Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Saturday, February 14, 2015


In response to my post, GASP!, a friend sent me some links to articles about acupuncture. Specifically, acupuncture was compared with counseling and treatment as usual for depression.

What is "counseling"? I've heard the word used any number of times, and I think I just assumed that it's what people say when they don't want to say "therapy", because they think "therapy" sounds too stigmatizing. Or it's therapy as practiced by someone not specifically trained in therapy,  per se, like the clergy.

But maybe not. Is it therapy? A specific kind of therapy? How does it differ from therapy, if at all? Who practices it, and why are they called counselors rather than therapists? Why would someone want counseling rather than therapy?

I Googled "What is counseling", and I got some interesting links.

There's the American Counseling Association, which offered this definition:

Professional counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. 

They provide further detail:

Counseling is a collaborative effort between the counselor and client. Professional counselors help clients identify goals and potential solutions to problems which cause emotional turmoil; seek to improve communication and coping skills; strengthen self-esteem; and promote behavior change and optimal mental health.

Okay, so counseling is some kind of professional relationship involving mental health.

According to the site, there are 4 different types of counseling: Individual, Couples, Family, and Group. There's a little blurb about each of these, and interestingly, the Family blurb, but none of the others,  uses the word, "therapy".

There are a number of counseling specialties, including but not limited to:

Career and employment
Adult Development and Aging/Gerontology
LGBTQ issues

and something called, "Assessment". When I clicked that link, it explained:

Counselors, educators, and other professionals advances the counseling profession by promoting best practices in assessment, research, and evaluation in counseling. Assessments are a systematic way to obtain information about the client’s problems, concerns, strengths, resources and needs.

Does this mean some counselors specialize in taking a history? I can't tell.

There are state licensure requirements. There are also 2 certifying boards, although certification is not required.

The National Board for Certified Counselors requires passing an exam, the National counselor Examination (NCE).

It also requires:

-Master’s degree in counseling or with a major study in counseling from a regionally accredited institution
-3,000 hours of counseling experience and 100 hours of supervision both over a two year post-master’s time period
-Post-master’s experience and supervision requirements are waived for graduate students who have completed CACREP accredited tracks.

I don't know what those tracks are.

The Commission on Rehabilitation Counselor Certification (CRCC) is the other board. It has its own exam, and a number of ways of meeting eligibility criteria for certification, which seem to involve supervision, work experience, a Master's or Doctoral level degree in Counseling or Rehab Counseling, or an advanced degree in one of 13 areas:

Behavioral Health                         Psychology
Behavioral Science                       Psychometrics
Disability Studies                          Rehabilitation Administration/Services
Human Relations                          Social Work
Human Services                           Special Education
Marriage and Family Therapy         Vocational Assessment/Evaluation
Occupational Therapy

I still don't understand the difference between counseling and therapy. I found a site with a piece called, "Psychologist v. Counselor". It claims that:
-Counselors usually have a master's level degree, and generally don't do research, or perform psychometric testing, though some get further training to so they can.
-Some psychologists get licensed as counselors.

Psychologists are more likely to work with individuals with serious mental illness. They are trained to perform psychotherapy with a range of clients, but in many settings, general therapy roles will go primarily to counselors and other master’s level mental health practitioners. The reason? These individuals are more cost effective.

Bottom line: I still don't know what counseling is. It seems like "counselors" have a certain type of training, +/- certification, with varying backgrounds and degrees. But what they do remains a mystery to me, although it sounds like therapy.


  1. You get a lot of it right--a word people use when they don't want to say therapy is often the case. Rehab counseling is usually a little different.

    Sometimes--depending on who does it--rehab counseling looks a lot like psychotherapy, but it's also about teaching basic skills, e.g. how do you use an ATM machine, how do you balance a checkbook and how can you use techniques to get around psychiatric barriers which get in the way of functioning. Job coaching is also a big part of it. I tend to think of it as more "practical" and kind of pedestrian compared to psychotherapy.

  2. Close attention to the terms helps sharpen the difference, I think. A counselor counsels, i.e., advises, directs, encourages, coaches, etc. A camp counselor helps kids enjoy the outdoors and have a good time; a job counselor helps job-seekers hone their search and clarify their goals; a pastoral counselor helps people articulate religious views and may recommend scripture or other reading. Psychological counseling at times comes close to "supportive psychotherapy" but starts from somewhat different premises. A counselor lends an ear, provides feedback, offers educated opinions and guidance, and (as the ACA says) "seeks to improve skills."

    "Therapy," in contrast, means to remedy a condition. Physical therapists remedy physical conditions. Occupational therapists remedy impairments that interfere with work. Psychotherapists remedy psychological problems, using psychological techniques. The fundamental aim of any therapy is to improve something that is amiss. Although the terms are sometimes used interchangeably, I believe this reflects at least a minor misunderstanding about what they mean.

  3. Great post! I also agree with Dr. Reidbord's comments. Essentially, counselors are therapists with a different connotation. "Counseling" seems to imply that a "normal" person needs help with problems of living, whereas "therapy" seems to imply that an "ill" person needs help recovering.

    I was curious about the education and training of many mental health professions and wrote this post: http://neurotransmitting.com/six-popular-mental-health-professions-explained/.

    One that I omitted was the psychiatric occupational therapist. There is much overlap there with the work of a counselor, as well as the tie to resources of a social worker.

    Essentially, there are many "helping professions" that independently developed evolved. They created standardized education and certification. They also created their own societies to promote the growth and health of their professions. Naturally, many of these groups converged on mental health care and have all tried to find a niche in caring for the mentally ill. Mental health delivery is rich with resources, but also confusing and redundant at times.