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 a counsellor works in a holistic manner with the person who walks into the room. 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. But with psychologists that you might be seeing on a Mental Health plan, you have a limited number of sessions with them that Medicare will pay for. After that you are up for the $200+ fee per session yourself.
As a rough guide, you would probably see a counsellor for a few sessions, and a psychologist or psychiatrist for personal challenges that appear to be taking longer to fix. But having said that, I have clients that have been seeing me weekly for over a year.
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.
