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Q: Psychiatrists, psychologists, psychotherapists, social workers, marriage and family therapists – I’m confused by all these terms. What are the differences and similarities among them?
A: While the general terms “therapist” and “counsellor” may apply to any mental health care provider, and while all such providers may address such common problems as depression, grief, anxiety, and stress, there are key differences in training and approach.
A psychiatrist is a medical doctor who has trained in general medicine, then specialized in psychiatry. As a Fellow of the College of Physicians and Surgeons of Canada, a psychiatrist must follow a code of professional standards and participate in a continuing education program in order to maintain his or her certification. Psychiatrists generally see patients as individuals and are not often trained in family dynamics. IFL has a consulting psychiatrist.
A GP psychotherapist is also a medical doctor, but with several years of training in psychotherapy. She or he may belong to the General Practice Psychotherapy Association in addition to the College of Physicians and Surgeons. The GPPA requires its members to have a minimum of 90 hours formal training, 1,000 hours of paid work in psychotherapy, plus a combination of 50 hours of continuing education and individual/group support work every year. IFL’s GP psychotherapists are highly trained and experienced counsellors.
[Note: Only psychiatrists and GP psychotherapists may prescribe medication. Their services are paid for by provincial health insurance plans. At IFL, our GP psychotherapists’ services are reserved for clients whose family incomes are below Canada’s “poverty line.”]
Clinical Psychologists are required by the province of Ontario to hold a Ph.D. degree in Psychology. This allows them to use the title “Doctor,” even though they are not medical doctors. As part of their training, psychologists must complete a year of supervised experience, followed by a rigorous exam. Psychologists are licensed by the province and are required to follow a set of standards and a code of ethics set down by the College of Psychologists . Continuing education is also required. IFL’s psychologists have specialized in family, child, and adolescent psychology.
Registered Social Workers hold master’s or doctoral degrees in social work, which consists of theory and practical field work in such areas as child welfare, community development, or gerontology. Social work degrees are accredited by the Canadian Association of Schools of Social Work, and registration with the Ontario College of Social Workers is required. A clinical social worker may work in a social service agency or be in private practice. IFL's mediation consultant is a Registered Social Worker.
Registered Marriage and Family Therapists (RMFTs) are members of the Ontario Association for Marriage and Family Therapy (OAMFT), a division of the American Association for Marriage and Family Therapy (AAMFT). Accreditation requires at least a master’s degree in a counselling program, plus a minimum 1,000 hours of clinical supervised therapy/counselling work. Sex therapists registered with AAMFT/OAMFT require additional psychotherapy training and supervised work. IFL’s RMFTs are also members of the Canadian Registry of Marriage and Family Therapists and are experienced couple and family therapists.
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What's the difference between a psychotherapist and a counsellor?
In practice, very little: some practitioners may choose to call themselves counsellors, while others - even with identical qualifications - may call themselves psychotherapists.
Traditionally, people offering short-term help to patients or clients - especially those in the voluntary sector - tended to call themselves counsellors, while people who had trained on a psychotherapy course, lasting at least two years, would call themselves psychotherapists. But nowadays this distinction seems to have blurred.
Quite apart from anything else, many psychotherapists also call themselves counsellors.
One reason for this is that they think the public find 'counselling' a more understandable and less frightening term than 'psychotherapy'.
Another reason is that when practitioners pay to put themselves into a telephone directory, they are aware that many potential clients will start by looking up 'counsellors' because it comes before 'psychotherapists' alphabetically. So they put their advert into the counselling section.
Sometimes therapists advertise in both the counselling and psychotherapy sections. And if they also have a qualification in hypnosis they often put themselves into the hypnosis section, too. So one therapist can be listed under all three headings. Confusing, isn't it?
Are there any other practitioners who offer psychotherapy/counselling?
Psychiatrists
Psychiatrists are people who have qualified as medical doctors, who have then gone on to specialise in mental health. Not all psychiatrists offer psychotherapy or counselling. Many of them are much more concerned with medication and other 'non-talking' methods. But in the private sector it is usually possible to find a psychiatrist for therapy - some people prefer to see someone who is medically qualified.
Psychologists
A psychologist is not a medical doctor. Instead, he or she has a degree in psychology. But there are all sorts of psychologists. Many of them are academics who never come into contact with real patients. In fact, the whole idea of psychologists treating patients is a relatively modern one and did not start happening properly in the UK until the 1950s.
A psychologist who has trained in the assessment of mental health problems and the treatment of patients is usually called a clinical psychologist. Some individuals with similar training are called chartered psychologists and some psychologists call themselves chartered clinical psychologists.
