There has been considerable professional debate, in the United States and elsewhere, regarding the precise nature of the functions and roles fulfilled by counselors, therapists, psychotherapists, and others who provide mental health services. Professionals using different names, such as counseling psychologist, counselor, and therapist, are viewed quite differently by the lay public. Much of the confusion centers on who provides what services, in what contexts, and to what end or goal.
A common differentiation is that counselors concern themselves more with normative stresses, adjustment difficulties, and life transitions, whereas therapists focus primarily on mental illnesses and psychological disorders. A more comprehensive view recognizes the extensive overlap in the work of the professionals using these designations, while, at the same time, acknowledging differences in the relative emphasis they afford to some issues. Increased clarity in this regard can facilitate an enhanced sense of professional identity for mental health practitioners and greater awareness among consumers of mental health services.
Counselors and Therapists: Similarities and Differences
A crucial question underlying this issue is whether the type of work performed by the various helping professionals (e.g., counselors, therapists, and clinical social workers) is essentially the same, or whether each “camp” has a unique contribution to offer when assisting clients with their problems. There have been many attempts, at times highly politicized and market driven, to articulate the services provided by the various mental health professions. These attempts have escalated, as the historical progression of these specialties has proceeded and as these groups have sought to professionalize their services. Thus, whereas some impart a distinct meaning to the term counseling or therapy, others use the two terms more or less interchangeably.
The basic roles and functions of helping are by no means new phenomena. The desire to help others with their personal and emotional problems has a long history that can be traced to ancient western and non-western civilizations and that entails the use of very diverse methods. As noted by Colin Feltham, some of counseling’s “cousins” include advising and influencing; friendship; co-counseling; teaching and coaching; consciousness-raising; self-analysis and self-help; psychotherapy; the application of basic helping skills by social and welfare workers, probation officers, nurses, and occupational therapists; and other charismatic and fortuitous encounters (e.g., religious conversion) that may lead to healing or change. However, the more formalized or stylized practices of modern counselors and therapists have developed separately and under different sets of influences that initially shaped their functions in somewhat divergent ways.
Perspectives Emphasizing the Distinctiveness of Counselors and Therapists
Use of the term therapist (or psychotherapist) to denote a helping relationship in the form of a “talking therapy” can be traced largely to the work of Sigmund Freud and his pioneering of psychoanalysis around the dawning of the 20th century. Thus, therapists preceded counselors in the establishment of a professional identity and came to enjoy some recognition and status among the medical establishment of psychiatry. Counseling, in contrast, is a more recent label first applied to professional helping activity in the early 1900s by Frank Parsons who used it to characterize his vocational guidance movement. Then, in the 1930s and ’40s, Carl Rogers popularized the term when he sought to promote his person-centered helping techniques and to circumvent restrictions reserving the term psychotherapist for psychiatrists.
Because of their different origins, counselors and therapists have historically placed a different relative emphasis on certain key issues or concerns. Counseling came to be associated predominantly with the enhancement and promotion of optimal functioning and decision making among relatively normal individuals. Therapy came to be associated primarily with the remediation of actual mental illness or psychopathology. This early difference in emphasis also gave rise to a number of other perceived differences in the roles and functions of counselors versus therapists.
The work of a counselor is viewed as a shorter-term, developmental, cognitive or informational, surface-level, conscious-oriented, future-focused, acceptance-based, and positive enterprise for less-serious and extrapsychic problems. The work of a therapist, in contrast, is viewed as a longer-term, remedial, affective or emotional, in-depth, unconscious-oriented, past-focused, change-based, and pessimistic endeavor for more serious and intrapsychic issues. As suggested by the aforementioned list of adjectives, the word counseling is often associated with more humanistic perspectives, such as that of Carl Rogers, whereas the terms therapy and psychotherapy have sometimes been used to connote the psychoanalytic orientation of Sigmund Freud, and its derivatives. Correspondingly, therapists may be perceived as having more expertise than counselors, attributable to the common misperception that they undergo a longer and more intensive professional training that may include participating as a patient in psychoanalysis.
The recent proliferation of training programs and influx into the system of many different kinds of helping disciplines that seek professional recognition and the ability to be competitive in today’s market economy has stimulated a renewed focus on this issue. Discussions about the differences attributed to counselors and therapists have at times been framed as a debate concerning which of the two services is more helpful, prestigious, or generally superior. Some argue that counseling is a subcomponent of the more comprehensive set of therapeutic skills, and thus counseling should be subsumed under the term therapy. They view counseling and therapy as lying on a continuum, with counseling representing a more circumscribed or less intense process and therapy representing a more thorough or intensive process. Others view counseling as more comprehensive than therapy because of the inclusion of specific vocational, occupational, and educational competencies in counseling training that are lacking in other training paradigms. Changes in the training of therapists and counseling psychologists and in the provision of mental health services in the last two decades render many of these issues obsolete. Nevertheless, it is likely that some associations and expectations concerning the work of counselors and therapists still persist today.
Perspectives Emphasizing the Similarity of Counselors and Therapists
As the practice of counseling and therapy has progressed, one notable phenomenon has been the diversification of counselors into new and multiple settings, including hospitals, clinics, correctional institutions, and private practices. Some of these were previously viewed as the exclusive domain of therapists. Given these developments, many professionals today view the work of counselors and therapists as virtually indistinguishable. Recent empirical studies of the training and functions of helping professionals, the nature and severity of client issues, and the treatment goals and strategies emphasized by the practitioner reveal that there is no essential difference between what is referred to as counseling and what is referred to as therapy.
Future Directions
It would appear that there are more similarities between the work of counselors and therapists than there are differences, and that the differences between the two are relative rather than absolute. In fact, as pointed out by J. Vincent Peterson and others, proposed distinctions between the roles of counselors and therapists are likely to be rooted more strongly in the perceptions and expectations of the corresponding professional organizations or of the general public than they are in any actual rigid state of affairs.
Although there is a strong precedent for counselors as a group to focus more on mental health and therapists as a group to focus more on mental illness, this pattern will not necessarily hold true for any given individual who identifies as a counselor or therapist.
This extensive overlap has led some leaders to call for one unified type of helping professional, often referred to as a “psychological counselor,” rather than exaggerating rather minor differences into an ever-expanding array of competing specialties and subspecialties.
References:
- American Psychological Association, Division of Counseling Psychology, Committee on Definition. (1956). Counseling psychology as a specialty. American Psychologist, 11, 282-285.
- Crago, H. (2000). Counselling and psychotherapy: Is there a difference? Does it matter? Australian and New Zealand Journal of Family Therapy, 21, 73-80.
- Farwell, G. F., Gamsley, N. R., & Mathieu-Coughlan, P. (1974). The counselor’s handbook. New York: Intext Educational Publishers.
- Feltham, C. (1995). What is counselling? The promise and problem of the talking therapies. Thousand Oaks, CA: Sage.
- Gladding, S. T. (2004). History of and trends in counseling. In S. T. Gladding, Counseling: A comprehensive profession (5th ed., pp. 4-25). Upper Saddle River, NJ: Pearson Education.
- Peterson, J. V., & Nisenholz, B. (1999). Orientation to counseling (4th ed.). Needham Heights, MA: Allyn & Bacon.