One of the questions that prospective clients often ask is ‘what type of therapist should I see?’. The answer often isn’t a straightforward one and depends on a number of factors such as what difficulties you may be seeking help for, what you are looking to get from therapy, how much you can afford to pay (if seeking a private therapist), therapist availability and ‘therapeutic fit’, amongst many other factors. If you don’t know that different types of therapists even exist or aren’t familiar with the various types available, it can be a bit of a minefield trying to navigate the system. You may have questions such as ‘Should I see a clinical psychologist or a counsellor? Do I need to see a psychiatrist? What do they all do??!’. We hope that this blog will make things a little clearer (although we must admit too that sometimes even the professionals find it hard to distinguish and agree on some of the more subtle differences!).
Firstly, it’s important to highlight that actually one of the main things that can help when in therapy is the therapeutic relationship, even more so than the specifics of what sort of help you are getting. The term ‘therapeutic relationship’ means the relationship between you and your therapist. It has been shown many times that this can be hugely influential in therapy outcome, regardless of what sort of psychological model or therapy is being used. Some of the main things to look for when finding a therapist (in addition to their qualifications and experience which we outline below) are factors that will help develop a positive therapeutic relationship. These often include things such as being an empathic listener, being non judgemental, showing interest and engagement, being warm and friendly (but not too friendly, for example asking to be your friend outwith sessions etc!), being boundaried, feeling safe, being respectful, compassionate, professional, credible, engaging, focused and genuine. And also very importantly, that the therapist abides by their professional code of conduct and ethics. An important part of therapy is to help you feel that it is a safe and confidential space where you can be honest, reflect, learn and grow and if these basics of the therapeutic relationship aren’t there in the first place then that’s going to make the actual therapy work potentially more tricky.
So what type of therapist should you see?
The term ‘talking therapies’ is often used to describe the different types of therapies which primarily work by talking through clients difficulties. There are many different professions that come under this catch all term with the more common ones including clinical psychologists, counselling psychologists, CBT (cognitive behaviour therapy) therapists, counsellors, psychotherapists and psychiatrists. It’s actually quite hard to distinguish who does what but it’s mainly down to training, qualifications and expertise which separates them.
What is a CBT Therapist?
CBT therapists are trained in a specific therapy called cognitive behaviour therapy (CBT). They often have a background in another profession such as nursing etc. CBT is an ‘evidence based’ therapy which means that lots of research has shown that it can be helpful for certain types of problems. CBT primarily helps you understand how your thoughts and behaviours influence how you are feeling and it helps teach you ways to change negative patterns of thinking and behaving. It is an active therapy where the client is often asked to do work between the sessions such as keeping diaries of thoughts and behaviours etc.
In order to be accredited, CBT therapists often have an undergraduate degree and can come from different backgrounds in mental health but have then gone on to do specific training in CBT (a post graduate diploma usually being one full time academic year). For those who don’t do a post graduate qualification, training involves producing a very detailed portfolio of client work over several years which is then submitted to their regulatory body for approval and in order to become accredited.
CBT therapists primarily work within the therapeutic model of CBT but some may do further training in other therapy approaches and incorporate this into their therapeutic work.
What is a Clinical Psychologist?
Clinical psychologists are trained to understand and work with a wide variety of mental health difficulties across all ages (child, adult, older adult) and across a variety of settings. Clinical psychologists are often trained in a wider range of ‘evidence based’ therapies (i.e. therapies that have been widely researched and shown to be effective) such as cognitive behaviour therapy (CBT), acceptance and commitment therapy (ACT), compassion focused therapy (CFT), cognitive analytical therapy (CAT), eye movement desensitisation and reprocessing (EMDR) amongst many other approaches. These psychological models will often help you to understand your difficulties and teach you active strategies to help move you towards change. Many clinical psychologists may ‘integrate’ different therapy approaches in order to provide unique and tailored therapy according to client needs. Many people choose to see a clinical psychologist due to the breadth and depth of their training and the service they can provide as a result. Typically, clinical psychologists may provide an integrative active therapy which helps clients both understand their life and also helps to provide ‘tools’ to deal with this.
Clinical psychologists usually have the title ‘Dr’ meaning that as a minimum they are trained to Doctorate level (so they have both an undergraduate psychology degree then a postgraduate Doctorate in Clinical Psychology, often studying / training for at least 7 years not including essential clinical and / or research experience gained between their degree and Doctorate) and their training focuses on difficulties across all age groups and across various presentations and systems. Clinical psychologists are specifically trained in how to ‘formulate’ difficulties with their clients, in other words they use their knowledge of a wide range of different psychological theories and models to help them and their client understand how their difficulties developed and what is keeping them going amongst many other things. They are also trained in specific areas such as psychometric assessment, neuropsychological assessment and audit and research methods amongst many other areas.
What is a Counselling Psychologist?
Counselling psychologists are very similar to clinical psychologists in terms of the therapeutic work that they do and it’s often very hard to tell the difference as there can be variations depending on where the training took place. Most of the above points in the clinical psychology section also apply. Counselling psychologists are also trained to Doctorate level with the same amount of years of study and training taking place. They also learn about a number and variety of different therapy models that can be applied to a variety of clients and presentations with this also often being 'integrated', and they are also trained to 'formulate' difficulties with clients as outlined above. Training experiences can vary (e.g., there may not be core training in neuropsychological assessment but many later go on to study this) therefore there can often be differing points of view about what a counselling psychologist does and how it differs or is similar to clinical psychology. Therapeutically speaking though it can be quite hard to distinguish between clinical and counselling psychologists!
