A question that is commonly asked by clients is "what's the difference between a counsellor and a psychotherapist? Aren't you both the same?" The terms are often used interchangeably and synonymously but there is a slight and distinctive difference. Psychotherapy is often treatment-based in response to a diagnosable mental health issues including anxiety, depression, bi-polar disorder, borderline personality disorder, etc. It is often in-depth and used in conjunction with psychotropic medication; but this isn't always the case. Counselling, on the other hand, tends to be wellness oriented, providing increased insight and learning how to effectively overcome problems and challenges. Here are the definitions and differences:
- Counselling -
Counselling involves encouragement, problem solving, and the provision of information about emotional or social issues. It is characterized by empathy and the recognition of feelings. Counselling carries less emotional intensity, insight and depth than psychotherapy.
- Psychotherapy -
The assessment and treatment of cognitive, emotional or behavioural disturbances by
psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or
non-verbal communication. Psychotherapy focuses on the patient developing insight about thoughts,
feelings and behaviours to facilitate fundamental change in behaviour, thinking patterns, cognition,
emotional response, and social functioning. Psychotherapy concentrates on the patient’s emotional
problems for the purpose of changing defeating patterns of behaviour and re-organizing the patient’s
personality.
Despite the differences, the professional engaging in counselling or psychotherapy is often the same person. However, the approach to care changes when you reach the realm of treatment provisions. In other words, depending on what concerns the client is presenting with, would determine the best course of treatment and professional requirement. As the controlled act of Psychotherapy is now a regulated profession in Canada, a psychotherapist should have at least a Master Degree with experience with treating diagnosable mental illness. At a minimum, a new psychotherapist should have had training and underwent a supervised practicum. Speaking for myself, I completed my Masters degree in Counselling Psychology last year and completed an 8 month practicum, working with various mental health conditions and illnesses in a private practice setting. Post-grad, I've worked in hospital settings with both developmental and intellectual disabilities and severe mental health conditions to assess and recommend treatment options depending on a client's mental health severity and need.
When deciding whether you should reach out to a counsellor versus a psychotherapist, experience is the main factor to take into consideration. If you are experiencing symptoms or problems that are leading to a significant negative impact on one or more aspects of your life (i.e. relationships, work, health, etc) then it is important to get a referral or seek out a psychotherapist with the knowledge and skill to treat the problem. If you are experiencing challenges or a major transition that is affecting your mood and aspects of your life and you want to learn effective coping skills and gain insight into your thoughts and behaviors, than seeking out a counsellor is a worthwhile, short-term solution. When deciding to seek counselling or psychotherapy supports and services, it is important to do your research to make an educated decision. Below are some recommendations for you to consider when deciding whether to choose a psychotherapist versus a counsellor:
1. Level of Education & Training - Although both a psychotherapist and counsellor should have at least a Masters degree to practice counselling, it is important to ask them about their backgrounds of study. Depending on your presenting need, it's important to seek a mental health professional that has a level of education that meets your need. For example, a Bachelors degree in Psychology is a good go-to for basic education in developmental, educational, cognitive, and occupational psychology. When searching for a therapist, be sure to ask them the following questions about their education, if it's not already advertised on their website or Psychology Today page:
What degrees have you obtained to practice?
Do you have a Masters degree? If so, what was your specialty of education?
Have you completed a clinical placement? If so, how long and in what clinical setting?
Are you licensed with a regulatory college or a certified member of any organization/association to practice counselling/psychotherapy?
Do you receive supervision from an experienced psychotherapist with 5 or more years of experience?
Are you engaging in continuing education in a particular area of specialty? If so, which ones?
What are the specific areas of practice or theoretical modalities you work in regarding your treatment approaches?