Any of these terms should give you confidence that the practitioner in question is fully qualified and competent.
For more details of how to find a psychologist, see the third part of our series on therapy: 'How to choose a private therapist'.
The essential difference between psychiatrists and psychologists is that the former group are specialists who qualified as medical doctors first. This means that a psychiatrist can prescribe medication should you need it, whereas a psychologist cannot.
Qualifications
Clearly a psychiatrist will have a string of medical qualifications attached to his name. And a psychologist will have a degree and probably other professional qualifications, too.
But when it comes to counsellors and psychotherapists the picture is less clear. In the UK there is currently no legal requirement for a therapist to have passed any exams, to have trained properly or to belong to a professional organisation.
This means that there are some dubious practitioners about. So, I advise you to seek out a therapist who is able to prove to you that he or she has had training, is qualified to see patients/clients, and is a paid-up member of one of the professional organisations are listed in the article on 'How to choose a private therapist'.
Even if you choose to go to a psychiatrist or psychologist, my advice still is to go through one of the professional organisations.
Coaching
In the past five years, there has been a huge growth in the UK in the numbers of people opting for coaching.
Some of these individuals might do better to have psychotherapy. However, in many cases there is quite a narrow dividing line between what coaching can do for someone and what psychotherapy might achieve. And increasingly, highly qualified and accredited psychotherapists are now also certified coaches and are able to offer either specialty.
Coaching is a process that is much more acceptable to some British adults than psychotherapy might be. And it would be true to say that some people who would avoid therapy at all costs are quite happy to see a coach.
Coaching cannot begin to address long-term, complex psychological problems. But it is very useful for addressing issues such as stress, chaotic lifestyles, work issues and procrastination.
Different types of therapy
Once you have decided which type of practitioner you want to see, you still have to decide what sort of therapy would best suit you. There are many different kinds:
Behaviour therapy
Coaching
Cognitive analytic therapy
Cognitive therapy
Gestalt therapy
Person-centred therapy
Psychodynamic therapy
Rational emotive behaviour therapy
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What are the differences between Psychotherapy/Counselling, Psychology and Psychiatry?
In Australia, Psychotherapists and Counsellors are not regulated by a specific government body - anyone can use the titles. A psychotherapist/ counsellor may be a health professional such as a psychologist, social worker, psychiatrist or medical doctor who has undertaken further specialist training in psychotherapy and counselling. Other practitioners do not have a health profession background but have completed a training in psychotherapy and counselling. Some psychotherapy and counselling practitioners choose to belong to one of the many professional associations.
A training in psychology or psychiatry is no guarantee that a practitioner has extensive training in psychotherapy and counselling.
Psychiatrists are medical doctors trained to treat mental illness. They can prescribe medications, and they offer access to Medicare and private health fund rebates. Psychiatrists may rely more on medications than on talk therapy.
Psychologists usually have a post-graduate qualification and may have a doctoral qualification that allows them to use the title Dr. They have access to private health rebates. Clinical psychologists and counselling psychologists are just two of the specialties that psychologists provide. Other specialties that do not involve psychotherapy and counselling are sports psychology, neuropsychology, educational and developmental psychology, forensic psychology, organisational psychology, health psychology or community psychology. To find out more about psychologists see the Australian Psychological Society website at
Australian Psychological Society : APS Homepage
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Le psychiatre
Le psychiatre est d'abord un médecin spécialisé en psychiatrie, préparé à traiter des maladies mentales sérieuses telles, la schyzophrénie, la maniaco-dépression, des psychoses de divers types etc. Dans la plupart des localités, sauf dans les plus grands centres, le psychiatre traite ses patients surtout à l'aide de médication. Un petit nombre seulement vont ajouter à la médication des rencontres de psychothérapie qu'ils assument eux-mêmes, ou parfois travaillent en collaboration avec d'autres professionnels qui assument la partie psychothérapie.
Certains clients, présentants des troubles plus légers de type névrotique réfèrent aussi parfois à un psychiatre pour être suivi en psychothérapie. Ca permet à ces personnes qui n'en auraient pas les moyens, d'avoir les services dont ils ont besoin, étant donné que ces services sont alors couverts par le régime de l'assurance-maladie. Il est à noter cependant que ça n'est pas tous les psychiatres qui sont formés en psychothérapie même s'ils s'engagent dans ce type d'activité. Comme pour les psychologues, la formation de base en psychiatrie ne fait pas nécessairement d'eux des spécialistes de la psychothérapie.
