Counseling & Psychotherapy
Counseling has been shown to be more effective than medications in the treatment of post-partum depression. There are many types of counseling and psychotherapy. Knowing how each works might help you choose a counselor or therapist that best meets your needs.
Difference between counseling and psychotherapy
In the past psychotherapy was used in reference to a form of psychiatric treatment used for severely disturbed individuals, whereas counseling was used to refer to the treatment of people with milder emotional problems or to advice given on vocational or educational matters, but this is no longer the case.
Today the difference between psychotherapy and counseling has become blurred and these terms are often used interchangeably. Which term is used may depend on where you live; psychotherapy being a more popular term in the US and counseling being a more common term used in the UK.
To further add to the confusion, many people provide counseling. Informal counseling may be provided by persons without formal counseling qualifications. We tend to think of professional people as automatically providing professional counseling or psychotherapy; however this is not necessarily the case. Although many professionals such as clergy, nurses, doctors and teachers etc. receive some level of training to provide counseling, only a small number undergo the many years of additional training and clinical supervision required to provide professional counseling or psychotherapy.
Psychotherapy (professional counseling) is conducted by trained, certified or licensed therapists who specialize in providing this service i.e. counseling is not a side line service of their professional role, counseling is the primary focus of their professional role.
Many people who claim to provide counseling are in fact providing consultation i.e. they are providing advice. This may be helpful to assist a person through a crisis but may not support long term change. Psychotherapy (professional counseling) does not involve telling others what to do, but instead draws out what others think and feel. It draws upon an individual's strengths and provides direction to learn new ways of thinking and behaving to maintain long term changes to their lives.
Benefits of professional counseling/ psychotherapy
Professional counseling/psychotherapy may help you to...
- Better understand your thoughts, feelings and responses.
- Learn new behaviors and responses to help you achieve your goals.
- Understand your loved ones better.
- Improve your family relationships.
- Improve your self esteem and boost your self confidence.
- Overcome negative thinking.
- Establish a healthy balance among life's responsibilities.
- Improve your decision making ability.
- Discover new ways to manage stress, anxieties and anger.
- Improve your communication skills; learn how to listen to others and have others listen to you.
- Heal old psychological wounds; repair damage from the past.
The main benefit of professional counseling/psychotherapy is that it helps you to have a life which you can enjoy and appreciate more fully. It can help you to become the sort of person you want to be.
Just as there are different types of therapies there are also different types of therapists. Although most health professionals receive training to provide some level of counseling not all are trained therapists when it comes to providing professional counseling or psychotherapy.
The level of qualification of each professional can vary e.g. certificate, diploma, bachelor's degree, graduate diploma, master's degree or doctoral degree (PhD). Professionals from any field may hold the title of "Doctor" if they have a PhD or the equivalent, this should not be confused with a medical doctor or psychiatrist. The professional qualification of a therapist often has little reflection on the type of therapy practiced. It also provides minimal insight into the level of clinical experience a therapist has.
To become certified or licensed to use a specific model or type of psychotherapy (listed above) may involve as much as 5 years of training and clinical supervision in addition to professional qualifications.
Psychiatrists are also medical doctors who specialize in emotional illness. After graduating from medical school, psychiatrists are required to complete 3 or 4 more years of professional training to become a psychiatrist. A psychiatrist is the only type of therapist who can prescribe medications.
Although we automatically assume psychiatrists are also skilled psychotherapists, this is not necessarily the case. Unless their training specifically focused on psychotherapy, a psychiatrist can conceivably have no training or experience in it. Many psychiatrists maintain a diagnostic or supportive role when it comes to the treatment of emotional illness, rather than provide psychotherapy.
Psychologists specialize in the study of human behavior. Clinical or counseling psychologists often have a PhD; school and industrial-organizational psychologists need a master's degree. Most clinical psychologists work in counseling centers, independent or group practices, hospitals or clinics.
Psychoanalysts differ from psychologists in that they have been trained specifically to provide therapy using a psychoanalytical model , whereas individual psychologists may train to provide different types of psychotherapy.
4. Social workers
Not all social workers are trained psychotherapists; however most are trained to provide informal counseling. A clinical social worker has a master's degree with training and experience in psychotherapy.
5. Mental health nurses
The majority of mental health nurses based in hospitals and community settings receive training to provide informal counseling. A nurse can be licensed to practice psychotherapy independently provided they have undergone master's degree or PhD in nursing or equivalent.
6. Other professionals
The ability to provide psychotherapy (professional counseling) is not limited to health professionals, many other professional people undergo the extensive training required to provide this specialized service e.g. clergy.
It's important to be aware that not all counselors undergo the same level of training. There are huge variations in the length and complexity of training programs for counselors. Training can vary from a few weeks, to many years; from correspondence courses to intense training and supervision. Licensing regulations vary significantly from state to state and country to country. Many people can legally set up practice as a 'qualified counselor' with minimal training or experience. Some may claim to be 'psychotherapists' when in fact they provide informal counseling.
Types of psychotherapy
Although both counseling and psychotherapy involve the use of verbal communication, unlike informal counseling which provides emotional support through listening and advice, psychotherapy (professional counseling) involves the use of treatment methods which are guided by well-developed psychological theories about the source of personal problems.
There are many different types of psychotherapy; each is based on different psychological theories. The most popular therapies in the treatment of postpartum depression (PPD) include...
