If I stopped people in the street and asked them ‘Do you know the difference between a psychiatrist and a surgeon?’ I imagine most would know. However, if I asked ‘How about a psychiatrist and a psychotherapist?’, my guess is the answers would be dicey. And if I drilled down even further, say,‘What is the difference between a psychotherapist, a counsellor and a life coach?’, most would be stumped. And then what about a Person-Centred Counsellor and Psychodynamic Psychotherapist?’ I’d have to ask someone stepping out of the Carl Rogers Institute to get that one right.
I regularly encounter people keen to know more about what I do. Saying ‘I’m a psychotherapist’ doesn’t usually end the matter, as most people only have a rough idea of what this means. Being pattern-making creatures, we want to know where psychotherapy or counselling ‘fits’ into our scheme of understanding of talking therapies/general head ‘doctoring’. So I often find myself describing what I do, as against psychology say, or psychiatry – professions with a more publicly defined profile. I’m never convinced that my explanations make things 100% clear, and I probably did a bad job of it recently when someone responded with a passionate tirade against a friend’s over-medication on a psychiatric ward.
For what feels a while now, we have been attempting to define our presence more in the eyes of the commissioning Powers That Be. Lynne Gabriels’ penultimate column in Therapy Today re-iterated the BACP’s ongoing efforts to challenge the NICE favouritism of CBT and to encourage them to pay closer attention to the counselling and psychotherapy professions. This is something that began before the IAPT roll-out, and indeed sparked my very first commission to write in this magazine in April 2008.
But while this campaigning work is done ‘up there’ for us, I often wonder if there is much more we can do, without great efforts, ‘on the ground’. People may not need to know too much about the theoretical differences between a Person-Centred Counsellor and Psychodynamic Psychotherapist (after all, it’s the relationship that matters), but we do need them to hear a strong voice that describes us just as loudly as other similar professions. Not least because this could also help potential clients make an informed choice about potential help they feel they need.
We can define ourselves more effectively in many ways, and we are now greatly advantaged by the information age we are in. Therapy Today has long encouraged us to adapt to this and an online shop-front is an essential investment if life in private practice has a chance to thrive. Our websites are one readily accessible place where we can spell out further what we do and what we don’t do, how we are professionally accredited or not, what our clinical limitations are. Dentists don’t need to this, but we do, and more so than we are doing now.
Another easy way to etch ourselves further into the public mind is to respond to media misrepresentations. I don’t watch much television nor do I read a paper daily, but invariably when I do either, I find people described as ‘therapists’, ‘shrinks’, ‘psychologists’ when they simply aren’t. The Guardian ran a piece before the summer, Who’s your favourite TV psychotherapist? which referred to Freud (ok, he’ll pass as one), a couple of psychologists, a counsellor, and a mental health nurse. No wonder there’s confusion.
Terminology always matters, and we therapists pay very close attention to words generally. But, if some of us, even better most of us, can (politely of course) point out to the media when they have got something wrong, this would serve us all well. Of course all professions aren’t accurately represented (I imagine lawyers and doctors regularly squirm too), but we don’t hear of teachers being described as ‘play experts’ or chefs as ‘domestic workers’. Most columnists and editors have public twitter and email accounts or reply buttons on their blogs, and they do read what their readers say.
The inevitable power differential in the therapy room is a big topic, and I don’t want to unpick it here. Of course it contributes to how clients want to see us, but not so long ago a client referred to me as ‘doctor’ in our first session. Regardless of his projections, I wonder if he would have done so if ‘psychotherapist’ was a profession nestled more snugly in his mind.