Confused about therapy and counselling?

What are the differences between counselling and psychotherapy?


There are a wide range of counselling models available. Generally counselling offers an unburdening of problems to a sympathetic listener within a supportive relationship. Psychodynamic counselling is based on abstracts of the psychoanalytic discoveries of Sigmund Freud. Counsellors are trained in a variety of settings ranging from counselling centres to university departments. The courses are designed for counsellors to work with clients on a once a week basis only. They require attendance and reading for theoretical lectures and seminars on the main developments in counselling work with clients. They are supervised in trainee groups by an experienced practitioner, usually a senior counsellor or psychoanalytic psychotherapist. Some trainings also stipulate individual supervision for their trainees.

Counsellors are required to have some experience of being counselled themselves. This varies in its length and intensity. The range can be from 80 sessions in total to a more in-depth, long-lasting psychoanalytic psychotherapy. Where counselling courses lead to a taught Masters degree (not necessarily following a first degree), the intellectual content, particularly concerning the psychology and philosophy underpinning the process of counselling, tends to be more searching. The training will take two or three years to complete.

Counselling is usually time limited,but can last for a year or more. Clients sit in a chair facing the counsellor. The sessions are 50 minutes long and the client mainly does the talking. The counsellor should never reveal anything about themselves to their client. as this disrupts and interferes with the counselling process. Counsellors are required by their code of ethics to have at least one and a half hours of supervision of their work. This is usually carried out by an experienced psychoanalytic psychotherapist.

While Freud acknowledged the crucial importance of parents in the lives of their children, it was the next generation of adult and child psychoanalytic practitioners who through their experience when working with their patients, uncovered the central place that early life plays in the lives of individuals. If early experiences have been mainly nurturing and containing the individual will grow up confident and generally contented and go on to find nurturing and sustaining relationships in adult life. When this has been disrupted for what ever reason a person continues to find relationships in adult life that repeat their difficult earlier experiences. The past is then like an unlaid ghost that keeps coming back to haunt us.

Psychodynamic counsellors are taught this theory. Generally however they will not seek, or have the in-depth training or experience to develop this fully with their clients. Some understanding however of the impact of past experiences will be explored. This can help the client have a better understanding about they way that they relate to important others in the present.

Many clients can be helped by gaining some insight into themselves and by the supportive relationship with the counsellor and this will be enough to help them get their lives back on an even keel. However, when the underlying problems are more deep rooted, a more in-depth treatment may be necessary. People often instinctively know when something is deeply wrong inside themselves.


There are some clear distinctions between psychodynamic counselling and Psychoanalytic psychotherapy. The difference lies not only in the depth and intellectual rigour of the best training for psychoanalytic psychotherapy but, also in the depth and intensity of feelings in the client that can be contained by an experienced psychoanalytic psychotherapist. The in depth theoretical training, based on Freud and his followers, generally requires at least a first degree, the clinical training of seeing patients three or more times weekly. In addition the trainee therapist will have to have a long period (often between four and seven years) of personal analysis. This helps to ensure that the psychotherapist has acquired a deep knowledge of their own motivations, feelings and behaviours, to the extent that they can work with the patient's powerful feelings without over reacting to them, or worse, retaliating with their own unresolved feelings. If, for example, when a person's usual response from others to their angry feelings is retaliation or being avoided or having their angry feelings dismissesd, the angry person ends up feeling very bad about themselves. The psychotherapist, by contrast, could bear the experience of the patient feeling angry with them, not retaliate but help the patient explore the causes and roots of their feelings. In other words, the psychotherapist survives the patient's powerful feelings and this in itself is very sustaining and therapeutic for the patient who would otherwise feel that they could destroy or damage others with their strong feelings. This greatly relieves the patient and lessens the intensity of their feelings.

Modern Psychoanalysts and Psychoanalytic psychotherapists have discovered that human beings have an unconscious life that is not accessible through conscious thought but which shows itself in our dreams, slips of the tongue and other seemingly unfathomable behaviours, Understanding these processes helps the individual feel more in charge of themselves, less engaged in internal conflict and more able to lead a contented and productive life.
Psychoanalytic psychotherapy aims to help people to understand and change complex, deep seated and often unconsciously based emotional and relationship problems, thereby reducing symptoms and alleviating distress. This includes people with serious psychological disorders. However its role is not limited only to those with a variety of mental health problems. Many people who experience a loss of meaning in their lives or who are seeking a greater sense of fulfilment, may be helped by psychoanalytic psychotherapy.

It is often helpful to have one or more preliminary consultations with an experience psychotherapist before deciding whether this is an appropriate treatment for the person concerned. Occasionally the treatment might be of short duration, but generally speaking, psychoanalytic psychotherapy is best considered as a long-term treatment involving considerable commitment for both patient and therapist.

It is often useful, following a consultation to allow time to relfect on the experience, before making snap judgements about starting treatment. All reputable practitioners will encourage reflection in this way.
Unfortunately, suitably qualified psychoanalytic psychotherapists are few and far between and treatment, if available at all through the NHS, can mean a very long wait.

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