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Monday 14 July 2014

All About Psychos

What exactly is the difference between a counsellor, a psychotherapist, a psychologist, a psychiatrist and a psychoanalyst... or “All About Psychos”.


As some of you out in the cyberworld may have guessed, I very much appreciate the films of Pedro Almodovar, who made a film called “All About My Mother”,

which was a film reference to another film called “All About Eve”.
So in talking about the differences between all of the above, we can basically call this post: All About Psychos. And no, we are not talking about the Alfred Hitchcock film, either.

I think I mentioned in one of my other posts that I would talk about the differences between all of these professionals. So here it is.


Okay, so we have five designations for professionals who work in mental health. And to someone who might be considering going to see someone for some issues that they have, the bewildering array of mental health professionals might be a little intimidating and/or confusing.


Whom do I see? And for what?


Or more likely, or perhaps.... “I have a brother/sister/wife/cousin/uncle/friend , etc., etc. (fill –in-the-blank) whom I am concerned about, whom should he or she go and see???


Right then, let’s begin. First of all, the designations about are in relative order of education from least to greatest. And, accordingly relative order of cost/expense to the consumer/mental health client.  Now, I stress the word: relative.  I am sure there are exceptions out there.

I am sure that there are psychoanalysts and psychiatrists out there who command an impressive hourly rate (or as I call it: charge a bomb!) but are unskilled or even unhelpful or even damaging to the clients. Just as I am sure that there are counsellors out there who charge very little (or as I call it: get by on a pittance!) and conversely aid the client to go through a tremendous amount of change and vice versa.


Now I should also state that I personally have met and interacted with all of the above types of mental health professionals and there are some in each category whom I highly respect and regard and then there are some who.... well, let’s just say I wouldn’t!


So the thing is you can find a psychiatrist who is wonderfully helpful or one who is...well...

And you may run across an ordinary, garden-variety counsellor who helps you tremendously.


So, time for a quick interlude. So in the immortal words of Smokey Robinson and the Miracles:

“Ya gotta get yourself a bargain, son.

Don’t be sold on the very first one.

... My mama told me.

Ya better shop around.”


So shop around. Most counsellors, psychotherapists, psychologists, psychiatrists, psychoanalysts usually will offer a first session or consultation for free. And if they don’t... Ask.

You need to know that you feel comfortable with your professional.

Both in terms of what you have to pay, but also and perhaps more importantly, that you feel comfortable interacting and trust the professional.


Remember, just like the song goes, you will be having an “intimate” relationship with this person. Now, I don’t mean intimate, like the expression “intimate relations” but, nonetheless you are going to be sharing private, personal details with this person.


So, for example if you are a woman and you working through past memories of a sexual assault that may have happened several years ago but which haunts you still, you may not want to see a male therapist, because you feel he may not understand or perhaps you may feel intimidated by such a situation. So maybe a female might be better. Or maybe not. Perhaps you feel angry and you wish to work with a man, in order to “get over your anger and work out your feelings of injustice”. I don’t know. But you, as the client, will know.


Or perhaps you are a man, and you are struggling with an issue that involved a past girlfriend or wife or your mother. Perhaps you feel distrusting of females and so would feel more a camaraderie with another male to whom to tell your story. Or perhaps you might feel that it would be better to speak to a female professional in order to understand and review “what you did wrong” or “if you did wrong” and therefore get a so-called “female” perspective.  I write so-called because, in experience in mental health any and everything you expect to find in one gender, you will invariably find in the other as well. So there is no true “male” or “female” perspective. There are only perspectives.


But I digress.

Okay, so you need to find a mental health professional.

You need to trust the individual and you need to pick the one right for you. We have that now.


So, generally “counsellors” are kind of like resource personnel. The term counsellor is somewhat vague. To counsel someone generally means to advise someone. So, as I see counsellors, they generally offer information and resources to the person and gently assist the client to make a decision based upon what the client says they want. The counsellor tends to be a little bit more actively involved in the decision-making process with the client. Edging the client nearer and nearer towards a healthy decision

So as a result, most counsellors are usually drug and alcohol counsellors or sometimes they can be social workers, who assist the client to find resources to help them alleviate the stress in their lives. They help them find housing, advise them on how to find employment, assist them on how to navigate the legal system and even sometimes to manage money.


            Psychotherapists, will and can do some of what a drug and alcohol counsellor will do or what a social worker will do, but tend generally, but not exclusively, to stay away from advising the client. Part of the reason why psychotherapists avoid trying to give advice freely is that at times when a client tries a solution to a problem and it doesn’t work, the client may come back and either accuse the therapist of “giving bad advice”, which may or may not have been the case as the advice may or may not have been carried out correctly.