Il sont les seuls parmi ces professionnels, actuellement ( les psychologues américains, et peut-être québeçois éventuellement...seront bientôt en mesure de prescrire des médicaments pour troubles mentaux. ) à être autorisés à prescrire de la médication pour problèmes mentaux.
Psychologue
Un psychologue, selon les règles du Québec, est un professionnel de la santé mentale détenant minimalement une maîtrise en psychologie et faisant partie de l'Ordre des psychologues du Québec.
Cependant, ça n'est pas nécessairement tous les psychologues qui sont habilités à faire de la psychothérapie. Car, il y a plusieurs spécialisations possibles à l'intérieur de cette discipline. On retrouve, entre autres, la psychologie industrielle, communautaire, scolaire, légale etc
Psychologue-psychothérapeute
Etre psychologue-psychothérapeute est donc une autre spécialité en soi. Il est possible d'obtenir à l'intérieur d'une maîtrise en psychologie d'orientation clinique, une certaine formation de base à la psychothérapie. Cependant, un grand nombre de psychothérapeutes reconnus au Québec, sont des professionnels qui se sont donné une spécialisation dans une approche quelconque ( soit gestalt, auto-développement, thérapie brève, approche systémique, psychanalyse, pour ne nommer que les plus courantes ). Perfectionnement qui implique habituellement entre trois à cinq ans (à temps partiel ) de cours théorique, de supervision professionnelle et parfois une psychothérapie personnelle.
Le psychologue-psychothérapeute peut intervenir sur des problèmes d'ordre psychologique de tout genre: soit d'ordre personnel, tels dépression, troubles de personnalité ou d'ordre relationnel comme des problèmes de couple, de relation parent-enfant, relations de travail etc. Le psychologue-psychothérapeute est le seul qualifié pour pouvoir permettre des changements importants au niveau des structures de personnalité. Sa façon d'intervenir variera dépendemment de l'approche dans laquelle il est spécialisée. Il sera alors habituellement spécialisé dans l'une ou l'autre des grandes orientations reconnues en psychothérapie, soit psycho-dynamique, humaniste, cognitive-behaviorale ou systémqiue-interractionnelle. (Voir autre fiche sur la différence entre les divers types de thérapie et ses résultats.) Contrairement au psychanalyste, il travaille en interaction directe avec le client.
À ne pas confondre:
psychologue-psychothérapeute et psychothérapeute en relation d'aide.
Le titre de psychothérapeute et l'acte de la psychothérapie n'étant pas protégés par la loi, comme l'est l'acte médical par exemple, ce titre et cette activité sont utilisés par des "aidants"qui n'ont pas toujours la compétence adéquate pour traiter sérieusement des problèmes humains. Ainsi au niveau des psychothérapeutes en relation d'aide, la qualité de la formation de ces "intervenants" peut varier énormément. On rencontre souvent de véritables amateurs, qui s'improvisent spécialistes d'une technique quelconque après une ou quelques sessions de fins de semaine. Par ailleurs certains psychothérapeutes n'ont pas la formation de base en psychologie, mais sont tout de même allés chercher une formation substantielle, leur permettant de faire une "relation-d'aide" de qualité, et efficace en autant qu'ils se limitent à ce genre d'intervention. ( support de deuil, aide par rapport à un problème préçis et bien circonscrit)
Psychanalyste
Le psychanalyste est, soit un psychiatre ou un psychologue de formation, parfois même quelqu'un qui a une formation avançée en sciences humaines, ( philosophie, sociologie ..) mais a satisfait à l'exigence première, soit d'avoir complété sa propre psychanalyse.
On pourrait définir une psychanalyse comme une psychothérapie, à très long terme (entre cinq à dix ans ) dont l'objectif est d'amener le client à réduire au maximum ses processus inconscients, afin de mieux comprendre les réels motifs de ses comportments. Par cette démarche la personne espère devenir de plus en plus capable de vivre en toute liberté.
Ce qui est caractéristique de la façon d'intervenir du psychanalyste, c'est qu'il ne se place pas en interaction directe avec son client. Le client est invité à s'étendre sur un divan et à exprimer tout ce qui arrive à sa pensée. C'est ce que l'on appelle la méthode de "libre-association". Le psychanalyste qui se place en dehors du champs de vision du client, va parfois interprêter les propos rapportés par le client.
Voilà les principales distinctions que l'on peut faire par rapport à ces divers spécialistes. D'autres fiches suivront pour expliquer de façon plus détaillée les différences importantes entre les grandes orientations.
Come vedi, anche fuori d'Italia, grande è la confusione sotto il cielo... dunque tutto va bene.
