Mental health ‘therapy’ in the UK
This article only applies to the UK. There are different rules and regulations depending on the country you find yourself in so please note that outside of the UK it might be quite a different situation.
What is a counsellor or therapist?
‘Counsellor’ (spelled ‘counselor’ in the US and not to be confused with ‘councillor’ which is a member of a council), ‘therapist’ (and ‘psychotherapist’) are often used interchangeably in the UK. Although my official title is psychotherapist (more on that in a minute) I quite often refer to myself as a therapist as it can sound less formal and some people are intimidated by official sounding titles.
Can anyone call themselves a counsellor, therapist or psychotherapist?
Yes!
Neither counsellor, therapist nor psychotherapist are protected titles in the UK which means that in theory at least, anyone can wake up one day and decide to call themselves a counsellor and nothing can be done (since it isn’t illegal). Now in reality, most people are not doing this and most professionals take their responsibilities very seriously but it is something to be aware of.
A ‘qualified’ counsellor is also not an official title, although it is seen in adverts – as there is no one single qualification to make you a counsellor. And some ‘counsellors’ have no qualifications.
Since there is no mandatory regulation of counselling, therapy or psychotherapy in the UK, the main bodies that offer regulation are voluntary – so there is no obligation to join.
Who regulates therapy in the UK?
No one. There are also no nationally agreed rules on what constitutes a therapist, counsellor or psychotherapist in the UK. In order to attempt to police people who offer counselling, therapy, or psychotherapy, practitioners are encouraged to become a member of a governing body. The main ones are UKCP and BACP (which is the largest).
Counselling qualifications
All therapist training should be comparable across the board by looking at the level (although this is not something that people always disclose.) And there are ‘levels’ of training. So a counsellor who has qualified (in something) at ‘level 4’ will have received less academic training than someone at ‘level 7’.
Level 6 is considered degree level equivalent, level 7 is Masters level and level 8 is PhD level.
But, as we say, some have no formal training.
What is a psychotherapist?
Some bodies, such as the UKCP, require that in order to call yourself a psychotherapist, you must be trained to level 7 which is normally a 4 year post graduate course. Below level 7, UKCP members are permitted to use the title ‘Psychotherapeutic Counsellor’, this is normally a 3 year training. Other bodies such as BACP allow members to choose whether they call themselves a psychotherapist or a counsellor.
Sounds like a right mess [“you got it!” MyHSN Ed].
What is a psychologist?
A psychologist is (normally) someone who has studied Psychology at university, but again thsi role no legally protected status. Other titles such as Counselling Psychologist or Educational Psychologist are protected and require specific training.
These protected names are governed by an organisation called HCPC. A Clinical Psychologist is a health professional who offers therapy often in a healthcare setting such as within the NHS. You can also see a Clinical Psychologist privately as with therapist/counsellors.
What is a psychiatrist?
A psychiatrist is a medical doctor who has further specialised in psychiatric medicine and helping with psychological problems. They are also able to prescribe medication. They might also offer psychotherapy depending on their training – i.e there are different types of psychiatrist. Some favour talking therapies (as described in this article), and some favour medication. Some combine the best of both! [“sorry re confusion, again” MyHSN Ed].
They can also provide an official diagnosis of a mental health issue.
So. Who do I need .. a counsellor, therapist, psychotherapist, psychologist and psychiatrist?
What most people are really interested in when they ask what the differences are, is ‘who should I ask for help’ and ‘will this person help me?’ Who you get to see will largely be dictated by whether you stay within the NHS system (which in the UK is free) or whether you seek therapy privately.
NHS treatment
Psychologists and Psychiatrists are most often found within the NHS, with most people only seeing a Psychiatrist for a diagnosis or more complex medication prescriptions. Within the NHS, you might also see an IAPT (an NHS counsellor/therapist), CBT therapist, a ‘psychological wellbeing practitioner’ or a ‘counsellor’ depending on your issues or the help available in your area.
If you do not feel that the help you are getting within the NHS is suitable, you can ask to be assigned a new therapist or to someone at a higher level, although this may or may not be honoured.
A doctor is often the first person people consider when looking for help. NHS waiting lists are often long for therapy, but there is no cost to be treated. So this is a good option if you can’t afford to pay for therapy.
Note 1. Yes, even within the NHS, it is not clear which service to use .. and there are mutiple different titles for similar things Great! [“sorry, again again” MyHSN Ed].
Note 2. Top tip. A good place to start on the NHS is with an IAPT – and in many areas you can self refer to these. You don’t need to see your GP first. Google ‘IAPT’ and your area. If you are not sure that is possible in your area, why not ring your GPs receptionist? They should know.
Private therapy
The benefit of private therapy is that you have much more choice in your treatment, although this can also make choosing more confusing. Waiting times are also likely to be much lower, depending on the therapist you might be able to get an appointment immediately.
Specialist therapists
If you’re looking for help with a particular issue, you can often filter for this on a directory or try searching on Google. If you want someone who has experience in the area you need, feel free to ask what experience they have in working with your problem.
Not all therapists specialise in a particular issue, some work with any type of issue. E.g. some may only work with children, or specialise in people with PTSD or autism.
The best indication of the success of therapy is the connection you have with your therapist. So think about whether someone looks approachable, whether you can ask them questions, whether they have experience working with the problem you’re experiencing, and whether you can afford to see them on a regular basis. This is a good enough start and later you can consider how effective your therapy is for you.
OK OK. That’s enough MyHSN. How can I choose between all of the above people with a bewildering array of titles, roles and training?
This is our basic guide:
- Therapist/counsellor (including NHS IAPTs) – mild mental health problem, e.g. mild depression or anxiety; or ‘life problems’
- Psychologist (not often on NHS) – when you want to know why you have a problem, and therefore how it can be sorted. And may need long-term care
- Psychiatrist (can be on NHS) – a doctor who specialises on major mental health problem, including severe depression or psychosis
- Specialist therapist – for specific issues, e.g. PTSD, autism etc.
Summary
We have described the difference between a counsellor, therapist, psychotherapist, psychologist and psychiatrist. It’s not 100% clear, and there is alot of overlap – and some practitioners combine roles. All deliver some form of talking therapy for mental health problems. We hope this has helped you (!) decide which you need.
Other resources
For more information about which factors to consider you can also read how do I choose a therapist
NHS mental health services
What is an NHS IAPT (talking therapist)?
