What’s the difference between a psychiatrist, psychologist, psychotherapist, counsellor and coach?

In the UK, there are many people who work as adult mental health professionals: psychiatrists, psychologists, psychotherapists, psychological well-being practitioners (PWP), counsellors to name a few. Note also that nurses, social workers, peer workers, occupational therapists and mental health recovery and rehabilitation workers also work with people who struggle with psychological difficulties. It can be quite confusing when trying to find help and decide who you should be seeking out. In the following I will give a brief overview of how to tell the difference between a psychiatrist, psychologist, psychotherapist and a counsellor. I will give broad generalisations, as each mental health practitioner is likely to have their own professional developmental journey, with varying training and additional degrees. Therefore, you may find an overlap in competencies and blurred lines between them when you encounter anyone with the above titles. The trick is to find the right person and sort of help for you, and knowing what questions to ask.

The shortest answer to what the difference is between these professions is their training. A psychiatrist is a trained medical doctor who has then specialised in mental health, or perhaps more accurately, mental ill-health. This journey will have taken around 13 years to achieve because they had to go through 5 years of medical school first. They are doctors. This means they can prescribe medicine. They are less likely to see you for therapy, but instead will seek to understand your symptoms, and if relevant, give you a diagnosis, prescribe medication and /or therapy to help alleviate those symptoms. They work from what we call a ‘medical model’. That is, an understanding that mental health difficulties stem from some sort of dysfunction or ‘mental illness’ which can be categorised and ordered akin to physical illnesses. 

A psychologist on the other hand, is not a medical doctor and cannot prescribe medication. At the time of writing, in the UK, the title psychologist is not a protected title, and is unregulated. This means, in theory, anyone can call themselves a psychologist and they don't hold themselves to the scrutiny or standards of an overseeing body. So if you encounter someone who presents their professional self as ‘a psychologist’, ask what kind of psychologist. If they can’t or don’t say any of the accredited titles (for example ‘sports’, ‘educational’, ‘coaching’ ‘forensic’, ‘clinical’, ‘occupational’, ‘health’, ‘neuro-’ or ‘counselling’), you may be wise to investigate their credentials a little further. Click here to check whether your psychologist is chartered.

Generally within adult mental health, there are two kinds of psychologists; clinical and counselling psychologists. These are protected titles. This means anyone who is a clinical or counselling psychologist, will have undertaken around 6 years of training that has been approved by the British Psychological Society (BPS), is regulated by law and registered by the Health and Care Professions Council (HCPC). They deliver talking therapy, also known as psychotherapy. They are likely to have been trained in at least two different kinds of therapy forms and have a knowledge of mental health diagnosis that psychiatrists work from (although not always). There are many types of therapy, the most common ones being psychodynamic therapy and Cognitive Behavioural Therapy (CBT) with its many variants such as Compassion Focused Therapy (CFT) or Acceptance and Commitment Therapy (ACT). Other common therapies are systemic, person-centred, Dialectical Behaviour Therapy (DBT), couples therapy and Cognitive Analytic Therapy (CAT). (I’ll probably cover this in another blog one day).

There is not much difference overall between a clinical and counselling psychologist, they both provide psychological assessments and therapy. A clinical psychologist is essentially trained within the NHS, whereas a counselling psychologist is likely to have received some of their training outside of the NHS. What I mean by this is, their training and placements vary. Clinical psychologists don’t usually get to choose which NHS service they train in. For example they may be allocated to a pain clinic, then an adolescent unit and then maybe a trauma service. In contrast counselling psychologists have to source their own placements. This means they are more likely to have crafted their training to fit their interests within mental health and therapy. For example, if someone is interested in problem eating or personality disorders, they will apply to services that specialise in those areas and get relevant work experience.I am a counselling psychologist.  I did a placement at the Maudsley’s Psychosexual service to strengthen my skills and interest in working with people when they struggle with romantic relationships. I was also interested in general mental health, so took on a placement at UCL’s.

Another significant difference between clinical and counselling psychologists, is that counselling psychologists are self funded, unlike clinical psychologists, they are on the NHS payroll at Band 6, after usually having to acquire work experience as an assistant psychologist on Band 4-5 pay.

Now, confusingly perhaps a psychotherapist is anyone who uses talking therapy as their means of intervention (as opposed to physiotherapy, hypnotherapy, occupational therapy, equine therapy etc). So psychologists are actually also psychotherapists. When we meet people who call themselves psychotherapists, they usually refer to being trained and specialised in one therapy modality,for example CBT-, psychoanalytic- or psychodynamic therapy (each of which have very specific ways of generating change for their clients). It can take anywhere between 1-3 years of training within these specific modalities. 

Counselling is a talking therapy that involves listening to and helping clients find ways to deal with emotional difficulties. Most psychotherapists are trained specifically to use counselling within their therapy. Counsellors are usually trained to use this specific part of talking therapy for their work, for example people who work on help lines such as The Samaritans or Childline. The training is not as intensive or lengthy as the other practitioners mentioned. Counsellors are not involved in diagnosis or assessment unless it’s for a very specific service, for example drugs and alcohol dependance or bereavement.

A  coach , like 'psychologist, not a protected title. Coaches are typically people who work on creating change in a future orientated way. Coaches don't usually delve into peoples past experiences.I think they do ultimately cover mental health in that the change they help bring about make their clients feel better about themselves, but the focus is on achieving tangeble goals.