1. Supportive therapy
Supportive therapy focuses on immediate symptom relief and support measures, in an effort to protect and sustain you through the early phases of the PPD crisis. Support is provided through reassurance, comfort, practical suggestion and empathy. Supportive therapy assists you to recognize and marshal your resources and coping skills.
The supportive therapist is active; he/she will talk more to you, do things for you and engage in direct actions to help you. The therapist will attempt to support you to bear the problem better rather than treat the cause of the problem. The results of supportive therapy are at least equal to those of other forms of therapy when dealing with PPD.
2. Cognitive behavioral therapy
Cognitive behavioral therapy (CBT), which is a combination of cognitive therapy and behavioral therapy, is the most popular treatment for most emotional and behavioral problems. CBT provides you with the knowledge and skill to stop your symptoms and get your life on a more satisfying track.
Cognitive therapy is based on the concept that the way we think affects they way we feel and what we do. It is believed that distorted or irrational thoughts reinforce feelings of depression. Cognitive therapy challenges what we think.
Behavioral therapy changes the way we respond. Behavioral therapy helps you to weaken the connections between troublesome situations and your habitual reactions to them; such as fear, depression, rage and self-defeating or self-harming behavior. Behavioral therapy also teaches you how to calm your mind and body, so that you can feel better, think more clearly and make better decisions.
A CBT therapist teaches you to recognize and change faulty or maladaptive thinking patterns, which in turn modifies your moods and emotions. The benefit is that we can change the way we think to feel and act better even if the situation has not changed.
3. Interpersonal therapy
Interpersonal therapy is also a short term therapy that has been proven to be effective for the treatment of depression. Interpersonal therapy focuses on the interpersonal relationships of the depressed person and how they impact on current functioning.
Although depression may not be caused by interpersonal events (i.e. conflicts in relationships with others) it usually has an interpersonal component that affects relationships and roles in those relationships.
The idea of interpersonal therapy is that depression can be treated by improving communication patterns and how people relate to others. Interpersonal therapy aims to strengthen communication skills and facilitate better interpersonal relationships.
4. Brief dynamic therapy
Using the model of psychoanalytic theory, brief dynamic therapy draws upon the significance of early childhood relationships and experiences and explores how they are affecting you as an adult, particularly during a crisis. It recognizes that what happened to us in the past and the sense we made of these events affects how we see ourselves and others and how we act today.
Unlike traditional psychoanalysis which takes years due to the impressive goal of "personality reconstruction", brief dynamic therapy aims to help an individual deal with a conflictual area. Brief dynamic therapy can be an extremely effective as a short term intervention (6 - 14 sessions).
5. Other therapies
There are also numerous other types of therapies that are used to treat PPD, these include...
- Adlerian therapy
- Existential therapy
- Gestalt therapy
- Person-centered therapy
- Rational-emotive therapy
- Reality therapy
- Transactional Analysis
Choosing a level of counseling/psychotherapy
It may help to think of psychotherapy (also known as professional counseling) as being a more specialized form of counseling; in much the same way as a pediatrician is more specialized than a G.P. when it comes to treating babies. For many baby related problems a G.P. will provide great service but occasionally the specialized knowledge and skill of a pediatrician may be required.
This may be the same regarding counseling for postpartum depression (PPD). In most situations the support of informal counseling provided by your local doctor, nurse, clergy etc. will be sufficient, but sometimes the more specialized skill of a therapist trained to provide psychotherapy (professional counseling) may prove more beneficial.
Choosing the most appropriate level of counseling/psychotherapy can depend on...
1. The depth of your depression. Mild to moderated depression will often respond well to informal counseling where severe depression may require the skill of a professional therapist.
2. Your underlying personality. Someone who generally has a bright and cheery personality prior to experiencing PPD may benefit from the support of informal counseling. Whereas someone who has always been troubled with low self esteem or a long history of interpersonal conflicts may benefit from professional counseling/psychotherapy.
3. Your commitment to making changes. It takes time to change life long patterns of thinking and behavior. Psychotherapy sessions often extend over periods of 6 - 16 weeks. However, this depends on the type of psychotherapy.
4. What you can afford to pay. Professional counseling/psychotherapy is generally more expensive than informal counseling (due to the specialized skill and years of additional training by therapists). Many health funds recognize the service of trained psychotherapists and will provide a rebate.
Your doctor will be the best person to discuss your options with. He/she can guide you in your choice and point you in the direction of a suitable therapist/counselor in your local area.
Cost of therapy
Generally, psychiatrists charge more for psychotherapy than psychologists, who typically charge more than social workers etc. However there are no studies that suggest that appropriate psychotherapy provided by an experienced and qualified practitioner in any discipline is superior to that provided by another.
Most therapists have a fixed rate per session, although some may be willing to negotiate the fee.
Questions to ask your therapist
- Ask the therapist to tell you about his/her credentials and show you his or her state license to practice .
- Ask your therapist to explain the type of therapy he/she provides, and how this form of therapy may benefit you.
- Ask approximately how many sessions he/she thinks may be necessary.
- Ask what costs are involved and if any medical benefits rebate is available.
Where to find a professional therapist
- Ask your doctor (or your baby's doctor).
- Ask family and friends.
- Ask a PPD support-group member.
- Ask the nurse at your local health center.
- Ask your local minister.
- Look in your local telephone directory.
Written by Rowena Bennett