What's The Difference Between A Counsellor, Psychiatrist, Psychotherapist & Psychologist?

What Do Different Mental Health Professionals Actually Do?

You’ve likely come across several types of mental health practitioners.  For example, there are Psychological Wellbeing Practitioners, Counsellors, Psychotherapists, Psychiatrists, and a range of Psychologists.  This can make it difficult to know who to go to for support, because it’s hard to understand what each actually does, or if there’s even a difference between them.  This article aims to clarify this ambiguity so you are better informed about the different roles.  Each professional is outlined below to include what they do, information about their training, who governs or regulates them, and how they work, whilst also highlighting differences and commonalities between them.  It is hoped that this will place readers in an informed position when selecting a professional.

Psychological Wellbeing Practitioner (Low & High Intensity Therapists)

Psychological Wellbeing Practitioners (PWPs) are practitioners who usually work in the UK National Health Service (NHS) as trainee or assistant PWPs in an IAPT service (Improving Access to Psychological Therapies), although they also work for private companies. 

PWPs are trained in either low intensity psychological interventions (working with mild to moderate anxiety or depression), or high intensity (moderate to severe).  They will possess a degree (usually in psychology, but sometimes in something unrelated).  And because they are often trainees they will also be studying for a Postgraduate Certificate in Low or High Intensity Psychological Interventions whilst delivering sessions.  They attain qualified status upon graduation, with training typically taking 45 days (one day per week at university) alongside supervised practice, over an academic year. 

Sessions are based in cognitive behavioural therapy (CBT) with support offered in the context of coaching or guided self-help (GSH), rather than counselling.  This involves teaching patients strategies to help manage and reduce anxiety or depression symptoms.  Sessions are 30 minutes (although the initial assessment lasts 50 minutes), and usually individuals are offered six sessions in total.  These are more often over the phone, but can be in-person and possibly over video-conference technologies.  PWPs also offer computerised CBT (cCBT) which is asynchronous text-based support via an online platform.  The IAPT service also offers the option of group sessions in which PWPs deliver GSH to a group, teaching CBT techniques.  Many IAPT qualifications are accredited by the BPS (British Psychological Society), or the BACP (British Association for Counselling and Psychotherapy).  It is important to realise that this kind of therapy is not an exploratory approach, although the NHS will offer counselling to patients who are deemed in need of it.   

Counsellor

A counsellor, like the others in this article, is a practitioner who offers a safe, trusting, and confidential space in which clients are able to explore a range of mental health issues.  In the case of counsellors however, this often means that sessions are not structured.  This kind of exploration can offer a useful space to make sense of difficulties.  Usually counsellors will have specialised training in a particular model to facilitate exploration.  For example, a more structured approach, or one which facilitates deeper exploration.     

When considering working with a counsellor, it is important to check the credentials as the title ‘counsellor’ is not a protected one, this means that the use of the title is not restricted by law.  Notwithstanding, many counsellors will be members of governing bodies such as the BPS, BACP, or UKCP (UK Council for Psychotherapy).  This means they have either completed accredited training, or have fulfilled the minimum requirements to qualify for membership.  By learning about a counsellor’s training and memberships, you will be better informed and can decide if you believe they can support you.

The title ‘Counsellor’ should not be confused with the act of counselling, which is often termed a ‘talking therapy’. Essentially you can have counselling by seeing any of the professionals in this list (aside from PWPs) because it is something they all ‘do’.  Counselling can take place in individual, couple, family, and group settings.  It is also increasingly offered online, as well as in-person, by email, SMS, and telephone.  Individual sessions normally last 50 minutes, because this is deemed the ‘therapeutic hour’ and this is the norm across most practitioners. 

Psychologist

Psychology is the scientific study of the human mind and behaviour; this involves the way people think and relate.  The field of psychology is quite broad and also covers cognitive functioning relating to learning and memory, as well as complex mental health conditions or disorders.

Psychologists can be applied which means they apply their training in a practical way with people.  For example, in a therapeutic context, or in forensic settings.  Psychologists can also be research oriented which means they will focus on experimentation and research in order to further society’s understanding of the field.

