What’s the difference between a counsellor and a psychotherapist? This may sound like the first line of a joke, but there is a great deal of confusion about the distinction. The terms are often used interchangeably and even if distinctions are made there is still a great deal of overlap. For many – therapists included – the terms mean one and the same thing; for others – again, therapists included – there are differences. The distinction is further complicated by variations in British and American interpretations.
A number of professional texts suggest that if a distinction is to be made this should be by reference to the settings in which the practitioners work. In practice, because of how the counselling profession has developed, this distinction would place counsellors in the so-called front line, dealing with various ‘problems in living’, with psychotherapists acting more as specialists and often taking referrals from other professionals.
This type of distinction is based on the fact that, generally speaking, counsellors draw on a range of theoretical approaches (cognitive behavioural, person-centred, solution-focused, etc.), as is reflected in their training. Because counsellors have this range of approaches available to them they are able to work relatively flexibly. But this doesn’t stop a counsellor describing him or herself as, for example, a bereavement counsellor or a couples counsellor because such descriptions express the sort of client situations with which they work.
A psychotherapist, in contrast, is more likely to be dedicated to a key approach or ‘core orientation’, such as psychodynamic or cognitive-behavioural therapy. So psychotherapists may receive referrals from GPs or counsellors where a particular specialism is considered appropriate for a client’s needs. Because psychotherapists are more likely to specialise it is less common for them to place the same emphasis as counsellors on a client’s social context or wider circumstances, although that is not to say that such factors aren’t taken into account.
But remember, in practice these are not hard and fast rules. Where some see differences others see similarities and many say that their respective approaches are converging anyway.
It should also be kept in mind that neither term is legally protected or restricted. In other words anyone can call him or herself a psychotherapist or counsellor. This makes it essential for potential clients to check that a therapist is recognised by and registered with a reputable industry association. Such association will preferably be on the accredited register of the Professional Standards Authority (look for the logo).
Whether the terms ‘psychotherapist’ and ‘counsellor’ should be legally protected is another matter and has been a point of debate for a long time. Those in favour of legal protection argue that it would be a more effective way of protecting clients from potentially damaging practice. Those against argue that the prescriptive framework that would be necessary to support legal protection would stifle the creativity and diversity within the profession that up to now clients have found so helpful. Both arguments have their merits.
In this field, only the term ‘psychiatrist’ is legally protected (even ‘psychologist’ isn’t), since psychiatry is a medical specialty. Descriptions of all four terms are outlined on the Counselling Directory website.
 McLeod 2009, 663/4; Mearns & Thorne 1999, 3; Atkinson et al 1993, 672