2. License to Practice - To be a psychotherapist in Ontario, the professional must be registered with the College of Registered Psychotherapists of Ontario (CRPO) or other regulatory college that allows the provision and ethical practice of psychotherapy. Counsellors may registered with a separate college (aka: Certified Canadian Counsellor), but this does not give them ability to practice psychotherapy, as this is a controlled act in Canada as of January 2020. If you have decided that seeking a psychotherapist would be the most advantageous option for you, ensure that the professional you reach out to has the licensing ability to call themselves a Registered Psychotherapist. They will have a unique license number that you can use for private insurance or benefits coverage opportunities. The following are professional Colleges who's members are able to practice the controlled act of psychotherapy:
College of Registered Psychotherapists of Ontario
College of Psychologists of Ontario
Ontario College of Social Workers and Social Service Workers
College of Nurses of Ontario, College of Occupational Therapists of Ontario
College of Physicians and Surgeons of Ontario
3. Experience - Someone who is a psychotherapist would have most likely completed a practicum at some point in their educational career to obtain training hours and adequate supervision towards the license and/or certification. Supervision of a psychotherapist includes regular "check-in's" with a seasoned psychotherapist (with over 5 years of practical experience and training to be a clinical supervisor) to work through client cases that may have left the young psychotherapist feeling "stuck" or unsure of the best treatment approach or modality. To be a psychotherapist, professionals must obtain over 450 direct client contact hours and over 100 hours of supervision before being fully licensed. They also have successfully pass an ethics course and a licensing examination. The strict guidelines and experiential learning that is involved in being a psychotherapist is what makes their training essential and ultimately, beneficial for addressing mental health concerns through a psychological, social, and behavioural lens.
4. Session Rate - If you do a quick search on Psychology Today, a commonly used site for therapists, counsellors, psychologists, psychiatrists, and social workers to advertise their services to the public, you will see the price ranges for session fees. On average (in London, ON specifically as this is where I live and practice), session rates for psychotherapists in private practice range from $125-175 per hour. Session rates for counsellors range from $50-120 per hour. Session rates for psychologists are upwards of $200+ per hour. The main reason for session rate differences often comes down to level of education, years of experience, and licensing qualifications. The more experience, education, and licensing costs the professional has, the higher their fee. Please be mindful in choosing a therapist who sets their rates fairly and with respect to their clinical experience, education, and their licensing bodies. Keep in mind that a psychotherapist or counsellor doesn't bank 100% of the fee they charge per hour. Here is what therapists in private practice must take into consideration in setting their session rate:
Cost of maintaining your professional credentials — does your industry require you to pay membership fees to the provincial professional associations?
Cost of certifications, core, and further education — being a mental health expert requires continuous learning. Your outstanding student loans and costs of conferences and coursework are all necessary for staying relevant.
Your online presence, advertising & marketing — do you pay to be listed in a directory, pay for
online ads or need to pay for your website domain and graphic designer to maintain a personal website? Advertising isn't free so many providers choose to still remain relevant by keeping up with their private practice websites and blogs.
Private & practice insurance — this is anywhere from $250-600 per year.
Rent — whether you practice from home, a clinic or a shared office, each location comes at a price.
Transportation — some therapists must account for their expenses when commuting to their office or if they perform work in a client's home.
Extra & miscellaneous costs — phone and internet expenses, cost of office furniture and supplies, credit and debit processing fees, office computer programs and file keeping software, virtual therapy subscriptions, etc.
As you can see, setting a session rate is often multifaceted and requires careful thought and consideration. Since every psychotherapist and counsellors operates their business differently and from different locations, their session rates will differ from professional to professional. Ultimately, the professional has set their rate for a reason and after careful considerations of their own expenses and financial aspirations. Running a private practice is no easy feat and it can sometimes be a struggle to balance the professional hat with the business hat. We want to be helpers and support systems to our clients, but we also have bills to pay. Professionals may offer sliding scale or low-income rates to clients who express a need. This depends on the professional you choose to see and if they decide to offer this as an option.
I hope this post has helped educate you on some of the "behind the scenes" knowledge regarding psychotherapists vs. counsellors and what goes on when setting rates. To the general public, these professions appear one-in-the-same. However, it's important to be educated and informed on the choices you are making and the hands you are putting your mental health care into. After all, quality health care isn't a privilege, it's a necessity.
Nicole
MA., Registered Psychotherapist (Q)
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