The difference


A client asked me the other day what the difference was between a psychiatrist, psychologist and me, a counsellor.

I answered that a psychiatrist is interested in the medical model and is the only one, apart from a GP, who can prescribe drugs. A psychologist works by seeing if you fit into a diagnostic ‘box’ and then working you as if they were working from an agenda. A counsellor works in a holistic manner, within the agenda of the person who walks into the room, and in a tailor-made fashion. Both psychiatrists and psychologists are only likely to see you once a month, whereas a counsellor will probably be able to see you more often than that. Also, you don’t get a Medicare rebate with counsellors whereas you do with psychiatrists and psychologists.

This Medicare rebate stuff is important. If you see your GP and get a Mental Health Treatment Plan, you can see a psychologist a maximum of six times, after which you either get another four sessions or you have to pay the psychologist the full $200+ fee per session. As it is, you will likely have to pay a gap between what Medicare pays the psychologist and what the psychologist charges; this is usually around $60-80 per session.

I work from a Solution-Focused perspective, which is a strengths-based way of looking at a person. Sharry, Madden and Darmody (2012, p. 10) drew up the following table to reflect the differences between a solution-focused therapist (of which I am one) and problem-focused therapists (irrespective of whether they are psychiatrists, psychologists or counsellors):

‘Problem detective’ ‘Solution detective’
Looks for ‘clues’ that will reveal deeper problems and diagnoses Looks for ‘clues’ that reveal hidden strengths and positive possibilities
Tries to understand fixed problem patterns in the client’s life Tried to understand how positive change occurs in the client’s life
Elicits detailed descriptions of problems and unwanted pasts Elicits detailed descriptions of goals and preferred futures
Interested in categorising problems and applying diagnoses Interested in the person ‘beyond the problem’ and in the unique story he or she has to tell
Focuses on identifying ‘what’s wrong’, ‘what’s not working’ and on deficits in individuals, families and communities Focuses on ‘what’s right and what’s working’ and on strengths, skills and resources in individuals, families and communities
Interprets and highlights the times the client ‘resists’ or is inconsistent in his or her responses Highlights and appreciates any time the client co-operates or goes along with the therapist’s questions
Explores how trauma has affected or damaged the client Explores how the client has coped with trauma and how he or she has survived its damaging effects

Source: Sharry, Madden and Darmody (2012). Becoming a solution detective (2nd Ed.). New York: Routledge.

Contact me if you’d like to know more.