Counsellor, psychotherapist or psychologist: what's the difference in the UK?

In the UK, counsellors and psychotherapists both offer talking therapy, and the two titles overlap a great deal; psychotherapists often (but not always) have longer training. Psychologists, by contrast, usually hold a psychology degree followed by doctoral-level training, and certain psychologist titles are protected by law and regulated by the Health and Care Professions Council (HCPC). Counselling and psychotherapy are not statutorily regulated, so the best safeguard is to choose someone on a register accredited by the Professional Standards Authority, such as the BACP, UKCP or NCPS.

Key points

• Counselling and psychotherapy overlap; the difference is often depth of training rather than a completely different job.
• Titles such as clinical psychologist and counselling psychologist are protected by law and regulated by the HCPC.
• "Counsellor" and "psychotherapist" are not protected titles, so check for membership of a PSA-accredited register (BACP, UKCP or NCPS).
• In England you can self-refer to NHS Talking Therapies for free psychological support.
• Whoever you choose, the relationship and sense of fit matter a great deal.

What does a counsellor do?

A counsellor offers a confidential space to talk through what is troubling you, whether that is anxiety, low mood, a loss, a relationship difficulty or something you cannot yet name. Counselling is sometimes described as shorter-term and more focused on present difficulties, but in practice many counsellors also work longer-term and explore patterns from the past.

Counsellors in the UK typically train through a diploma-level course (such as a Level 4 Diploma in Therapeutic Counselling) or a degree, which includes supervised client placements and personal development work. Many then join a professional body such as the British Association for Counselling and Psychotherapy (BACP), which sets ethical standards and requires ongoing supervision.

I am an integrative psychotherapist and a registered member of the BACP. Integrative means I draw on more than one approach (in my case person-centred, CBT-informed and psychodynamic ideas) and adapt to the person in front of me rather than applying one fixed method.

What does a psychotherapist do?

A psychotherapist also offers talking therapy, and many people use the words counselling and psychotherapy interchangeably. Psychotherapy training is often longer and may go into more depth on a particular model, for example psychodynamic, psychoanalytic, humanistic, systemic or integrative psychotherapy. Some psychotherapists work with more complex or long-standing difficulties, and some work in an open-ended way over months or years.

Because the title "psychotherapist" is not protected by law in the UK, it is worth checking that a psychotherapist is registered with a recognised professional body, such as the UK Council for Psychotherapy (UKCP) or the BACP.

What does a psychologist do?

Psychologists study how people think, feel and behave. Not every psychologist offers therapy: some work in research, education, workplaces or the courts. Those who do offer therapy are most often clinical psychologists or counselling psychologists.

Clinical psychologists

Clinical psychologists usually complete a psychology degree, gain relevant experience, and then train on a doctorate in clinical psychology. They often work in the NHS, carrying out assessments and offering therapy for a wide range of mental health difficulties, and may contribute to diagnosis and care planning within a team.

Counselling psychologists

Counselling psychologists also train to doctoral level, with a particular emphasis on the therapeutic relationship and on personal therapy as part of their training. They work in the NHS, in private practice and in other settings.

What about psychiatrists?

Psychiatrists are medical doctors who have specialised in mental health. They can diagnose and prescribe medication, and they are regulated by the General Medical Council. You would usually see a psychiatrist through a referral from your GP.

How is each one regulated?

This is where the differences are clearest. Practitioner psychologists are regulated by the HCPC, and titles such as "clinical psychologist", "counselling psychologist" and "practitioner psychologist" are protected by law. Someone using one of these titles must be on the HCPC register, and you can check this on the HCPC website.

Counselling and psychotherapy are not statutorily regulated in the UK. In principle, anyone can call themselves a counsellor or psychotherapist. To address this, the Professional Standards Authority for Health and Social Care (PSA) runs an Accredited Registers programme. Professional bodies such as the BACP, UKCP and the National Counselling and Psychotherapy Society (NCPS) hold registers accredited under this programme. Being on one of these registers means the practitioner has met training standards, agrees to an ethical framework, has regular supervision, and can be held to account through a complaints procedure.

How do I choose the right person?

For many common difficulties, such as anxiety, low mood, stress, grief, relationship difficulties or low self-esteem, a qualified, registered counsellor or psychotherapist may be a very good fit. You might lean towards a psychologist or a specialist service if you need a formal assessment, if your difficulties are complex and affecting many areas of life, or if you want a particular specialist treatment.

Some questions you might ask yourself:

• Am I looking for space to talk and make sense of things, or for a specific structured treatment?
• Do I need a diagnosis or formal assessment, or is that not important to me right now?
• Would I prefer to meet online, in person, or have the option of both?
• What can I realistically afford, and for how long?

And some questions to ask the practitioner:

• Which professional body are you registered with, and can I check that register?
• What is your training and how do you work?
• Do you have experience with what I am bringing?
• How long do people usually see you for, and how much does it cost?

What does it cost, and can I get help on the NHS?

In England, you can refer yourself to NHS Talking Therapies for free psychological support for common problems such as anxiety and depression. You do not always need to see your GP first; you can usually self-refer online through your local service. Waiting times vary by area, and the type and number of sessions offered are decided by the service. Your GP can also refer you, and may refer you to other NHS mental health services if your needs are more complex. Arrangements are different in Scotland, Wales and Northern Ireland, so your GP is a good starting point there.

Some charities, universities and workplaces (through employee assistance programmes) also offer free or low-cost counselling. Private therapy costs vary depending on the practitioner, their training and where they work. If you are considering private therapy with me, my fees are listed openly.

Why does the relationship matter so much?

Whichever title someone holds, the quality of the relationship between you and your therapist is one of the most important parts of therapy. Feeling safe, listened to and not judged is what makes it possible to talk honestly about difficult things. It is completely reasonable to have an initial conversation with more than one practitioner before deciding, and to say so if something does not feel right once you have started.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If you are wondering whether therapy might suit you, you are welcome to get in touch to book an initial consultation. We can talk about what you are looking for, and if I am not the right person, I will do my best to point you towards someone who might be.