Some people define Psychotherapy and Counselling synonymously, while others consider these roles / processes to be very different.
There are many different models of psychotherapy, and varying approaches within these models. Generally speaking, all types of psychotherapy aim to help people experience relief from different 'life' problems. These problems are often of an emotional nature - although not always - and can span a diverse range of issues from family or relationship conflicts, to individual feelings affecting self-esteem, depression, anxiety, anger, attentional difficulties, struggles with food, experiences of trauma, such as sexual abuse, difficulties in going to school, and suicidal feelings.
Regardless of whether these psychotherapeutic approaches emphasize change through working with experience/meaning, behaviours, thoughts, or emotions, most types of therapy are based on the person being seen (often referred to as the 'client') engaging in dialogue with the person trying to help them (often called a 'therapist'). Sometimes, this 'dialogue' may be based in less common modes of therapy such as music or art therapy.
It is also worth bearing in mind that in the year 2000, it was estimated that there were approximately 450 different types of psychotherapy in the Western world: if nothing else, this shows that there is no single, 'right' kind of therapy.
Here are some descriptions of 'Psychotherapy' and 'Counselling':
"Psychotherapy Services" are defined as any form of treatment for psycho-social or emotional difficulties, behavioural maladatptations and/or other problems that are assumed to be of an emotional nature, in which a social worker establishes a professional relationship with a client for the purposes of promoting positive personal growth and development.
"Counselling Services" are defined as serves provided within the contest of a professional relationship with a goal of assisting clients in dealing with issues in their lives by such activities as giving advice, identifying alternatives, problem solving and the provision of information and not as defined [above in "Psychotherapy Services"]
Ontario College of Social Workers and Social Service Workers' Code of Ethics and Standards of Practice (First Edition, 2000)
Most places in which people work as psychotherapists have legislation governing the use of the terms 'psychotherapists', 'psychotherapy', 'counsellor', and other designations, reflecting the fact that the person has trained in a certain discipline which is recognized as providing the appropriate experience for working in the mental health field or helping professions.
Although elements of the following may reflect mental health practices and conditions in different regions and countries, the contents of this section are the opinions of the authors, and seek to provide a general description of structures and approaches to practice in and surrounding Toronto, Canada, at the time of writing (2004).
It should also be noted that many people from the disciplines named above and discussed below can have widely varied specializations, many of them outside of what is known as the 'mental health' field. The classifications itemized here are restricted to those practitioners from each discipline who have trained and worked in the counselling/psychotherapy specializations.
There may be general differences in the emphasis that this training has taken, and specific differences in the type of therapeutic model or approach chosen by an individual practitioner - even if those practitioners are from the same professional background or discipline.
It is also conceivable that the professional preferences of people from different theoretical backgrounds, for example a social worker and a psychologist, may mean that they practice in like ways, which differ from others from their own professional disciplines.
Social workers' training - regardless of specialization - emphasizes looking at people as members of society, and requires the practitioner to take this larger, political, context into account.
For example, iin the case of a social worker who works as a psychotherapist, in addition to 'traditional' clinical ways of working, the therapist may look at the larger context of the person's life. This examination may create an acknowledgement of the effects of poverty on the individual's situation and mental health.
Further, acknowledgment of broader contexts such as that of poverty, may require the social worker to also engage in advocacy initiatives to address these issues, both on behalf of the individual and on behalf of others who may be at risk of being adversely affected by these political issues.
A Psychologist, on the other hand, is trained to view people with an emphasis on what they view as the 'intrapsychic' realm. That is, clinical psychologists generally see the person as a self-contained individual, influenced primarily by his or her own personality traits. This view places less emphasis on the importance of society, and the importance of interrelationships, than that of social work training does.
Psychiatrists, are trained as doctors, and therefore tend to adopt a medical perspective on people's mental health. This generally means that they are trained to look for evidence of pathology, and if they find this, will view people as being psychologically/mentally ill, or maladjusted in some way. This view will often result in a diagnosis of some kind.
