What is the difference?

There isn’t a clear or unanimous answer to this question because people (including psychologists and psychotherapists) often apply their own idiosyncratic definitions to these words. All psychotherapy is psychological work. All applied psychology (work with patients as opposed to e.g. research or corporate work) is a form of psychotherapy. Hence the understandable and enduring confusion, especially amongst the general public. Here are a few facts that will help tease these two terms apart. I will also explain the limited but real value in using these terms differentially, and then explain how and why I differentiate the two when explaining my own practice.

A psychologist is a legally-protected term. That is, only registered psychologists can legally claim to be psychologists. It is a profession which is regulated by the Australian Health Practitioners Regulation Agency (AHPRA). You can confirm that a psychologist is registered via the AHPRA website. It takes a minimum of 6 years full-time training to quality as a registered psychologist.

Psychotherapy is a broad term that can be used to refer to any type of psychological work between patient/s and therapist. The term is not protected by the law hence anyone can call themselves a psychotherapist. You can confirm that a psychotherapist is qualified by asking about their credentials and then checking with the relevant professional body. Many legitimate psychotherapy courses have a website where you can confirm that a psychotherapist is a member. There are many schools of psychotherapy e.g. Gestalt, Transactional Analysis. Many practitioners have multiple qualifications e.g. may also be psychiatrists, social workers, psychologists.

Psychologists often continue to learn additional psychotherapeutic approaches following registration. They endeavour to convey this to their patients by using the two terms.

Some clinicians distinguish the terms psychology and psychotherapy based on the duration and frequency of sessions attended; Short-term work being referred to as psychology; long-term work with more than one session per week as psychotherapy. So a patient/client who attends 3 sessions per week over the course of years would typically be described as a person in psychotherapy whether working with a psychologist or any other type of psychotherapist.

In my practice

Psychology

In these days of Medicare rebates it makes some sense to distinguish between psychology and psychotherapy. Medicare rebates are limited to a maximum of 10 sessions per calendar year. Such time-limited work, partially funded by Medicare, is technically referred to as psychological services by the Australian government. There are clear guidelines on what therapeutic approaches can and cannot be used when accessing Medicare rebates. In my practice I call this type of work psychology. Many patients/clients choose to continue following their 10 Medicare-rebated sessions. At this point they may choose to continue to work in the same way (limited to Medicare-endorsed approaches) or they may decide to include other modes of psychological work.

Psychotherapy

The type of longer-term psychological work I practice is called psychodynamic psychotherapy. Patients have the option of sitting in a chair opposite me or lying on a couch facing away from me. They are invited to say whatever comes to mind. The reason for this is that whatever comes to mind is by virtue of its existence seeking attention. Things which “sit well” with us are mentally filed away or digested and therefore are no longer on our minds. Saying and hearing what comes to mind is a useful way to approach the area of concern/difficulty/blockage. It is like following a rivulet back to the main river. There may be parts of the way where damns need to be cleared, circuitous paths which frustrate, but progress is slowly made back to the source.

Use of the couch raises anxiety for some patients. The reason I use the couch is that, for some people, it makes saying what comes to mind much easier. Maintaining eye contact can be quite inhibiting for the patient. The couch can also be an advantage to the therapist in that their mind is free to solely concentrate on and think about what is being said. However it is not for everyone. The choice of chair or couch lies with the patient. It is not used for initial consultations or short-term work.

Short-term or long-term work

Some people want a limited number of sessions to help them work through a particular and circumscribed problem. The Medicare 10-session rebate has in some ways influenced peoples’ expectations of what can be accomplished in 10 sessions. Some people feel satisfied with 10 sessions, many decide to continue beyond the rebate allowance. You can decide as you progress.

Clearly, the longer the time spent in psychotherapy, the greater the amount of psychological terrain explored. Longer-term work gets more into long-held patterns which have become self-defeating and difficult to identify, understand and then transform. Shifting life-long patterns takes time: time to identify the pattern, to understand the pattern, to process the associated feelings which are released when a hitherto unconscious pattern is consciously recognized, and time to allow a new way of being to evolve.

A useful analogy is the cleaning-out of one’s house. Very short-term work can be compared to cleaning out a drawer or cupboard. Alternatively a whole room can be cleaned out, redecorated, or completely renovated. Further along the spectrum would be the decision to renovate a few key rooms of one’s house. On the far side would be the choice of a major renovation of the entire house or even a (slow and simultaneous) deconstruction and reconstruction. The more work we do on ourselves, the longer it takes.

Another useful analogy is the work involved in becoming an accomplished musician. It takes many years of practice and continually attending private lessons, at least once-weekly, to become an accomplished musician. In psychotherapy, we are not only endeavouring to evolve and assimilate new ways of being; there is the added task of identifying, unlearning and replacing old, unhelpful habits/patterns.