Although I was certainly aware that the term ‘counselling' was being used to describe a variety of situations (as in ‘counselling for medical/engineering admissions'), I never realised that it had entered popular imagination so strongly until I encountered a teenager who told me she had tried her best to ‘counsel' her parents to fight less with each other, but it hadn't worked. After this, perhaps because my mind was tuned to it, I kept hearing other people using the term in the course of normal conversation. Everybody, it seemed, was counselling everybody else. And enjoying themselves thoroughly. Until, of course, they realised that the ‘counselling' was not helping and that they perhaps required ‘professional help' (a scary term implying that one has gone beyond the realms of normal behavioural variances). Then the questions began. Is counselling enough or do I need psychotherapy? Who is a professional counsellor? Should one see a psychiatrist? Or, a psychologist? Or...?
Different approaches
First off, let's examine the issue of counselling vs. psychotherapy. Typically, psychotherapy is a set of interventions offered by a psychotherapist (or simply, therapist) who is intensively trained in one particular theoretical orientation, such as psychodynamic, systemic, gestalt, cognitive-behavioural and so on. (I am excluding psychoanalysis from this discussion since it is a much more involved form of psychological intervention and is quite different from counselling and psychotherapy). Counselling, on the other hand, refers to a more generic and eclectic process, although some counsellors are affiliated to a particular theoretical orientation. It's not as if one is better than the other, it's just that they are slightly different in their approaches, and the intensity of the training requirements are also not the same. However, in our country, for all practical purposes, the terms psychotherapist and counsellor are used pretty much interchangeably and it hardly matters what you call the person sitting across you and encouraging you to share every little detail of what is bothering you.
Just to give you some perspective on the different kinds of mental health professionals available out there, a psychiatrist is a medical professional who undertakes post-graduate training in Psychological Medicine (a psychiatrist would hold either an MD degree, a DPM or both) and is licensed to prescribe medication. In general, the large bulk of psychiatrists in the country practise or work in medical settings where they deal with severe mental disorders like schizophrenia etc. However a small number of them, yours truly included, work in the field of psychotherapy and counselling as well. Although most people who've obtained a bachelor's or masters degree in psychology can be called psychologists, when it comes to counselling, it is the clinical or counselling psychologist, a person who has a M.Phil. or doctoral qualification in the field of clinical and/or counselling psychology, whose help one needs to seek. Clinical and counselling psychologists cannot prescribe medication, and most work in the fields of psycho-diagnostics (doing psychological or psychometric tests to aid in diagnosis), counselling and psychotherapy.
A psychiatric social worker is a person who has done a masters or doctoral degree in medical and psychiatric social work. Basically a psychiatric social worker is more oriented to the social aspects of psychological problems, although a few of them also do work in the fields of counselling and psychotherapy. Then you have the trained counsellor who, more often than not, has an educational background in psychology and has earned a degree or diploma in counselling after undergoing specialised training in recognised training centres. This kind of professional is not to be confused with the lay counsellor who usually does not have a formal background in psychology, but has been trained in basic counselling skills for a one to six month period and can provide counselling ‘first-aid', if you will. These apart, you have a whole bunch of not-necessarily-trained counsellors who usually use conventional wisdom or engage in more esoteric interventions like hypnotic regression and so on.
Wide choice
So, that's the menu available today to whoever wants to be counselled. A fairly wide array of professionals, you might think, but the unfortunate part is that none of them is really licensed to practise counselling (only psychiatrists, being doctors, require a medical licence, but this is primarily for administering medical care). This means there is no overseeing body that monitors quality, redresses grievances and mandates refresher education, even though, most trained professional counsellors are affiliated to their respective professional associations and get the benefit of continuing education and skill upgrades.
How does one then choose a counsellor? For a start, asking around is not a bad idea. If you've nobody to ask, try your family doctor. If you don't have one, I guess Google or the yellow pages are your only option, but have a chat with your potential counsellor before you make a commitment. As long as the person is a trained professional (as described above), from a recognised training facility (medical college, PG medical training facility, university department, school of social work or counselling training centre) and you feel comfortable with the counsellor, you're probably okay. But do remember that bad counselling can damage the mind as much as a quack can the body. So, some time invested in choosing your therapist will be well worth the trouble.
The writer is the author of The Fifty-50 Marriage: Return to Intimacy and can be contacted at vijay.nagaswami@gmail.com.
