What’s the difference between a Psychologist, a Psychiatrist, a Counsellor and a Coach?

Do you need a Clinical Psychologist in Birmingham?

It can be confusing to navigate the different types of mental health and wellbeing practitioners, making it difficult to decide which one to go with. They all seem similar, and they all help with life’s challenges, but what are the differences and who is right for you?

In this article, I will focus just on the differences – between psychologists, clinical psychologists, psychiatrists, counsellors and coaches. I will look at the educational pathways, how each is accredited and regulated (or held to account if something goes wrong), and the sort of treatment each tends to offer.

This article is meant to be a comprehensive but simple account of the differences for the general public. Also, it presents a UK view of training, regulation, and accreditation vary between countries.

The following table summarises the differences between the different professionals.

You may be surprised to know that anyone can call themselves a psychologist. There is no regulation of this title.

Typically, a psychologist is recognised as someone who completed an undergraduate degree in psychology and pursued a career in psychology. Training takes 3 to 4 years full-time, and the course quality is accredited by the British Psychological Society (BPS). The BPS accredits all UK Psychology undergraduate courses.

There are many different areas that a psychologist can decide to specialise through extra professional qualifications; these include:

• Clinical psychology
• Counselling psychology
• Occupational psychology
• Forensic psychology
• Educational psychology
• Neuropsychology

Traditionally, Clinical Psychologists tended to occupy the space that several other specialisations now occupy. The reasons are historical, in that Clinical Psychology was one of the first established specialisation pathways and remains a robustly comprehensive training pathway with a diverse career pathway. One will still find Clinical Psychologists working across the spectrum of the different specialisations.

Nevertheless, one can assume that different specialisms lead to distinct areas of expertise. For example, mental health (clinical), wellbeing (counselling), workplace (occupational), criminal justice system (forensic), child development (educational), and brain injury (neuropsychology).

In this article, I will focus on the role of clinical and counselling psychologists as these tend to be most commonly encountered by people seeking help for mental health problems.

Most psychologists choose to register with the BPS after they finish their undergraduate training. Registering with the BPS is not required to practice, but it means that the Psychologist will have to abide by the BPS code of ethics and practice.

The BPS code of practice sets specific expectations about how a Psychologist should behave, both at work and outside of work, how much ongoing training to have, and sets high ethical standards for their work with patients.

When a Psychologist is registered with the BPS and has achieved a level of experience in applied practice, they can call themselves a “Chartered Psychologist”. The BPS gives this title, and it’s based on the fact that the BPS operates under a Royal Charter, similar to the Royal College of Psychiatrists, Royal College of Nursing.

These are all titles that show a psychologist’s seniority and reflect the NHS competency framework for psychologists. A newly qualified psychologist doesn’t have an additional title, demonstrating both lacks of experience and seniority. As they become more experienced and take on additional responsibilities (e.g. supervise other psychologists, manage smaller services, run more substantial complex services), they progress to Senior, Principal and Consultant levels.

To achieve the title of Consultant, a psychologist’s competency should be assessed by the BPS through a formal process. However, unfortunately, this does not always happen nowadays, especially for psychologists who work in private practice. You can assume that a psychologist has achieved the level of competence reflected in their additional title if they have had a paid post at that level.

Clinical psychologists are mental health professionals who completed an undergraduate psychology degree. They completed a preceptorship in Clinical Psychology, plus three years of intense doctoral training. Clinical Psychologists focus on the psychological, social and biological factors that impact mental wellbeing. They are trained to work with children, adults, older adults and people with learning disabilities. Clinical Psychology remains the only discipline in Psychology that teaches practitioners by design how to support mental health across the age span.

Clinical psychologists apply a wide range of evidence-based (that is, research showed these to be effective) methods to treat mental health difficulties. They combine effective treatments, such as Cognitive Behavioural Therapy (CBT) and Systemic Family Therapy, with current research findings to develop individualised courses of treatment for mental health problems of varying complexity.

Their training at a doctoral level included conducting vigorous research. This is important because it trained them to tell which academic research findings will be most applicable to the unique individual needs of their patients. Then, only the appropriate research recommendations can be combined with existing psychological theory to create custom interventions for patients.

Due to their ability to combine new research with existing evidence-based therapies and psychological theory, Clinical Psychologists are also called (Reflective) Scientists-Practitioners.

As a result of their extensive training and experience, the NHS has traditionally referred to Clinical Psychologists, those with the most complex mental health difficulties, even though they are trained to work with all mental health difficulties.

