Even though psychiatric and psychological services have developed over the recent years, people still have a lot of confusion about the process of counselling. This leads to a delay in seeking help, lack of service utilisation, myths and misinformation about what counselling is and an abundance of quacks who claim to be qualified counsellors.
The terms counsellor and psychotherapist are often used interchangeably and have many similarities, but there are some important differences as well. In general, counselling is recommended for milder situations (like job stress), is solution-focused and may take place over a brief period of time. Psychotherapy, in contrast, tends to explore past issues or present thoughts/beliefs that might be contributing to more severe problems (like job stress due to depression). It is based on certain structured modules and theories. Also, psychotherapy involves the usage of specific techniques to deal with negative thoughts and unhealthy action patterns in an individual. At times, it includes certain psychological assessments of personality, intelligence, thought patterns, etc., that may guide therapy.
In actual practice, however, there is a great deal of overlap between the two. While the same therapist may provide both counselling and psychotherapy, the latter generally requires specific skills, training and certification. While a psychotherapist is qualified to provide counselling, a counsellor may or may not possess the necessary training and skills to provide psychotherapy. It is usually provided by trained clinical psychologists who need to possess a Masters in Philosophy (M.Phil.) degree and need to be licensed with the Rehabilitation Council of India. Even though there have been several designations common in social media platforms these days like life coaches, life trainers, healers, psychological motivators, etc., they can only practice therapy if trained and licensed. They may be experts in their respective fields, but blurring the boundary between clinical psychological work and lay counselling is confusing to patients and harmful to mental health. Unfortunately, the ambiguity continues in our country in the absence of strict regulation and monitoring.
Psychotherapy or counselling depends on the development of a healing, trustworthy, safe and therapeutic relationship between a therapist and an individual. The main goal is to understand a person’s or couple’s (in case of couple/family therapy) feelings, behaviours and thought processes, eventually addressing the problematic issues with the goal of improving a person’s life. It can involve multiple techniques based on the psychiatric problem that a person is undergoing (e.g. depression, social anxiety, personality disorders, phobia, etc.). A common technique is Cognitive Behavioural Therapy (CBT), which involves a therapeutic collaboration over time-limited sessions with a fixed agenda to modify certain disturbing thoughts and beliefs in the patient that lead to change in his/her behaviours. However, CBT is not the only form of therapy. It is important to understand that psychotherapy is not an endless and non-specific undertaking. At the very beginning of any therapy session, a predetermined plan is made in discussion with the client that forms part of what we call a therapeutic contract. In most cases, this determines how the remaining sessions will follow through. Each session typically lasts for 45-60 minutes and usually the duration is once per week.
Therapy is not a class or lecture session. It is true that at some point, the therapist only listens to the client but that does not make him/her passive. It’s like the tension in the rope pulled equally at both ends. If it isn’t nearing 100% commitment from both sides, it isn’t going to work. For therapy sessions to be useful, the client needs to be equally participative, receptive and collaborative. The therapist cannot induce any change forcefully. Mutual trust and commitment determine the success of the process.
Psychotherapy is a process, not a one-session magic. Unlike medicines that act on their own once you take them, therapy depends on live human interaction and dynamics. Change takes time to develop and sometimes gains are gradual. At times, it depends on the involvement of caregivers, social support and other environmental factors as well. It is common to see patients dropping out after only a few sessions, expecting a drastic relief in their mood. This is unrealistic as the first few sessions are dedicated mostly to building rapport between the therapist and the client.
Counselling and psychotherapy are both complementary and not substitutes for medicines. While some problems respond to the former alone, others may need a combination of both. The decision is best left to the mental health professional. Severe depression, anxiety, obsessive-compulsive disorders, addiction problems, etc., often need both of these for adequate treatment. Decades of research across the world has shown that psychotherapy is not only as effective as medicines if administered appropriately, but also works in children and older people alike. Couple relationships, sexual problems and family discord can also be helped by psychotherapy in multiple ways. The goals of therapy vary and evolve throughout the sessions.
In a country with an ever-rising mental health burden, it is important we seek appropriate help from the right person at the right time with realistic expectations. Psychotherapy is not meant to make you happy but to guide you through your problems in a constructive way. To quote Carl Jung, the legendary psychoanalyst, “The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help the client acquire steadfastness and patience in the face of suffering.”
Dr Debanjan Banerjee
Psychiatrist, NIMHANS, Bengaluru
(dr.djan88@gmail.com)