The terms counseling and psychotherapy sometimes cause confusion - for both professionals and lay people. What are they? What's the difference?
Steadman's Medical Dictionary defines psychotherapy as:
treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication with the patient, in contrast to treatments utilizing chemical and physical measures.
and it defines counseling as:
A professional relationship and activity in which one person endeavors to help another to understand and to solve his or her adjustment problems; the giving of advice, opinion, and instruction to direct the judgment or conduct of another.Stedman's Electronic Medical Dictionary, 1994
These definitions help draw a clear distinction, but they don't really capture the essence of either procedure, psychotherapy in particular.
Lewis Wolberg, in his massive work The Technique of Psychotherapy, provides us with this definition:
Psychotherapy is the treatment, by psychological means, of problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the object of (1) removing, modifying, or retarding existing symptoms, (2) mediating disturbed patterns of behavior, and (3) promoting positive personality growth and development. (Wolberg, 1977)
The first recorded psychotherapy patient is referred to as "Anna O." She was treated by Josef Breuer through a "talking cure" in the early 1880s. Breuer told his friend Sigmund Freud about the technique, and he later adopted it with some of his own patients.
Freudian psychoanalysis has been criticized by many because of its tendency to create long-term dependent relationships. Psychoanalysis attempts to "get to the root of the problem" by analyzing the "transference" relationship which develops between the therapist and patient. This is a lengthy process, typically taking several years. There are some recent models of psychoanalytically-oriented brief therapy. The focus in these therapies is narrower, and the work focuses more on the problem at hand than on the root of the problem.
Other schools of psychotherapy have a different focus. Behavior therapy focuses on changing behavior. B. F. Skinner is sometimes seen as the father of behaviorism. Behavior modification focuses on setting up rewards and punishments in order to shape someone's behavior. Behavioral treatment can involve relaxation training, desensitization of phobias and biofeedback.
Cognitive therapy seeks to help people change how they think about things. Albert Ellis's Rational Emotive Behavior Therapy is an example of this. Ellis considers strong emotions to result from an interaction between events in the environment and beliefs and expectations which we have. Some of these beliefs are too strong or rigid (such as the belief "Everyone should like me."). The patient or client learns to modify the belief so that it is less extreme and less likely to get in the way (such as "I like for people to like me, but I realize that not everyone is going to.").
Much psychotherapy is not limited to a particular school. Many therapists are trained in several different approaches. They then take techniques from these approaches which fit their own style and personality. It has been difficult to research the effectiveness of psychotherapy, since the term can refer to so many different activities. It is often used along with medications to treat mental disorders.
There are many other ways to look at psychotherapy. Psychotherapy consists of two (or more) people sitting in a room talking. At least one of these people is trained in helping people change. At least one has something about their life that they want to change.
- Stedman's Electronic Medical Dictionary, New York:Williams and Wilkins Co, 1994. (based on Stedman's Medical Dictionary, 1990)
- Wolberg, Lewis R. (1977) The Technique of Psychotherapy. New York: Grune & Stratton, 1977, p3