Psychiatrist, Psychologist, Counsellor, or Psychotherapist… What’s the Distinction?

Psychiatrist, Psychologist, Counsellor, or Psychotherapist… What’s the Distinction?

One of the most common questions we receive when clients approach us for mental health support is “What is the difference between a Counsellor/Psychotherapist and a Psychiatrist or Psychologist?”, followed by “What is the difference between a Counsellor and a Psychotherapist?”. So, we are here to demystify these approaches to help you work out which avenue is right for you. 

What’s the same?

Firstly, all three approaches use the same basic skills of deep listening. Your clinician, regardless of their profession, should make you feel warmly welcomed, heard, and understood. If this is not your experience, it may not be anyone’s fault – despite their training, all practitioners are human beings first and sometimes the fit, just does not fit. Raising concerns with your practitioner about how they work with you can help shift their focus to what is important to you relationally (they will appreciate it, we promise!). When it comes to supporting your mental health, your progress will have more to do with the relationship you develop with your therapist than the qualifications they hold. If your concerns are not addressed or you continually struggle to feel comfortable with a practitioner, it is perfectly okay to try someone else. While each industry has different underlying assumptions covered in the following section, specific modalities and interventions are shared between them. Each industry must meet guidelines for ongoing professional development which ensures clinicians are up to date with evidence-based treatments. Members from each industry come together during professional development based on which modalities they believe will be the most beneficial for their clients. All of this is to say that while initial training and underlying assumptions may be different between industries, individual clinicians will overlap in the modalities they use. A psychologist may use cognitive-behavioural therapy with you, but so might a counsellor.

Differing Underlying Assumptions

All three industries focus on supporting individuals’ mental health, they just do so in different ways and with different approaches. Multiple different models of care exist, but today we will focus on the medical model and the biopsychosocial model of care. The below descriptions are generalised views and individual practitioners might find different approaches more aligned with their practice to these.

One approach is not better than another, it’s about finding someone who meets your unique needs.

Psychiatrists begin their training in medicine and work predominantly from a medical model, focusing on assessment, diagnosis, and medication to support clients from a biochemical perspective. The medical model sees brain structures, neurotransmitters, and genetics as the cause of symptoms, with interventions to improve these areas. An example of this might include working with a client diagnosed with schizophrenia and prescribing anti-psychotic medications, aiming to treat the underlying biological imbalance. Some psychiatrists also use therapeutic approaches in addition to medical interventions. A psychiatrist may be the right fit for you if you are curious about accessing medications to support your mental health and/or if you are seeking a diagnosis.

Psychologists can also fall within the medical model, with mental health care plans requiring a diagnosis to direct treatment. This framework exists to orientate the clinician towards the most evidence-based treatment for that diagnosis, e.g., anxiety and cognitive behavioural therapy. Psychologists also include behavioural, cognitive, and psychodynamic components to biological imbalances in their work with clients. Psychologists are not trained to prescribe medication, but they are trained in diagnostic assessments. A psychologist might be a good fit if you are seeking a diagnosis and/or therapeutic support.

Counsellors and Psychotherapists work from a different viewpoint, they are actively non-medical. Instead, counsellors take a person-centred and bio-psycho-social approach. Counsellors view individuals through a strengths-based approach, highlighting the individual’s inherent skills, resilience, and survival mechanisms, as well as growing the individual’s awareness of these strengths. The focus is on what challenges do you face and what do you already possess that you can draw upon. They tend to look holistically at the client’s current mental health challenges against the landscape of their current and historical life circumstances to facilitate change. Counsellors do not focus on diagnostic labels to guide treatment, but rather they aim to take the lid off the jar and understand what’s inside. A counsellor might be the right fit if you want therapeutic support, and many are happy to work alongside or refer to a Psychologist/Psychiatrist if you are seeking a diagnosis and/or medication.

Counselling vs Psychotherapy

Finally, the distinction between counselling and psychotherapy, which is mainly the breadth of these two treatments. Counselling tends to focus on short-term treatment, e.g., you have a workplace issue or need support through a period of grieving. Short-term is subjective, there is no limit to how long these processes take and only you as the client know when you feel the situation is manageable. Psychotherapy, however, tends to be a long-term treatment, often taking place over multiple years and exploring your life from intergenerational patterns all the way to the present. To use an analogy, counselling is pruning, weeding, and planting in the garden of your life, and psychotherapy is looking down into the roots of those plants to understand how they grew and using this information to support their ongoing growth. The reason the term counsellor/psychotherapist is used at Rehab Solutions Adelaide is because the distinction between these two can blur. Many people come in for a ‘counselling’ issue and through that psychotherapy emerges –the roots naturally become visible when you are pruning the leaves.