gain from working with a psychotherapist.
The chances are that if you’re reading this, you’re interested in psychotherapy. Perhaps you’re thinking about having psychotherapy yourself or are wondering if it may benefit a family member or a friend. Maybe you have heard someone mention psychotherapy, and so you’re now doing your own research, trying to find out some more about it.
A scenario of this sort seems possible because while psychotherapy is something we’ve all heard of, there is often a lack of clarity about exactly what it actually is. Who is it for? What sorts of problems does it deal with? How is it different from counselling?
So, what’s the difference between counselling and psychotherapy?
Any confusion is certainly justified and cannot be fully alleviated, as there is considerable overlap between counselling and psychotherapy. Practitioners may identify as both psychotherapists and counsellors, in effect claiming they can offer both. For instance, I am both a school counsellor and offer private psychotherapy, and I also offer counselling in my own practice. They are not mutually exclusive. However, there are some differences between psychotherapy and counselling which can be useful to know about.
Psychotherapy is commonly understood as representing something more in-depth, rigorous, and formal than counselling. This difference perhaps reflects the origins of these professions, with counselling having roots in activities such as guidance and advice, and psychotherapy with greater links to the medical and psychoanalytic establishments. Those identifying as psychotherapists will typically be registered with the UKCP or with the BPC, whereas counsellors are more likely to be registered with the BACP.
Confusingly, some psychotherapists (like myself) may also have a BACP qualification, in effect, becoming psychotherapists and counsellors.
And what training is required for psychotherapists?
Becoming a psychotherapist and registering with either the UKCP or BPC usually involves postgraduate training lasting around 4 years, most likely at a Masters level qualification.
Psychotherapists in this longer training will usually have amassed more experience than counsellors will have during their training (simply through more patient/client hours); have been used to seeing patients for longer periods of time (often training organisations will require the trainee psychotherapist to see the same patient for 1-2 years), and have had more personal therapy themselves.
This not only differentiates psychotherapists from counsellors, but also from clinical psychologists, who would not necessarily have experience of seeing patients over longer periods of time and are also not required to have their own personal therapy.
Psychotherapists work with the same sorts of problems as counsellors and psychologists, such as depression, anxiety, relationship problems etc. Psychotherapists typically won’t diagnose or medicalise, although they often work closely with other professionals, such as psychiatrists, depending on the setting in which they work.
Psychodynamic and psychoanalytic psychotherapy is effective at treating many mental health conditions and psychotherapists may work in the NHS providing psychological therapies in adult mental health teams. Child and adolescent psychotherapists comprise a vital part of NHS CAMHS services and are skilled at using play to work with young children who are experiencing mental health difficulties.
What is it like to see a psychotherapist?
First, you’re likely to have sessions at the same time and place each week. The regularity of sessions in psychotherapy is important, and committing to regular sessions, and not arranging them on a more ad-hoc basis is key to the process. Regular weekly sessions (or sometimes 2/3 sessions a week) that lasts exactly the same time (normally 50 minutes) form part of something which psychotherapists will often call ‘the frame’.
The frame describes the highly boundaried structure around the sessions (time, place, length of session, formality and behaviour of the psychotherapist) that help you to enter a different state of mind than usual and to think and talk about things that you might not be able to when the arrangements are similar to other aspects of day-to-day life.
Psychotherapy, like counselling, is available online. If your psychotherapy is online, your psychotherapist will still try to set up the frame as if you were attending in-person and have the same sort of boundaries around the work as usual.
And how does this differ from your counselling sessions?
Working as a counsellor – which for me is primarily associated with working with children and young people – is that I make more of an active effort to convey warmth. I make an effort to actively form a therapeutic relationship. The therapy is likely to have more supportive elements and has more person-centred, humanistic underpinnings. The topics covered might be those relating to life events: divorce, grief etc. These are likely to be those identified at assessment, and the work would be focused on these.
As a psychotherapist, working primarily with adults, I would be less active in forming the therapeutic relationship and would instead be neutral. This doesn’t mean that I would be cold or disapproving, but I would be seeking to facilitate a setting in which transference might develop. This is a key element of psychodynamic or psychoanalytic psychotherapy and refers to how a psychotherapist uses their understanding of how they relate to the client as a means of understanding the client’s other key relationships in life. For this to develop, the psychotherapist needs to be relatively neutral and not try too hard to attempt to be a ‘good’ figure as such.
In psychotherapy, the topics covered are likely to be those identified at assessment but are also examined in the greater context of the client’s life. Issues may include more long-standing issues, such as depression, anxiety, relationship and sexual problems, addictions. There is a greater focus on exploring the client’s mind overall. Desires, fears, fantasies are all explored in psychotherapy, which tends to last for longer than counselling.
Having said all this, most clients (children and adults) receiving therapy will have elements of both approaches, depending on what is felt to be best and appropriate for them. It’s also the case that it may be the psychotherapist’s capacity to think about the client very carefully and deeply, rather than any particular difference in the external nature of sessions, that may differentiate them from counsellors.
Psychotherapy is a process. People might say they’re ‘in therapy’ and perhaps that phrase is a simple explanation of what psychotherapy is. It’s something that you attend for months or even years, and in that time, your psychotherapist helps you to understand yourself in a deeper and fundamentally more truthful way. You get into a process in which you get to learn about your mind, your blind spots, your preconceptions.
Psychotherapy aims to help us confront our most problematic aspects, with the security and boundaries of the therapeutic relationship providing the structure for us to explore how we can sometimes be our own worst enemies. It’s not easy and it shouldn’t be. However, it helps us to develop a more honest relationship with ourselves, and in doing so, allows us to engage more fully with others and the world around us.