The perceived differences between psychotherapy and counselling have long been debated. A fundamental problem is that these activities and any boundaries between them are poorly defined both in practice and in research. None of the criteria often argued to differentiate counselling and psychotherapy (such as: type of problem; symptomatic relief or personality change; 'depth' of working; internal or external focus; working with the conscious or unconscious; directiveness or non-directiveness; duration of therapy; frequency of sessions; practitioner's job title or length of training) appear to be applied consistently or proven clinically reliable. Moreover, research on therapeutic effectiveness does not support the relevance of these supposed distinctions to client outcome. Commonalities between counselling and psychotherapy are, however, considerable and highly significant to outcome. For these reasons, we conclude that there is no meaningful difference between the terms.

The evidence is clear: successful therapy depends much more on the individual therapist than on the type of therapy. Also, the competence of a therapist is best measured by the actual results they achieve with clients, rather than relying on their qualifications, training history, or professional affiliations. Consequently, you should seek the most competent therapist possible with whom you can build a good working relationship. Recommendations from family or friends with similar beliefs and values, or referrals from knowledgeable professionals, can be most useful in this regard. The most important characteristics of good therapy and good therapists are discussed in detail in More interesting facts and Tips for clients.

Although you may feel more vulnerable than usual, do not suspend your own personal judgement and common sense when dealing with a therapist, assuming that the professional "knows best". No one knows your life better than you! Beware of trusting a therapist simply because they subscribe to a particular professional code of ethics or practice. Evidence is lacking that these therapists practice more safely or ethically than others. If problems with the therapist arise, consider the recomendations in the When to move on section and elicit the help of trusted family and friends.

Specific to Scotland: You can gain further reassurance if the therapist has been checked by Disclosure Scotland. This reveals criminal convictions and police concerns which may affect working with vulnerable persons.

There is no special legislation or state licensing governing the practice of psychotherapy and counselling in Scotland and the United Kingdom. However, the right under common law to offer such services is subject to the same laws of contract, trade description, breach of confidentiality and so on that regulate the provision of any other service. In certain areas of work, such as in the National Health Service and Social Work, there are some statutory measures which do impinge on psychotherapy and counselling practice. Also, the Data Protection Act applies to the gathering and processing of clients' personal data. See Mowbray (1995) for a comprehensive review of the regulatory situation and the substantive recommendations of Hogan (1999).

Many services providers and professional associations of practitioners have their own schemes for self-regulation. However, contrary to popular belief, no professional or trade association (such as COSCA, BACP, UKRC or UKCP) has been granted the statutory power to regulate psychotherapy and counselling in Scotland or the United Kingdom. Unfortunately, most existing self-regulatory schemes fail to fulfil the requirements for credible schemes proposed by the National Consumer Council, which aim to avoid conflicts of interest between the profession and the public. Also, there is no evidence that current professional accreditation and registration schemes engender more ethical or effective practice. See the Baxter (2004) article.

Please see this warning about the UK government's plans for the statutory regulation of psychotherapy and counselling.

Reflecting the diversity of humanity, good therapists come from a wide range of personal and professional backgrounds. Research shows that being effective as a therapist depends much more on your personal qualities and ability to form helping relationships with individual clients than having completed a particular training or possessing certain qualifications. The state does not endorse routes to becoming a psychotherapist or counsellor. At the present time, the supply of therapists outstrips demand in Scotland and the United Kingdom.

A therapist's knowledge and skills can be enhanced in a variety of ways, including life experiences, training, and personal development. To ensure that the client's needs take priority, a therapist should have a good sense of balance in their own life and a sufficent network of personal and professional support.

You might consider some of the following steps:

• Joining, or training with, a voluntary agency which provides psychotherapy or counselling services.
• Extending the use of psychotherapeutic skills in your existing job, if this is appropriate.
• Completing an evidence-based training course which suits your individual learning style and preferred approach to therapy.
• Entering related professions in the statutory sector, for example, in health care or social work. However, the dominant models of helping in these areas can conflict with the nature of psychotherapy. For example, see how psychotherapy is not like medicine.
• Finding placement opportunities for supervised practice with a good cross-section of clients.
• Being guided by an experienced mentor.

Research has proven that not only do therapists need zeal for their therapy, but also they need flexibility to accommodate the client's unique worldview and ideas about change. However, most training courses still reflect the traditional 'orientations' or schools of therapy, which place undue emphasis on only one or two models of psychotherapy and their prescribed therapeutic techniques. Several of these schools evolved more because of having forceful figureheads and skilful marketing than achieving good results for clients. At another extreme, there are gimmicky therapies in vogue, usually with the false allure of obtaining "faster, better results" using special techniques. See Miller, Duncan & Hubble (1997) for a review of the situation. Unfortunately, at the present time there are very few training courses available which can be endorsed as truly evidence-based, emphasizing the importance of the common factors to outcome. (The Heroic Clients, Heroic Agencies manual is a rare exception.) Finally, psychotherapy is very much a practical vocation and no amount of academic study can compensate for a lack of natural aptitude or insufficient experience of counselling real people.

When considering a training course, you can ask:

• Does the content take account of the current best evidence about "what works" in therapy?
• Does the content reflect the relative importance of the common factors to outcome?
• Does the course give priority to the aims of achieving and sustaining good outcomes for clients?
• Does the course's therapeutic approach recognize the importance of the individual client's feedback?
• Does the course favour the experience of real client work over academic work?
• Is the course's therapeutic approach congruent with your own philosophy of therapy?
• Does the presentation of the course fit with your own style of learning?
• Have the course's presenters established their own integrity and competence with clients?
• Does the course provide trainees with appropriate mentoring and supervision for client work?

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Last updated 26 May 2005