Therapy vs. counseling: Is there a difference? Which is right for you?

The terms “therapy” and “counseling” are often used interchangeably, but there are some differences between the two:

How counseling and therapy are similar

Psychotherapy and counseling are both treatments for mental health problems that involve talking with a trained mental health professional. You talk about thoughts, feelings and behaviors to understand them better and work in a collaborative way to promote mental wellness. The term psychotherapy is often used interchangeably with counseling, talk therapy or therapy. There can be a lot of overlap between psychotherapy and counseling.

How they’re different

Broadly speaking, counseling tends to be focused on one specific issue and considered a short-term treatment. You may learn coping techniques and problem-solve the issue together. Psychotherapy tends to treat a broader range of issues and more complex problems. It can be a long-term treatment.

Depending on the type of psychotherapy or counseling offered, goals can include helping people learn to cope with and better manage their responses to life's stresses, understand and change patterns of behavior that get in the way of their personal goals, have more satisfying relationships and feel more fulfilled.

What type of therapy is best for you?

If you’re trying to figure out where to start, it's helpful to reflect on your current difficulties and what you’re expecting from treatment before you get started.

Additionally, you can read about the different types of therapies available. Some therapies are better suited for certain conditions than others. Looking up the mental health professional's profiles to see their areas of expertise and training can also help determine who may be a good fit.

Types of therapy

There are many different types of psychotherapy available, so reading about the types of therapies out there can help:

• Cognitive behavioral therapy (CBT) focuses on exploring a person's thoughts, feelings and behaviors. During CBT, a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors, and then help change those harmful thinking styles and behaviors.
• Psychodynamic therapy is a talking treatment based on the idea that thoughts and feelings you may not be aware of can cause problems such as anxiety, depression, poor self-esteem and difficulty with relationships. The therapist helps a person become more aware of their unconscious thoughts and feelings and develop healthier ways of dealing with their painful thoughts and feelings. The goals of treatment include improving how one feels about oneself, how one relates to other people and how one copes with stress.
• Dialectical behavioral therapy (DBT) was originally developed to treat chronically suicidal individuals with borderline personality disorder (BPD). Over time, DBT has been adapted to treat people with multiple different mental illnesses, but most people who are treated with DBT have BPD as a primary diagnosis. The therapy focuses on mindfulness, distress tolerance, regulating emotions and developing interpersonal skills.
• Interpersonal therapy focuses on the relationships a person has with others, with a goal of improving the person’s interpersonal skills.
• Mentalization-based therapy helps people develop the skill of mentalizing, which means perceiving and understanding their feelings and considering the feelings of others. Mentalization-based therapy (MBT) can bring long-term improvement to people with borderline personality disorder.

Which mental health professional can help?

There are several different types of mental health professionals who can provide psychotherapy:

• A psychiatrist is a medical doctor who specializes in diagnosing and treating mental illness, including prescribing medications. Some psychiatrists provide psychotherapy as part of their treatment, but some will refer the person to another mental health provider for this treatment.
• A psychologist has a doctoral level of training in psychology and able to diagnose and treat mental illness, perform psychological testing and provide psychotherapy.
• A licensed social worker has, at minimum, a bachelor's level degree in social work while a licensed independent social worker has at least a master's degree with two years of supervision. They’re trained to diagnose and treat mental illness, provide psychotherapy, advocate for patients, perform discharge planning in the hospital and provide case management.
• A licensed professional clinical counselor has, at minimum, a master's degree in counseling, psychology or a related field, followed by two years of supervision. They’re trained to help people identify goals and potential solutions to emotional problems, improve coping skills, self-esteem and promote behavior change.
• A licensed marriage and family therapist has a master's or doctoral degree in marriage and family therapy and at least two years of clinical experience. They’re able to diagnose and treat mental disorders within the context of marriage, couples and family systems.
• A psychiatric or mental health nurse has specialized training in mental health. Depending on their level of training and certification, they can evaluate for mental illness and may provide psychotherapy.

Tips for finding a counselor or therapist

• Talk to your primary care doctor to ask for a referral or list of options.
• Talk to people you know who are already in therapy to get recommendations for a therapist. You can learn what they like or don’t like about their current therapist.
• If you plan to use insurance, look up the providers covered under your plan. Find out how many sessions are covered per year and what’s covered by the insurance.

Useful websites to use during your search

• Psychology Today's therapist search
• American Psychological Association
• American Psychiatric Association
• American Association for Marriage and Family Therapy
• National Board for Certified Counselors

Sometimes it can take up to a few sessions to know if it will be a good fit with your therapist. You want to feel comfortable speaking freely about your concerns, be able to trust your therapist and feel that they’re working with you in a collaborative way.