What is a Counsellor?
Counsellors tend to offer confidential ‘non-directive’ support meaning that they offer a therapeutic space to listen to your problems. This is often done in a less structured or active way with sessions tending to not have a specific plan or offering specific strategies but are instead more of a space to explore and reflect on your difficulties. This can be a very helpful process especially when you wish to talk through problems such as adjusting to life events, relationship problems, bereavement etc. Some counsellors are also trained in specific therapies however so it’s worth exploring what a potential counsellor can offer you. It’s important to note that things like befriending, mediation, mentoring and coaching differ from counselling as they don’t have the same training or structures regarding confidentiality and boundaried time frames.
Training pathways to be a counsellor vary widely. Since the term ‘counsellor’ is not a protected title and does not have compulsory training or qualifications, you can technically call yourself a counsellor even with as little as a few weeks training (see info about ‘protected titles’ below!). However, the BACP (British Association for Counselling and Psychotherapy) have their own standards which involves training over 3-4 years and the minimum of a diploma in counselling or psychotherapy.
What is a Psychotherapist?
The term ‘psychotherapist’ is often used to describe therapists who use a particular model of working called psychoanalysis (or ‘psychodynamic psychotherapy’) with this normally being a more in depth longer term therapy. This often involves frequent and long term exploration of how childhood experiences have impacted on the way a person relates to others and themselves, both consciously and unconsciously. This is often done in a non-structured way, reflecting on patterns and emotions that occur in therapy as well as in the clients life outside therapy. Psychoanalytic / psychodynamic psychotherapists usually have an undergraduate degree and often have previous experience in a career working with mental health. They then undergo a further 4 years of training which must be approved by the International Psychoanalytical Association (IPA) and in the UK The Institute of Psychoanalysis / British Psychoanalytic Association (BPA).
Very confusingly, the term ‘psychotherapist’ can also be used as a catch all umbrella term for practitioners who do any sort of talking therapy and can often refer to anyone who is trained to help people deal with emotional and mental health difficulties within a therapeutic framework. Many counsellors, CBT therapists and others may refer to themselves as ‘psychotherapists’ so it’s important to check out exactly what they mean by this term. If you are in any doubt about what someone does, please just ask a prospective therapist to explain how they usually work.
What is a Psychiatrist?
Psychiatrists are firstly trained in a 5 year undergraduate medical degree (so have the title 'Dr') and they then specialise in working with mental health / psychiatry over a further 3 years on average, with this comprising core psychiatry training and then speciality training. Given that they are primarily medically trained they are able to prescribe medications to clients with this being one of the main differences between psychiatrists and other therapists. In addition to their medical training, many psychiatrists may also be trained in ‘talking therapies’ including cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), cognitive analytical therapy (CAT) and so on. If you are looking for a someone to have ‘talking therapies’ with, it is important to ask any prospective therapist what therapies they are trained in and how they may be able to help you. Psychiatrists also often have a lead role in multidisciplinary team working and when working with clients who present with significant risk or more severe difficulties.
These are the main types of therapists that people may have heard of and hopefully their roles are now a bit clearer and will help you decide on what sort of professional you may wish to contact.
One final but very important note though is:
Be aware of who is properly qualified and regulated and who is not!
It is important to note that terms such as ‘clinical psychologist’, ‘counselling psychologist’, ’health psychologist’ amongst other titles are what is called ‘protected titles’ by their regulatory body The HCPC (Health Care and Professions Council). This means that by law only people fully trained and qualified in that specific profession can use that title. Most people don’t realise that the terms ‘psychologist’ ‘psychotherapist’ and ‘counsellor’ on the other hand are not protected titles. This may surprise you but this basically means that anyone can call themselves these titles! Thankfully the vast majority of people who use these terms are suitably qualified BUT there are some who aren’t. The amount of times we have had Wowcher deals drop into our email inbox advertising CBT and counselling courses for the great price of ‘£29 REDUCED FROM £524! LIMITED TIME ONLY!’ (this being an actual real email we have received) really concerns us and it is often really hard for the public to know how to spot someone who is appropriately trained and someone who isn’t. There are also some ‘therapists’ who promise the world and more and use non evidence based ‘techniques’ that are very questionable. If you get a feeling that a prospective therapist is promising all sorts and in a way that makes you feel in any way uncomfortable whatsoever then it’s probably best to steer clear! If you have serious concerns you should report them to their regulatory body.
In order to make sure you know your therapist is appropriately trained, qualified and regulated, don’t be afraid to ask them and you can also check with their regulatory body that they are registered. The HCPC has a list here that lists regulated professionals and the BACP has this list to check CBT therapists and counsellors, in addition to the BABCP. COSCA is another regulatory body which is often used for counsellors and the General Medical Council (GMC) has a register for regulated psychiatrists. At The Wellbeing Rooms, we ensure that anyone applying to offer their professional services from The Wellbeing Rooms is appropriately qualified and regulated, with this being important in order to provide a transparent and professional service to the public. Further information about the professional standards that are essential when working in private practice can be seen on this previous blog.
Thanks for reading and we hope you’ve found this blog to be informative and it can help you think about what sort of therapist might suit you best.
All the best!
Jo, Jan & Catherine @TheWellbeingRooms