Types of Counseling

 

By Bill McDonald

The terms Therapist or Counselor have different meanings, often depending on the background and training of the professional you're dealing with. Here is a list of some standard terms for the people and the processes - and a description of what they each mean.

I. The People who do therapy:

Psychiatrist:

A psychiatrist is initially trained as a Medical Doctor (M.D. or D.O.). After their medical training, they obtain additional training through a psychiatric residency or training institute. Today’s psychiatrist is most highly specialized in the use of medication for the relief of psychological problems. Some psychiatrists deliver direct one-to-one psychotherapy services, but they most commonly have their expertise these days in the management of medication.  A technical name for this is “psychopharmacology.” 

 

Psychologist:

A psychologist has a doctoral degree in psychology, hence the “Ph.D” after his or her name. There is a movement these days to allow psychologists also to prescribe medication to their patients. However, their specialty is usually in the area of psychological testing or the direct delivery of one-to-one psychotherapy services.

Social Worker (That’s how I am licensed, so I may have some prejudice here):

A Social Worker usually has a graduate degree in Social Work - the most common being am MSW (Master’s in Social Work). Social workers generally work in one of two primary settings - agency or clinical work. The original social workers were mostly professionals who worked among the poor or disadvantaged population of society. And most social service agencies still use social workers both for direct delivery of care and for administrative work. Our training makes us excellent in both areas. However, because we are trained in the awareness and intervention in larger social systems, we are also excellent in a clinical setting. In most psychiatric clinics, the majority of actual clinical care is given by social workers. A psychiatrist will often head or “own” a clinic, and provide medical (medication) supervision for all the other workers. Some psychologists are usually on staff, but the majority are social workers.

One of the “advantages” of hiring a social worker, other than that they can make excellent therapists, is that they are cheaper (which means that insurance companies can pay them less). When I’m in a testy mood, I’ll often describe psychiatrists as primarily “pill people” who memorize pharmaceutical manuals, psychologists as people who learned their skills primarily from have studied the behavior of “rats” in graduate school, and social workers as people who have studied what happens in city slums and ghettos. The general income level follows the same progression. Social workers are at the bottom - and know from the outset they will never get rich doing therapy. If they want more money, they have to go into administration work and supervise their poorer colleagues. They can also go back to school and get a PhD (or M.D.).

 

II. Now for a list of the kinds of therapy available, and the language of kinds of therapy:

Therapy.

This is a word that essentially means the treatment of bodily, mental, or behavioral disorders by the use of remedial agents or methods that provide or assist in a cure. So it assumes there is something wrong, or at least not right with a person – and a therapist then offers skills to help make it right for the person. (As a social worker, that can include a couple, family, organization, or other social system.) My own interest and study of systems theory (Google that if you really want to know more) has helped me to understand or “map” what goes on inside a person, as well as what goes on in a larger ‘system’ like a marriage or family.

Psychotherapy.

This word basically means the same as “therapy.” However, it helps focus the work on the ‘psyche’ of the individual, hence it’s slightly more specific in focus. However, in the State of Michigan, any advertising that uses the work “psych-” in it is reserved for licensed Psychiatrists and Psychologists. Social Workers can use it if they are working in a clinic setting where there are under the supervision of a psychiatrist or psychologist. Since I have a purely private practice, I cannot uses the term. I can (and I do) do it, I just can’t advertise it. And I have no essential argument with the State of Michigan for protecting the term.

Counseling.

Generally, “counseling” means giving advice that is specifically tailored to the client’s needs or situation. (This is the same sense as an attorney being a “counselor at law”). It assumes (1) the client’s ability to act on that advice, and (2) a professional setting for such a consultation. Merriam-Webster (11 th Collegiate Dictionary) spells it out further: It is “professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes.” This is technically distinct from Psychotherapy, which is often the assisting the client or patient who has a functional inability to act or think in certain situations, so that whatever is psychologically blocking the person can be encountered and hopefully removed.

Analysis or Psychoanalysis.

These terms refer to the method of analyzing psychological phenomena and treating emotional disorders, which involves treatment sessions during which the patient is encouraged to talk freely from his or her deep experiences, and with feedback from the analyst that encourages and enlightens this process. Classical analysis (generally beginning with Sigmund Freud) involves the analysand (the technical word for the one being analyzed) talking freely about personal experiences and often focusing on early childhood and dreams. I have specific clinical credentials to do analysis in a field called Transactional Analysis.

Psyche.

This term used by some analysts to refers to the soul or personality. Technically the word is directly translated as “soul” - not in the common religious sense, but in the sense of a person’s vital essence or deep self. Different schools of psychology use this term somewhat differently. The word “psychology” basically means “the (understanding, or logic) of the psyche. 

“Patient” or “Client”

In what is commonly called the “medical model,” the term patient is most commonly used. It assumes (though it is by no means still completely operative) that the “doctor” is the one who “does something” and the “patient” is the one who (passively) has “something done” to him or her. The term client, however, assumes a greater parity between the professional and the person seeking assistance. Lawyers use this language. And it is the preferred language of the social work community as well. It has the benefit of assuming the person being worked with is a full partner in the process.

Private Practice.

Many clinicians will say they have a private practice while working within a psychiatric or psychological clinic. This may include psychiatric supervision or not, depending on the structure of the clinic and the contract with the particular therapist. However, a pure private practice is just that. It is a solo practice, legally and structurally independent of management or supervision. That is what I have had since 1977. If I want or need outside management or supervision, or other resources, I contract for them independently. If I need the assistance of a psychiatrist or psychologist, I have resources with whom I have a private agreement or contract for those purposes.

Bill McDonald