Mental Health blogs /

Counselling,CBT and Psychotherapy: Senior Psychiatrist Explains



Terms counselling, psychotherapy, CBT and therapy (and counsellor, psychotherapist and therapist) are often used interchangeably but should not be. It confuses people Counselling is directive approach mostly addressed to here and now situations. It often includes directions on how to sort out relationship difficulties which are ongoing but can include other ongoing difficulties like with colleagues at work. Psychotherapy is based on the premise that roots of current psychological problems lie in conflicts in distant past, often during childhood and psychotherapy is to that extent exploratory in nature. It takes longer than counselling and the aim is slowly building an insight enabling the client to see his specific present problems in the light of conflict often forgotten. It is a much less directive process. It is more of a nudging rather than 'do this or do that'. Cognitive Behaviour Therapy aims to correct distorted cognitions like in persons with mild depressions, OCD and phobias. 'Therapy' is a generic term which obfuscates more than it clarifies. It can include all of the above but also things as diverse as music therapy and aroma therapy which are relaxing but have no evidence base for sustained improvement. Therapy and counselling are formal treatment processes and should happen in formal treatment settings. Friends/ family members cannot be objective, they are too invested and they cannot do counselling. Their advice is is friendly advice which can be helpful in a crisis, but must lead to formal treatment. With counselling and therapy becoming fashionable terms there is a mushrooming of people trying to do it since there is no clear cut regulatory frame work in place. The ease of online counselling has muddied the field further. Do your research, find a qualified person who has a proper office. It is a good idea to have at least first few sessions in person, in an office, before shifting online. Ostensibly, to destigmatise the process and to make you feel 'comfortable' people are even willing to talk to you in cafes. Please donot do it. The person sitting in front of you is probably less qualified than you and certainly has no idea about what psychological treatment is. Also it is not safe. You do not want a proven boundary violator to treat you and have access to your intimate secrets. Informal psychological treatments, with therapists becoming friends belong only in the movies and are a scam. Professional psychotherapy discourages any interaction between a psychotherapist and a client outside a pre-fixed session, except in an emergency. Professional counsellors and psychotherapists are there to steer you at a vulnerable time in your life with your interests paramount. But they are not your friends in the usual sense. Those you have already tried.



Written By Dr. Jash Ajmera