There are many specialisms within the field of psychology that are protected by the HCPC (Health and Care Professions Council).  These include the titles: Registered Psychologist, Chartered Psychologist, Clinical Psychologist, Counselling Psychologist, Educational Psychologist, Forensic Psychologist, Health Psychologist, Occupational Psychologist, Sports and Exercise Psychologist, and Practitioner Psychologist.  Individuals with these titles are accredited by the HCPC which means they have undergone accredited doctoral training.  They must also abide by the HCPC’s strict ethical codes of conduct which guide respective professions. Such psychologists may hold multiple memberships or accreditations with other governing bodies, such as those mentioned. 

A degree in psychology confers individuals with the use of the title ‘Psychologist’, however because it is not a protected title it can be misappropriated by people who are not psychologists at all.  This is why it is is important to check the qualifications and governing membership bodies of those who use the title, as well as the specialised following psychologists: Criminal Psychologist, Business Psychologist, Consultant Psychologist, Child Psychologist, Graduate Psychologist, Expert Psychologist, Organisational Psychologist, and Neuropsychologist.

Counselling Or Clinical Psychologist

Two of these disciplines, as mentioned, are counselling and clinical psychologists and both are doctors.  They are also quite similar in ways which is why NHS job advertisements will often use the titles interchangeably.  Both blend therapeutic practice with psychological research and theory (like attachment theory) and often address similar issues as counsellors.  However, they are more likely to work with more serious or complex cases.  They may also apply the medical model in their work, with the use of diagnostic questionnaires which are scored and help measure the severity of conditions and mental health diagnoses like depression, anxiety, PTSD (post-traumatic stress disorder), or health anxiety, etc. These questionnaires can help clinicians monitor the utility of the treatment plan and some clients find the scores helpful, sometimes feeling optimistic when they notice symptom reduction in this quantifiable way. 

Applied psychologists will often have training in a few different therapeutic models, for example, CBT, psychoanalysis, or the person-centred approach.  Although clinical and counselling psychologists’ work does overlap, they are slightly different.  Counselling psychologists are more likely to place mental health diagnoses as secondary in their overall analysis of individuals due to their holistic approach which prioritises life events and environment and the impact these have on individuals.  Clinical psychologists, though holistic, may place more focus on mental health diagnoses which are more heavily emphasised in their training.   

Psychiatrist

Psychiatrists possess medical training which means they can conduct medical examinations and tests (like CAT scans), and prescribe medication.  They are therefore regulated by the General Medical Council (GMC).  Beyond this medical training, they also specialise in psychiatry – the study of mental health disorders.  This means they work to prevent, diagnose, and manage mental health conditions.  

Psychiatric research involves observing and monitoring mental health conditions and utilising diagnostic systems to identify clusters of symptoms and behaviours that happen together, and how these might be impacted by social, psychological or physical causes, with the aim of managing and helping.  These include mental health conditions like schizophrenia, disorders like PTSD, or OCD (obsessive compulsive disorder), as well as bipolar, or ‘personality disorders’ like BPD (borderline personality disorder).  Like psychologists, psychiatrists will usually start by conducting an initial assessment with the view to create a treatment plan, which in the case of psychiatry may include medication, alongside a form of talking therapy (like counselling, CBT, etc).  

If individuals are referred to a psychiatrist (usually by a GP or another type of doctor, unless sourced privately), it is usually to seek a diagnosis or eliminate one, or because their mental health condition is severe and may benefit from medical intervention to help manage symptoms.  Psychiatrists can take further training in order to specialise in a particular area, for example, learning disabilities, or psychotherapy.

Psychiatrists often work as part of community mental health teams (CMHTs), sometimes conducting sessions in GP surgeries, or working in outpatient clinics, hospital wards, or for private practices.

Psychotherapist

A psychotherapist is a mental health practitioner who works with clients on a long-term basis.  This means the title ‘Psychotherapist’ can be thought of as an umbrella term, that is, a psychotherapist can be a counsellor, a psychiatrist, a psychologist, or any other kind of mental health practitioner who works in a long-term way with clients, using psychological theories and therapies.  It is helpful to know the qualifications of practitioners who use this title, as this offers clarity about whether they are a counsellor, psychologist, registered psychologist of some description, or psychiatrist, and will allow you to determine whether their support could fit your needs.