How to Find a Counsellor Part 2: What is the Difference Between a Counsellor and a Psychologist?

So, you’ve decided to seek help for an issue that is invading your life and causing disruption and distress. You’re feeling more confused than ever. You may also be seeking the answer to the following question I get asked a lot:

What is the difference between a counsellor and a psychologist?

The simplest way to distinguish the difference between a Counsellor and a Psychologist is by definition. These are provided by the ACU, a university that runs courses in both:

Psychology studies the human mind and behaviour. Studying psychology provides students with a comprehensive understanding of behavioural and mental processes.

Counselling focuses on client’s concerns and difficulties and includes understanding people’s patterns of thoughts, behaviours, feelings and the ways in which these may be problematic in their lives. Studying counselling involves learning how to assist people to develop understanding about themselves and to make changes in their lives.

What does these difference between counsellors and psychologists in Australia mean in real terms?

To expand, I would say that Psychology training focuses primarily on understanding, analysing and diagnosing mental health issues. Counselling training focuses primarily on skilfully listening to people, and then using those skills to explore possibilities in helpful ways via reflections and questions.

What is the difference between a counsellor and a psychologist? Do they already seem kinda different so far?

The language is vastly different and describes two entirely different ways to approach problems. However definitions may not mean much in terms of actual practice.

A psychologist may decide to enhance their counselling skills with studies in psychotherapy. A counsellor or psychotherapist may decide to complete studies in psychology in Australia so their clients are eligible for the Medicare Mental Health Plan rebate (see more below). So you kinda need to do a lot more research to find out if the person you’re going to see has the right skills and personality that suit YOU.

Therein lies the crux of the issue in understanding our mental health system. By attempting to medicalise mental health (for which we have some concerning outcomes), the system has made a lot of us feel totally powerless. We feel we need someone to ‘diagnose’ us to manage problems of the mind, heart and with the society we live in. We’re forced to look for answers in a simplistic system that doesn’t account for the ‘un-box-tickable’ experiences of the human condition.

The truth is you might be a lot more powerful than you have given yourself credit for.

Well that’s great, but I’m in mental distress and looking for help…?

Ok ok, let’s break it down.

1)When you see ads on TV regarding mental health or start Googling, the first point of call recommended is usually your GP. In our culture, doctors are generally given the authority to know everything about health regardless of actual expertise in specific areas. I question the wisdom of this pathway, particularly when it comes to mental health.

Some food for thought… Consider that the average doctors appointment is 15 minutes long, and how little mental health training is included in a medical degree. Surely that’s not comparable to a longer conversation with a qualified counsellor or a psychologist who has 3+ years of specific mental health training minimum?

Also, a mental health professional will often suggest you see a doctor, or refer you to one who is known to be good with mental health if they think you might need it. So it can work the other way around, and you have the added comfort of knowing you’re likely to see a GP who understands mental health.

2) When you go to the GP and raise a mental health concern, you will generally be asked 10 questions from a very basic assessment form called a DASS. This is gauge your ‘level’ of mental illness and distress. The GP may or may not take into account much of your personal circumstance other than what you say on the DASS, depending on their own experience and comfort levels with mental health.

• If your mental distress is assessed as acute/very high or crisis level, you may need immediate support. You may also be linked in with a psychiatrist who can manage mental health medication.This can be a positive experience, though it doesn’t necessarily sound like it, because it’s better not to wait when it comes to this stuff.
• If it’s assessed as somewhat moderate-high (this is most people) you may be given a Mental Health Plan (now called the Better Access Initiative) and perhaps a referral to a registered psychologist or a social worker. Sometimes this occurs on top of prescribing medication such as anti-depressants, even if there was no in-depth discussion about your circumstances. Sometimes you may even be talked into taking medication even if you say you don’t want any.

3) Job done! You can begin your ‘treatment’. After some medication and 6-10 sessions you’ll be well on your way to happiness and normality.

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I know for a lot of people this process takes a weight off their shoulders, and I completely understand that: “What a huge relief. I want the pain to end and someone is going to take care of it”.

For some folks it really works and that’s brilliant.

It’s also brilliant that people with more ongoing severe mental health concerns can get the help they need from medical professionals.

However, if it worked that easily for everyone, we wouldn’t have such high levels of mental health struggles such as anxiety, depression etc.

The reality of the Australian mental health referral system can be not-so-great for many people

It makes me sad to continually meet people who are bewildered and devastated by the fact that this process didn’t solve the issues they were being paralysed by. It didn’t lead to the relief and long-term benefit they were hoping for, and ultimately just didn’t help.

For starters, anti-depressants aren’t magic happy pills and shouldn’t be promoted as such. Medication should always come with a thorough explanation of what to expect and the potential benefits and side-effects. There should also be an understanding that finding the right medication involves some experimentation and ongoing support with an expert. Medication is not a quick-fix.

And a psychologist who practices Cognitive Behavioural Therapy (CBT) and/or mindfulness will be a perfect fit for some people, but not so much for many others.

