#Counseling Isn’t #Psychotherapy

Many folks, including some clinicians, use the terms counseling and therapy as if they are interchangeable. Many clinicians engage almost exclusively in the use of counseling techniques and mistakenly call what they do as psychotherapy. This is a serious pet peeve of mine. Okay, not really a pet peeve as much as something I consider outrageous and inappropriate and ultimately a dangerous misrepresentation of education/skill/technique level.

Counseling has as its goals to support and validate, to provide advice, suggestions, and resources, and to offer motivation for change. Those things are great. But they are not therapy. And we should not pay therapy prices for them.

Counseling is something we can often get from friends or family, or even from ourselves through journal writing, meditation or a long walk in the words. When in crises with a particular issue, like domestic violence, or a cancer diagnosis, a recent death of a loved one, or desired career change, we might benefit from seeking out professional counseling by a specialist, frequently in an agency setting, and at an agency price. This won’t result in alterations in how we see ourselves, the people in our lives or our world, but it can help support us through a difficult time when we need to make some quick decisions.

Some therapists offer/use some counseling techniques in sessions with clients, but for the goal of furthering the therapy work.  But when used routinely, counseling skills actually interfere with therapeutic goals.

Here are some of the tactics used by counselors, and why they don’t work so well in therapy.

• Advice
  is best received from seriously wise people. It is not the job of a therapist to be a fountain of wisdom. We often know little about how our therapist lives their life. If we are to seek out advise in life, it should be from folks whose lives we have seen and admire.
• Validation
  also assumes the therapist is somehow an anointed arbiter of correctness and can determine from on high what is right for us to do or feel or be. We should never let anyone have that version of power over us.
• Motivation
  is great. But when a therapist becomes our cheerleader, it frequently backfires, as our cheer moves out of us and into them, leaving us with less motivation the more they amp theirs up. (This happens through a process related to Splitting and Projective Identification, which hopefully I will write a blog about soon, but in the meantime, trust me!) This happens with Hopefulness too, which can leave clients in a seriously compromised and hopeless place.

What does good psychotherapy contain?

• Supportive, containing environment:
  This isn’t an end goal though; it is a means to many different goals. It is intended to help us tolerate seeing things about ourselves that we are actively defended against seeing; aspects of ourselves, our lives, our parents, our partners, that we turn a blind eye to, cloak in personally-designed attire to avoid facing. It is intended to help clients over time who have a limited capacity for internal containment to develop a stronger, less constricting way to hold their internal truths, so they are less frequently flooded or shut out of their emotional world.
• I spy with my little eye:
  We can’t rely on therapists to be fountains of wisdom. What we should be able to count on is that they are trained and attuned to noticing/reading language, behaviors, dreams , patterns, inconsistencies, associations, absences, gestures, shifts in mood and speech, etc. that can alert us to information our unconscious might have about what it ailing us.
• Ambassador of the Unconscious:
  A well-educated psychotherapist knows a thing or two about how the unconscious operates and can help us to learn its ways, decode its messages, listen to its urgings. This is not so that our unconscious can become our master. Quite the opposite; it is so that we can have open dialogue with our unconscious instead of having it insert itself, unbeknownst to us, because we are not listening to its needs and truths.
• Courage and History:
  One of the ways people mock therapy and therapists is noting the most therapists have had a dark journey of their own at some time in life. Well I would hope so! First of all, if you don’t think therapy is a good tool for yourself, why would you think it a good tool for others? Others need it but you don’t? Ick. I would never see a therapist who did not value therapy for themselves. And also, if a therapist knew nothing of the terror of facing darkness they had kept buried away, what good are they? A therapist is someone how has traveled a journey of self-discovery, and has found courage they later chose to share with others as well. Sessions are intense for therapists as well as clients, but good therapists are one who know the value, from personal history, of facing whatever truths have to be faced, with boldness, and courage. They know about pitfalls and how to avoid them, supports and resting places along and about lots of ways to get out when it is time.
• Multi-genre Dance Archeologist:
  Okay, this is a hard one to explain in a paragraph, but here I go. I know sometimes people wish our childhoods and our family of origin wasn’t viewed as so key in therapy, but here is the deal. By engaging with us in very specific ways, and engaging with others and each other in very specific ways, our parents teach us a handful of “dances”. These dances are so deeply ingrained in our psyches, we don’t even notice what moves we are making, and that we are even engaged in a dance, much less that there are tons of other dances we could do instead. As we enter adulthood we do our dance, which is a combination of the dance each of our key people did with us, and the dance the adults in our lives did with each other, and go about to find partners who do a dance similar to ours. Then we dance with those partners, get into fights about the slight differences in our dances, and slowly teach them to dance like us and us like them until we have finally successfully created an eschewed version of whatever dance we had hoped we would never do again once we grew up. Good times.I am not going to try to explain here how we manage to find and teach partners our dance, but here is what a good psychoanalytically oriented psychotherapist does capably. We can feel the push of our clients’ dance moves. We can try on the complimentary dance moves inside ourselves. We can reflect upon them with our client. We can stay aware of the pressure to do our clients dance, and suggest other possible dance moves until our client starts to understand that they are at choice about what kind of dance they want to do, but only once grabbling with each ingrained, assumed step.

Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.

If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists' personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.

For posts on similar topics, follow the links below:

How Does Psychotherapy Help?

Listen to Your Unconscious (a video blog)

Up-Selling Psychotherapy: Are Therapists Even Allowed to Do That?

Author

Karen L. Smith MSS LCSW Karen is the founder and director of Full Living: A Psychotherapy Practice, which provides thoughtful matches for clients seeking therapists in the Philadelphia Area. She provides analytically oriented psychotherapy, and offers education for other therapists seeking to deepen and enriching their work with object relation concepts.