Clinical psychologists have a protected title. This means that they can only call themselves a “Clinical Psychologist” if they completed accredited doctoral training. They must also be registered with the Health and Care Professions Council (HCPC), the regulatory body for the profession. The HCPC provides licenses for Clinical Psychologists to practice. It also keeps Clinical Psychologists ‘in check’. This reassures you that if something goes wrong and there are serious concerns about your healthcare professional’s practice, action can be taken. Action can lead to loss of license to practice and their ability to call themselves a Clinical Psychologist. It is illegal for someone to call themselves a Clinical Psychologist if they don’t have the required training and registration with the HCPC. In practice, this means that a prospective client has an assurance of quality under the oversight of UK law when they see a Clinical Psychologist.

Similar to clinical psychologists, Counselling Psychologists also need to complete an accredited psychology degree. Some proceed to complete doctoral training that is different from that achieved by Clinical Psychologists. In their work, Counselling Psychologists also use psychological theory and research to help children, adults, families, couples and groups with a range of challenging life issues and mental health conditions.

However, counselling psychologists are more likely to work with individuals who have fewer complex psychological problems and may be struggling with challenging life issues, such as bereavement or relationship difficulties. Counselling psychologists must adhere to a code of ethics of their respective professional bodies, and they are also required to register with HCPC to practice. This means that a government-appointed institution can remove their license and stop them from practising or calling themselves a Counselling Psychologist.

Psychiatrists are medical doctors, meaning that they completed a medical degree followed by further specialist training in psychiatry. Psychiatrists focus primarily on the biological factors that cause mental health problems, identifying them as illnesses. They receive little training in delivering talking therapies. When it comes to treatment, psychiatrists provide primarily medical advice and prescribe medication (or pharmacological treatment) to treat mental health problems of varying complexity.

Similar to Clinical Psychologists, Psychiatrists’ title is also protected. This means that it is illegal to call yourself a Psychiatrist if you don’t meet a specific set of requirements set by the Royal College of Psychiatrists. Psychiatrists need to be registered with the General Medical Council to practice and treat clients. The consequences of malpractice can involve a psychiatrist being struck off the medical register by the General Medical Council, leading to them being unable to practice medicine.

Both Psychiatrists and Clinical Psychologists can diagnose mental health problems.

Counselling Psychologists and Counsellors are different. Confusingly, anyone can call themselves a counsellor, but it is usually someone who has completed a course in counselling. These courses can be full-time, part-time, accredited or not and vary in duration, method and vigour. They can be short online courses lasting a few hours to years-long face-to-face courses.

Generally, counsellors receive less formal (e.g. not at university level) training than clinical psychologists, psychiatrists and Counselling Psychologists.

Counsellors actively listen to clients, offering them time to reflect, empathy and space to talk about their issues and problems. The aim is to help the client achieve their own realisations. Then, the clients can make positive changes to their lives. Many counsellors are non-directive during therapy, even though this is not the rule. Being non-directive means that they avoid giving advice or train clients in specific coping skills. Counsellors are not qualified to treat significant mental health difficulties. They typically refer those clients to Clinical Psychologists and Psychiatrists.

Unlike Clinical Psychologists and Psychiatrists, Counsellors do not have to register with a regulatory body. This profession is not regulated by law. However, many counsellors have been accredited by a professional organisation like the British Association of Counselling and Psychotherapy (BACP). The accreditation means that they have to abide by the code of practice of that association. However, their professional bodies have limited powers to hold them accountable for any misconduct because of the lack of a legal framework. This means that even if accreditation is withdrawn, a counsellor can continue to practice and call themselves a counsellor. Registration with a professional body can demonstrate competency to help with mild to moderate mental health and life issues.

 Similar to Counsellors, confusingly, anyone can call themselves a Coach. There is no formal training required, even though there is an increasing number of accredited coaching courses available. Like counselling courses, the length and quality of training can vary significantly.

Coaches tend to focus on the ‘here and now’ and typically help achieve goals specific to your personal life and professional career.

Coaching can help you explore what you want in life, how you might achieve your aspirations, and fulfil your needs. Coaching is about bringing out the best in you and inspiring you to act on your potential. Coaches don’t typically have any training in mental health issues and should, therefore, not try to treat people with mental health difficulties.

There are two broad types of coaches:

• Executive: They have in-depth knowledge and experience in a business area. For example, entrepreneurship and could help individuals in practical as well as emotional aspects of their development.
• Life: They receive specific training in coaching and support people in achieving goals relating to their personal lives.

Since coaching is less established and unregulated, so, there is much variability in the level of experience and knowledge between coaches.