By Eoin Stephens, President of PCI College (Dublin)
1. There is some fundamental difference between Counselling & Psychotherapy
In fact, there is no clear difference; both are “Talking Therapies” or Psychological Therapies”.
What matters to a client in distress is that the professional helper who works with them can listen to their problems and help them find some better way forward. In some contexts the term “Counsellor” is used more often (e.g. “Addiction Counsellor”); in other settings the term “Psychotherapist” is preferred (e.g. in private practice). Whether someone is called a Counsellor or a Psychotherapist, or both, they should be able to work with a client on a range of issues, for short-term or long-term work, as needed.
2. Counselling /Psychotherapy never works
3. Counselling /Psychotherapy always works
Therapy, like many other forms of helping (medicine, personal training, etc) can help people to a greater or lesser extent depending on many factors - other sources of support, emotional readiness to change, clarity and realism of goals, etc…
The “chemistry” between therapist and client can also be an important factor, so any particular client will find that some therapists will suit them better than others. Clients may even have a preference in relation to the gender or age of their therapist.
The working relationship, or “Therapeutic Alliance” seems to be the main thing that gives Counselling /Psychotherapy its value, though a range of useful techniques have also been discovered over the years, from Graded Exposure in the case of anxiety problems through to the Empty Chair technique (imagining someone sitting in the chair and expressing feelings to them) in the case of anger etc.
4. Counselling /Psychotherapy is no good for Depression
5. Counselling /Psychotherapy is always good for Depression
Depression is a good example of what we were saying above – therapy can help some people, in some circumstances, to some extent… sometimes a lot, sometimes only a little; sometime with the added support of medication or a support group, sometimes without.
While medication may help to directly intervene at the physiological level, raising serotonin levels (regular aerobic exercise can also do this), talking therapy can help in changing stuckness in areas such as fixed negative thinking, self-sabotaging habits, withdrawal from contact with people etc. Therapy can also help clients to explore the history and possible roots of their depression.
6. Counselling /Psychotherapy should always take a long time
7. Counselling /Psychotherapy should always take a short time
As they say, “How long is a piece of string?” Some problems are bigger, some are smaller. Some people want to address all their issues, some people just want to make a slight improvement in their lives. Sometimes further issues emerge as therapy develops. Some therapy approaches believe that all clients need long-term therapy, and some believe that no one should ever need to be in therapy a long time, but the reality is that it just depends.
8. Only psychiatrists can do Counselling /Psychotherapy
9. Only psychologists can do Counselling /Psychotherapy
Either of these professional groups can provide Counselling /Psychotherapy if they are qualified to do so (many aren’t), but so can qualified Counsellors /Psychotherapists who don’t have any such background, but have been trained to the proper standard.
Psychiatrists are medical doctors who have specialised in the area of Mental Health. Their primary role is still to prescribe medication, though most have some training in Counselling/Psychotherapy as well. They rarely have the time to provide much of it, however, except maybe in a private practice setting.
Psychologists work in a variety of areas, as educational psychologists, research psychologists, forensic psychologists, etc. Some specialise as Clinical Psychologists, in which case they are likely to work with some Mental Health issues, though they might equally work in an area such as Intellectual Disability. Some specialise as Counselling Psychologists, in which case they do the same work as Counsellors/Psychotherapists, in other words “Talking Therapy”.
Most people who describe themselves as Counsellors and/or Psychotherapists do not come from any of these related professional backgrounds (though some may). They are trained from scratch in the profession of Counselling & Psychotherapy. They may or may not have worked in other careers before, but one way or another this now becomes their main qualification and their main career.
10. Only one kind of Counselling /Psychotherapy works (Psychodynamic, CBT etc)
Counselling /Psychotherapy is still developing as a profession, and there are still a variety of approaches and theories. These will gradually become more and more integrated with each other – in the meantime, many Counsellors /Psychotherapists work in an “eclectic” way, using the best from different approaches depending on the client’s issues.
11. Counselling /Psychotherapy is no use if the client is taking medication
It mainly depends on the medication in question. In some cases, taking an anti-depressant can help a depressed client engage in therapy, by easing emotional pain without necessarily numbing emotions. Tranquilisers, however, have much more capacity to cut the client off from their emotions, and to provide them with a “quick fix” which may demotivate them from using therapy.
12. Only someone who has experienced Addiction can provide Counselling /Psychotherapy to an addict
This myth is still met with commonly enough in and around the field of addiction counselling. It doesn’t really make any sense, and interestingly enough it is said much less often in relation to other problem areas, such as depression or relationship problems. We should rather assume that sufficient knowledge, skills, personal development and professional experience should enable any counsellor/psychotherapist to work with any problem area experienced by humans. As the Roman playwright Terence said, “I am a human being; nothing human can be alien to me.”
13. Counsellors/Psychotherapists have their own lives all worked out
Therapists can sometimes be seen that way, and might even believe it themselves sometimes, but it is definitely a myth!
14. Clients always become over-dependent on their Counsellors/Psychotherapists
15. Clients never become over-dependent on their Counsellors/Psychotherapists
It’s a risk, as with any situation where someone is helping someone else who is vulnerable, but it’s definitely not the norm, and a well-trained therapist will be able to handle it sensitively.
16. Only very intelligent/educated clients benefit from Counselling /Psychotherapy
Intelligence and education have nothing to do with success in therapy, unless the client or the therapist believes it to be the case, in which case it may become a self-fulfilling prophecy. What make the difference are the kinds of factors mentioned above – readiness, commitment, motivation, support etc.
17. Counselling /Psychotherapy should always look at the client’s past
18. Counselling /Psychotherapy should never look at the client’s past
This something that actually varies a lot, depending on the client’s issues and their roots, the approach of the therapist, the amount of time available, what the client wants to do, etc. There is no one-size-fits-all rule here.
19. Nobody really needs Counselling /Psychotherapy
20. Everybody really needs Counselling /Psychotherapy
Once again, as is often the case with myths and vague notions, neither extreme is true.
Many people may find themselves in a position at some point or points in their life when they could benefit from the kind of help that Counselling /Psychotherapy can offer. Some may never feel the need; others may decide that it suits them to make regular therapy an on-going support in their life. There is nothing wrong with needing Counselling /Psychotherapy; there is nothing wrong with not needing Counselling /Psychotherapy.
One of Ireland’s leading Cognitive Behavioural therapists, Eoin has more than 20 years experience in the field as a counsellor, lecturer and supervisor. He has served as Vice-Chairman of both the Irish Association for Counselling and Psychotherapy and Addiction Counsellors of Ireland (formerly the Irish Association of Alcohol and Addiction Counsellors), and was the 2010 recipient of the Carl Berkeley Memorial Award for contributions to the field of counselling & psychotherapy. Eoin has made many contributions to press, radio and TV, expecially in the areas of addictive behaviours and anxiety problems. He has a particular interest in the links between addictions and other mental health problems, and is a co-founder of the charity Dual Diagnosis Ireland.