Because of the popularity in society at this time of the medical viewpoint that mental health issues often result from chemical imbalances in the brain, and can be addressed by pharmaceutical interventions to address these issues, psychiatrists are likely to prescribe medications, such as antidepressants, as treatments for the mental health 'disorders' which they perceive to exist.
Other mental health professionals, disciplines, and theoretical/academic training Many types of therapy, practiced by those with M.A.'s in Counselling Education, Nurses, Music therapists, Art therapists, or holders of other professional qualifications, have been influenced by the broad themes described above (societal/contextual; personality; medical model). It may be useful for those searching for a therapist to be aware of the likely emphases, and potential biases of practitioners working within the perspectives discussed above.
Finding a therapist can be a confusing, and sometimes an intimidating, experience. Finding a good therapist can also be a life-changing event. Here are a few suggestions for finding a therapist that we hope you will find useful:
1. Ask People You Know to Recommend a Therapist
If someone you know has been in counselling, and they feel comfortable talking about their experiences, you may want to ask them about their therapist. Although liking your therapist is not necessarily a guarantee of that person's effectiveness, chances are that you will benefit most by working with someone with whom you do feel comfortable.
2. Consult Other Sources
In addition to talking to friends and acquaintances who may be able to recommend a therapist, it is likely that you can access other sources of information for leads on finding a therapist.
For example, professional bodies for social workers, psychologists, and psychiatrists, may be able to provide you with contact information for therapists in your area, and may also have details of these therapists' specialities. Also, try looking in The Yellow Pages under relevant areas such as 'Marriage and Family Therapists', 'Counsellors', 'Social Workers', 'Psychotherists' and 'Psychologists'.
3. Trust Your Gut
At first, it can be uncomfortable talking to someone whom you do not know about your personal problems (sometimes it's uncomfortable talking about these things with close friends or relatives, too!).
If this discomfort persists after one or two sessions, ask yourself if you feel uncomfortable with your therapist, or about the issues that you are discussing.
If you feel at all uncomfortable with your therapist, you have the right to stop seeing him or her; it is, of course, polite to let them know that you will not be seeing them again, and you might decide to ask them to refer you to someone else.
If, for any reason, you feel that therapy is not working, discuss this with your therapist - if you feel that your therapist is not providing the space you need to talk about this, then change your therapist.
4. Ask Questions- And Expect Answers
A therapist should answer all of your questions about fees, length of appointment times and contracts (if relevant), their ways of working, training and qualifications, and other questions that you may have pertaining to their professional work. If you do not get straight answers to your questions, or you feel at all doubtful about the therapist, do not agree to an appointment.
5. Ask the Therapist to Describe his/her Strengths and Ways of Working
These might include the therapist's views on using medication, their preferences in working with others, and how they think they could help you.
6. A Word About 'Qualifications'
Generally - and we mean that - having completed a recognized or accredited psychotherapy training program is an indication that your therapist has had a certain amount of supervised experience working with people, and that they have done this work using an established theoretical framework. And generally, a therapist will be a member of some kind of professional organization that has a code of ethics, or some equivalent standards for treating their clients, to which member therapists are required to adhere.
However, although completion of training programmes, membership of professional organizations, and a thorough knowledge of particular therapeutic models or practices may represent a commitment and conscientiousness in a therapist preparing to work with clients, these factors do not necessarily determine therapeutic success, or a satisfying therapeutic relationship.
By all means, ask your therapist about their academic background, training, and their standing in any professional organizations that they may be members of, but also trust your instincts in choosing a therapist.
Narrative Therapy is a way of working with people that says that we experience the world in the form of the stories that we tell ourselves about our experiences, and that these stories, in turn, have an effect on how we experience the world. Further, these stories are 'constructed' as a result of social interactions on many levels - familial, institutional, community, societal.
Narrative therapy takes into account the contexts in which people live, and uses the resources that people bring with them to help people change their relationships with the problems that they find oppressive.
The basic tenets of Narrative work are:
For further information about Narrative, please follow these links:
© Copyright Geert van der Veen & Natasha Kis-Sines (Collaborative Therapy Associates), 2004, Toronto, Canada