Counsellor, Therapist, Psychologist, Psychiatrist - What’s the Difference?

Full disclaimer: This article is regarding Australia and written by a ‘counsellor & psychotherapist’ who has worked in collaboration with all the later mentioned mental health professionals.

Titles in mental health are confusing

If you find the many different professional titles within mental health to be confusing, be assured that the nuances are sometimes unclear even for someone in the industry. In this article, I aim to explain the differences between these titles and how a patient might choose who to work with.

What can each type of professional do?

Perhaps the clearest way to begin delineating among clinicians is based on the services that each offers. For that, see Table 1 below which shows that: all the mentioned professionals *may* offer talk therapy, only psychologists and psychiatrists formally diagnose conditions, and only psychiatrists prescribe medication. This serves as a quick guide of which professionals one might inquire with depending on the services they are seeking.

Table 1: Comparing mental health roles in Australia.

So how do I choose who to do therapy with?

It’s also clear from Table 1 that multiple types of professionals can offer the services of talk therapy and diagnosing conditions.

So using talk therapy as an example, a patient might wonder ‘How do I choose who to do therapy with? Given that every type of professional can offer therapy?’ In my view, there might be a few key considerations.

• Individual fit: It’s important to first say that every professional works differently, i.e. any two psychologists would work differently despite both being psychologists. Along these lines, it may be useful to evaluate each professional as an individual person rather than based on their title alone.

  So a patient might consider if they would feel comfortable, understood, and helped by a specific professional. This judgement might be based on the clinician’s online presence, customer reviews, or an introductory phone call if offered. This is highly subjective of course, so what else might help?

• Therapy ‘style’: Although there is *very* significant cross-over among the ‘styles’ of therapy that each type of professional offers (and hence why individual fit is important as mentioned above), there are some general trends within each group.

  • Counsellors or psychotherapists lean more towards a more ‘relational’ style that emphasises the importance of a safe space and relationship with the patient.

  • Social workers are trained in systemic approaches and may be well-suited to clients who are constrained by their circumstances (i.e. housing insecurity, lack of social support).

  • Psychologists study mental health as a scientific discipline and hence place emphasis on therapy styles with more scientific evidence, such as cognitive-behavourial approaches that focus on understanding and modifying unhelpful thoughts & behaviours.

  • Psychiatrists may not always offer therapy as a primary service, as many are more focused on medication. Those that do may lean towards similar styles as psychologists.

• Presenting concern: Although not always the case, psychiatrists and clinical psychologists may have more experience working with clients who have ‘severe’ or ‘complex’ mental health conditions like schizophrenia or bipolar disorder, as a virtue of their training programs.

• Finances: Generally the services become more expensive when going downwards on Table 1. When comparing rates, note that working privately with counsellors or psychotherapists is not eligible for a Medicare rebate, unlike for the other listed professions.

• Availability: Psychiatrists generally have longer waiting times as compared to the other professions.

I hope this framework is a helpful starting point for clients who are considering therapy.

A necessary note: Counsellors & psychotherapists are not government-regulated

Aside from the above, I find it necessary to note that currently counsellors & psychotherapists are the only title mentioned herein that is NOT directly regulated by the Australian government. This is slowly changing. But it does mean that any person is legally able to call themselves a counsellor, therapist, or psychotherapist. Today many counsellors and psychotherapists self-register with a professional association - typically ACA or PACFA - which require members to have relevant training & expertise, which may be useful information for potential clients to consider.