For many people it’s not really the right pathway. That might be largely because they weren’t really consulted. It might also be because the intervention was not culturally appropriate for them, or not suited to them or their situation as an individual.

If it didn’t work for you, you are not broken! Maybe the system is the problem.

What’s a Mental Health Plan and why is there a problem with it?

• A Mental Health Treatment Plan allows you to receive a number of subsidised therapeutic sessions with a Psychologist or a Social Worker. So you might be able to have some sessions with a professional who—for example—normally charges $250/hour for only $95/hour, because Medicare will rebate you the remainder amount. Which is awesome, and a very positive thing about the Australian system.

Limitations with this system:

• You may not be referred to someone who really suits you and the problems in your life.
• You only get 10 sessions per calendar year. That is 10 maximum hours of therapy. So you might want to ask yourself ‘Can I afford the full price of this professional once my sessions are used? I may not need more than 10, but if I do is it in my budget?’ or ‘What if the Government reduces the amount of sessions per year for a Mental Health Plan in the middle of my work with someone [this might happen, it already has]? Will that be a problem for me?’
• Counsellors and psychotherapists are not providers under the Mental Health Plan which means a GP will usually not refer you to one, no matter how amazing they are (unless they are also a registered psychologist or social worker).

That is because counselling in Australia is unregulated. This means any old joe can say they are a counsellor and it is legal to do so. Whereas it would be illegal to say you’re a psychologist, social worker or doctor if you are not qualified and registered to practice.

I really hope this changes in the near future, as many of us counsellors have chosen our pathways for a reason and we are highly qualified, experienced and committed to helping people.

On the plus side:

It could also be argued that some countries over-regulate counselling, and that the testing required for registration might leave out a wonderful mixed-bag of practitioners from diverse backgrounds and cultures. Being booksmart and/or having the money to get a degree have nothing at all to do with this work.

Our qualifications can be colourful, creative, culturally diverse, and unique with years of evidence behind them (think of Art Therapy, Gestalt Therapy, Hakomi, and varying other psychotherapies including my own Narrative Therapy Masters Degree through Melbourne University). There’s enormous scope for you to find someone who will totally get you.

The issue with the Mental Health Plan pathway is that you may then not be inclined to look beyond the referral from a GP, when a qualified counsellor or psychotherapist who specialises in your area of need might actually be what you are looking for and desperately need.

An extra word on fees…

• There is an enormous range in the fees charged by private Counsellors and Psychologists. Generally speaking, fees could be anywhere from $150 – $350/hr. Most professionals set their own fees. What you choose to pay is really about how much you can genuinely afford, and how much seeing the right person means to you and is helpful to you (which is kinda priceless TBH).
• Some parameters around what therapists’ base their fees on are: how experienced and qualified they are, what they need to live on, how much it costs them to provide the service in a particular location, time for research and admin, and keeping up with professional development and supervision requirements. There’s a lot going on outside of just you and them sitting in a room together.
• Do not assume because it’s free that it’s not good. There are free or heavily subsidised services out there. Quite a lot of private practitioners also work part-time in free services. If you think about why we might go into this kind of work, that won’t surprise you. Also, when we are applying for a job in a service we have to be qualified and clients should be notified if a counsellor is ‘new’ or an intern. Newbies ought to be receiving extra supervision from an experienced practitioner. The organisation did the pre-interview for you!
• However, you also may have to go on a wait list, you may have to prove you have a low income, you may only be allowed a few sessions, you may have to travel and fit into limited time slots in business hours, and you might not get much choice in who you work with. Them’s the breaks with stuff that’s free.

You are entitled to ask questions about therapists located at any service though: even if it is free you deserve quality.

• If you can afford it, isn’t it worth budgeting and paying for the RIGHT person for YOU? We think nothing of spending $160 on an extra pair of shoes, a 5th electronic device, a new doona cover,  a night in a hotel, or other ‘needs’ that provide a temporary good feeling. Imagine the real permanent difference a commitment to some time in counselling can make to your entire life.

Ultimately though, the most important piece of information is this:

When it comes to your life and your mental health, You are the expert of You

What if the Mental Health Plan and overall medical approach outlined above doesn’t sound like it would suit you, or you’ve been down that road before and it hasn’t helped? Or perhaps you’ve used up all your subsidised sessions and feel at a loss as to where to turn next. Don’t worry, I’ve got your back.

We are invited to hand over our power to so many people every single day in many different ways. Counselling is a space in which you should be compelled to recognise your own power. It needs to makes sense to you and you need to feel genuinely heard, have some hope your counsellor can help you, respects you and the effort you’ve put into living your life and managing the problems that have arisen.

That’s the kind of gold dust I try to incorporate into my work as a narrative therapist. I’ve been very fortunate to receive positive feedback from clients over the years, so I know for a fact that even if the system hasn’t worked for you yet doesn’t mean counselling can’t.

If you’re intrigued and want to know more about how to find the right counsellor for you, Part 1 of this blog post might be just what you need.

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Have you had an experience of the Australian mental health system, or the difference between counsellors and psychologists you’d like to share?

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