May 24, 2018 by lucieromarin
A psychologist’s daughter once told me that therapists were just people who failed psychology at university. (There’s that word ‘just’ again). There might have been some truth to this damning statement at the time; twenty years ago, the world of counselling was not as regulated as it is today. Even today, you can legally advertise yourself as a ‘therapist’ without needing any qualifications or training in your field of therapy. (This is not the case for counselling or psychotherapy.)
Obviously, here, I can only give the differences between psychology and counselling in outline. In real life, the distinctions are not always so clear. There are good and bad in both professions, as well as those who draw from both disciplines in their work. Even so, the outline might help with a decision about what sort of help to seek in trauma recovery.
Psychology follows the medical model. The psychologist’s skill is in her ability to diagnose and treat. The psychologist is the expert, and the client can be interpreted according to precedent as expressed in the definitions of medical textbooks. You can leave a psychologist’s office with a diagnosis. That diagnosis might become a new label or a new identity: “I’m anorexic,” “I’m bi-polar,” “I have PTSD,” “I have depression.” A bad experience of this kind of treatment can make you feel like a specimen, or a mere number, one of 1,000 faceless cases. It is possible to become attached to a diagnosis. (It is also wrong, I believe, to label people as in some way ill, whose symptoms or experiences are in fact no more than the perfectly normal consequences of being on the receiving end of someone else’s sickness. I know this is not the intention of diagnosis, but it is sometimes its unintended effect. If someone is depressed, it might not be because she lacks resilience, but because someone else is an entitled sociopath who should be behind bars.)
A counsellor who interrupts, who makes you feel bullied, makes you feel that she is the expert or that you are in some way failing her methods, is a bad counsellor. Counselling does not diagnose. The biological consequences of trauma are recognised, as are those experiences on the spectrum known as ‘depression.’ However, those consequences and experiences are never pathologised, and the counsellor avoids giving the client any label to which the client might inadvertently become attached. In fact, the counsellor avoids giving the client anything which might position the pair in an expert/dependent relationship, not only because she wishes to avoid being the fiftieth judge in your life telling you what you are and what you should do, but because your healing is not simply about doing something or fixing something. It is about becoming someone. The counsellor’s skill is in hearing, not only your words, but the words behind your words. She helps you to hear those unspoken words, too, to see your inner life with greater clarity. She will walk with you to that revelation, but she will not tell you what to do with it.
If you tell your psychologist that you had a vision of an angel, the psychologist must decide whether this vision was a delusion, an hallucination or part of a psychotic breakdown. The counsellor – while bearing these possibilities in mind and checking that the angel didn’t tell you to kill anybody! – is also curious about whether or not you come from a culture in which visions are seen as normal or desirable, whether visions are a help or a hindrance to your life, your social status, or your self-concept, what your experience of spirituality has been in the past, and what it would mean for you to explain the visions as psychosis. In short, the psychologist wants to know how the DSM-V classifies your set of dysfunctional behaviours. The counsellor wants to know what the function of those behaviours is for you. Only once she knows the details that are unique to you can she ask you about where you would like to go next.
The two disciplines are sometimes presented as inimical, but they need not be. In one class, we watched a video in which a counsellor (a narrative therapist) talked about her work with a client whose sufferings included paranoia. That client needed medication. As such, her experience of psychology and psychiatry were necessary – not only for the prescription drugs, but because the receipt of a diagnosis helped her to stop judging herself as ‘crazy’. However, it was only when the medical aspect of her treatment was combined with the counselling practice known as Narrative Therapy that the client’s life changed. She needed both.
The counselling approach does have one major disadvantage. If you want to seek compensation from your abuser, you’ll need to present a diagnosis to the court. Counselling brought me great healing. My counsellor was able to talk me through the symptoms of post-traumatic stress with a psychologist’s competence, but in a way which left my agency and my identity mine. But the lawyers needed the medical model. How to explain to a court that it is only after years of healing that you can even think of beginning the process of legal redress, by which time it is too late to seek a retrospective diagnosis? The psychologist’s method would not have helped me, but the psychologist’s medical certificate would. Bear that in mind.