Psychotherapy and Counseling: What's the Difference?

Psychotherapy is a working communication relationship between two people--a clinician and a person seeking help.  Five factors make a difference.

Therapy Outcomes: 5 Factors

The kinds of help provided vary with the clinician but commonly include strategies for relieving emotional distress, solving or coping with life problems (e.g., grief, couple or family relationships, school or career decisions), and changing thoughts and behavior patterns that interfere with adapting to and enjoying life.

In the past, psychologists, psychiatrists, and social workers provided psychotherapy. Counselors, some nurses, and some clergy provided counseling. Nowadays, many clinicians use the terms counseling and psychotherapy interchangeably. Most providers are licensed or certified to provide the services they advertise. Psychiatrists are physicians. Psychologists hold doctorates in psychology (some hold a master's degree). Other clinicians usually hold at least a master's degree.

I was a psychotherapist for many years. Like others of my era, we went to conferences, watched demonstrations, and read books in an effort to become better psychotherapists. Many of us had years of supervision during school and after graduation. We believed that new research would uncover effective treatments or new components of treatments that would help our clients get well.

Medications Made A Difference

As medications became more specific for the treatment of common conditions like depression and anxiety, I and others began to wonder about the value of psychotherapy- especially if medication was better or equal to psychotherapy and cost less. In this light, I began to take courses in psychopharmacology in the hope that psychologists could prescribe medication. I worked with others to pass legislation before I retired. Now, some states license psychologists to prescribe medication.

The second factor was the emergence of managed care insurance companies that gained control of approving psychotherapy visits. Approvals required increasing amounts of paperwork and the payment to clinicians was drastically reduced. For therapists trained in cognitive-behavioral approaches like myself, it was no big deal to provide treatment goals, document interventions, and provide data. Indeed, we considered this "scientific approach" the only way to do psychotherapy. The hassle was mostly dealing with approvals and different forms from different insurance companies.

Today, psychological scientists continue to add to the collection of evidence-based treatments that guide psychotherapists regarding best practices for people with different diagnoses and other factors.

Psychotherapy Works

On average, a person who participates in psychotherapy is better off than about 79% of people who do not get treatment.

This statistic is based on an average effect size of .80 in treatment studies reported by Bruce Wampold, “The research evidence for The common factors models: A historically situated Perspective.” 2010, p. 55.

  

Psychotherapists still care a lot about effective interventions. But what we have learned is that there are other factors at work when people get well. Psychotherapy works. Psychotherapy can be powerful. But it's not always a particular treatment technique that works. Instead, psychotherapy works based upon several interactive components.

The secret sauce in psychotherapy is the whole package consisting of five active ingredients.

Remembers the five factors by the acrostic PRICE.

PRICE =  Psychotherapists, Relationship, Interventions, Clients, Extratherapeutic factors.

Psychotherapists

The fact is, some clinicians are better than others. We know that and yet you do not hear much about it. It's difficult to isolate specific factors. But in common experience we know people who are warm, inspiring, and full of hope. Their enthusiasm can be catching. We also know people who are dull and boring or who appear cold and aloof. Some psychotherapists are also brilliant and full of creative ideas-others not so much.

Findings from the work of Carl Rogers still make sense about the need for a warm and caring psychotherapist. Psychotherapists are also responsible for setting expectations. Expectations are important to outcomes. Psychotherapists are not equally effective. More research is needed on the therapist as a highly important factor.

Relationship (therapeutic or working alliance)

The relationship between a psychotherapist and a client is a critical component in treatment. Many effective outcomes can be traced to the connection made at the first session. As in any endeavor in life involving two or more people, a working relationship is important to success. Research suggests that an effective working alliance depends on the therapist and agreement on the treatment goals and procedures.

Interventions/Treatment

Treatment does matter in the context of the other factors. But often a specific type of treatment can be as good as another if the therapist is skilled at the intervention and an organized approach is employed. It's also important that both psychotherapist and client collaborate in the process. The fact that different interventions work suggests there is something about the confidence therapist and client place in the explanation and activities.

Clients (or Patients)

 More research is needed about the role of clients in successful outcomes. But we do know that some client characteristics are important. Level of motivation, personality factors, and attachment history are a few factors linked to outcomes. What's highly important is their participation according to Orlinsky and colleagues. Clients are agents who actively shape therapy as they interact with a therapist.

Clients are better at determining successful outcomes than are therapists. Getting client feedback is important to evidenced-based practice.

Extratherapeutic factors

This is a catchall term for things that happen in life, which can be linked to outcomes. Changes in general health, jobs, relationships, and many other aspects of life can make a significant difference in how people fare during a course of psychotherapy. These factors are beyond the control of the psychotherapist but must be kept in mind if we are to be honest about the role of psychotherapy.

Perspective on Medicine

I continue to be in awe of the advances made in modern medicine. I am glad for the progress that helps so many of us live better and longer lives with less pain than in the recent past. There is no reason to detract from the medical model.

But there is reason to realize the important role of psychological factors in wellness overall and in the treatment of those conditions considered psychological (e.g., depression, anxiety). The fact is, at this point in time, psychotherapy is more effective than some medications. And that relationship factors between physician and patient are important for outcomes in general health as well.

A Multidimensional Approach

One way to integrate various interventions into a treatment plan is to think about the major areas of functioning and where we are along the mental health continuum from illness, to the blah middle range, and to wellness and beyond toward flourishing.

See more in the book:

Flourishing in Six Dimensions: The SCOPES Framework

A Multidimensional Continuum from Mental Distress to Human Wellbeing

Available on AMAZON     and     GOOGLE

References

To read more, see the edited work by B. L. Duncan and others The heart and soul of change: Delivering what works in therapy (2nd ed.).  Washington, DC, US: American Psychological Association.

For an important summary:

Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy
process-outcome research: Continuity and change. In M. J. Lambert (Ed.),
Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (5th ed.,
pp. 307-390). Wiley.

Other related research

Sutton, G. W., Arnzen, C., & Kelly, H. (2016). Christian counseling and psychotherapy: Components of clinician spirituality that predict type of Christian intervention. Journal of Psychology and Christianity, 35, 204-214. Academia Link    ResearchGate Link

Sutton, G. W., Kelly, H., Worthington, E. L. Jr., Griffin, B. J., & Dinwiddie, C. (2018) Satisfaction with Christian Psychotherapy and Well-being: Contributions of Hope, Personality, and Spirituality. Spirituality in Clinical Practice, 5 (1), 8-24, doi: 10.1037/scp0000145  Academia Link    ResearchGate Link

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Post Author

Geoffrey W. Sutton, Professor Emeritus of Psychology at Evangel University, holds a master’s degree in counseling and a PhD in psychology from the University of Missouri-Columbia. His postdoctoral work encompassed education and supervision in forensic and neuropsychology. As a licensed psychologist, he conducted clinical and neuropsychological evaluations and provided psychotherapy for patients in various settings, including schools, hospitals, and private offices. During his tenure as a professor, Dr. Sutton taught courses on psychotherapy, assessment, and research. He has authored over one hundred publications, including books, book chapters, and articles in peer-reviewed psychology journals. 

His website is https://suttong.com You can find Dr. Sutton's books on   AMAZON    and  GOOGLE. Many publications are free to download at ResearchGate   and Academia  

Note
I no longer provide psychotherapy. I write, give talks, and consult on research projects