Psychotherapy vs Counselling
Maslow said the territory is bigger than the map. Counselling and psychotherapy are both maps of the same territory, but they cover different ground, at different scales, with different instruments.
Counselling is almost always focused on something specific: addiction counselling, eating disorder counselling, bereavement counselling, couples counselling. The presenting difficulty is named, and the work organises itself around it. For many people, in many situations, that is exactly what is needed.
Psychotherapy begins from a different premise. The person arriving often cannot name a single thing that is wrong. There is a sense of unease, with themselves, with their relationships, with the life they are living. Something is not working, but it resists a label. Or the label has been applied, and the treatments designed for that label have not held. The symptoms have shifted. The territory keeps moving.
Psychotherapy works at the level of structure rather than symptom. It is concerned with why the same patterns recur (in relationships, in behaviour, in the way a person relates to themselves) and with what it would take to change them at depth rather than at the surface.
What I listen for
When someone arrives having completed a course of CBT and is wondering whether they need something different, I am listening to several things at once. I listen to what they are saying. I listen to how it is landing in me, what the account of themselves produces in the room. And I listen to what they are not saying. Do they have friendships? Do they have things they do for pleasure? The absences in a person’s account of themselves are often as significant as what is present.
CBT is a powerful instrument for behavioural change. But it works primarily on the surface. The clearest illustration of this is in eating disorders: a person comes with anorexia, completes CBT, and returns a few years later with bulimia. The symptom has mutated. The underlying structure was never addressed. A symptom displaced is not a symptom resolved.
Different tools for different jobs
Counselling and psychotherapy overlap. There are counsellors who do genuinely deep psychological work, and psychotherapists whose practice does not extend far beyond structured support. The title does not always tell you what you are getting.
What matters is the fit between what a person needs and what the work can offer. You cannot do every job with a hammer. The question is not which is better. The question is which is right for what you are trying to do.
If you are deciding between the two, Dr Philippe Jacquet is a psychotherapist in London offering sessions in person and online.
Not sure which you need? Arrange a confidential consultation and we can work out the right fit together.