            But more importantly, when a client tries a new behaviour or a new solution to a current problem they are experiencing they may be fragile and are expectantly hoping the solution will work. If the person then comes back the next week saying: “I followed your advice and it didn’t work. In fact, I feel worse” This then immediately damages the relationship between the therapist and the client. The client may then feel they can no longer trust the therapist to “guide them in the right direction”. However, the job of the therapist is not to guide the client but rather to empower the client to make decisions for themself. The idea is that the therapist trusts that the client will make their own, adult decision about what they want to do with their life. If however, the therapist perhaps sees the client moving in a potentially destructive direction, like drinking more or doing (more) recreational drugs or repeating patterns of behaviour that are detrimental, the therapist will draw the client’s attention to it and get them to ponder their behaviour.


Generally speaking, sessions with a counsellor are shorter in course than with a therapist. Generally. And generally as we move from a counsellor to a psychotherapist, the level of education increases and length of engagement with the client (usually) increases. But not always.


So for example, if one engages in psychoanalysis, usually it involves seeing an “analyst” two, three or even five times a week for a number of years at considerable expense.  Whereas work with a regular psychotherapist may take place once weekly for several months or even upwards of a year. 


Most psychotherapists usually have a designation with a university degree or, more often, a masters degree.


Most psychologists have a masters degree if not a doctorate in psychology, specializing in a particular area. A number of psychologists also have the ability to be able to do formal psychological assessments and testing on clients for use in a clinical setting or for legal or medical reasons. In terms of “counselling work”, many psychologists have a little bit more skill that an average psychotherapist although, this is up for debate, depending on whom you ask and what regulating body is answering.


            Psychiatrists are usually first and foremost medical doctors by training. On top of this training there is also an element of experience with true psychiatric disorders. So for example, yes you could go and see a psychiatrist to discuss your marital problems or your anger issue. But you probably would not go to see the psychiatrist to talk about how you lost your rental housing or where to go to learn English as a second language as you are an immigrant or if your brother-in-law or your roommate has a serious substance abuse problem.  For these issues you might rather just talk to a drug and alcohol counsellor or a social worker.


However, if you are critically or chronically suicidal or if your 22 year old son appears to be showing signs of paranoia and starts to tell you that he “is hearing messages from aliens coming through the television”. Or that your next door neighbour states he or she is hearing voices, then it is time to see a psychiatrist. As a medical doctor and mental health professional, he or she will be able to help you and even prescribe medication if necessary. A psychologist or psychotherapist does not have this level of skill or education to intervene to this degree.


And finally, what does a psychoanalyst do?


Well, as already mentioned a psychoanalyst can conduct sessions with a client that can go two, three or even five times a week for several years. And yes, psychoanalysis is where the person finally gets to lie on the proverbial couch and regress/go back to childhood. Really, only in psychoanalysis do you ever see this cliché, however the cliché has a very valid reasoning behind it.  Psychoanalysis may seem like overkill. And indeed, before I, myself even got into this profession, I remember hearing from someone else, when I was a teenager that “Therapy is great but I have heard of people going for therapy for years and never really changing all that much”.  


Now if that really were indeed true, the validity of psychoanalysis would go right out the window. However, psychoanalysis is usually used for patients or clients who are really hardened or difficult cases --  and no, I am not talking about someone who has smoked filter-less cigarettes by the case and drinks gin and whisky and hangs out in tough biker bars! What I am referring to are patients or clients who are highly “resistant” in terms of being able to be relieved of their problems – I won’t say “cured”. So you have someone for example who has a personality disorder, say something like borderline personality disorder, who disrupts the session with the analyst/therapist with questions and/or causes drama in the session or seeks to test the therapist/analyst, e.g.
            “I will see if he really cares about me! I will go and make a suicide attempt and then if he does not respond within the hour, I will just KNOW that he doesn’t care about me”.

            This kind of blatant manipulation by the client is counter-productive to the client getting better, because at some point the therapist/psychiatrist/analyst is just going to want to get rid of the client – not because the client is intrinsically “bad” but because the therapist is being frustrated and emotionally manipulated by the client. However, the client does this precisely because  they have a dysfunctional past history with regards to trusting people and being honest (among other things). They therefore have what is known as a personality disorder. A personality disorder typically will have something endogenous within the person’s character which will limit their being able to obtain help. Hence the personality disorder is rarely able to be worked with or helped, because certain elements of their personality prevent them from being able to be helped at all.  We have all met people like this. In fact there is a rather well-known book which illustrated the Borderline Personality Disorder: I Hate You, Don’t Leave Me, by authors Jerold J. Kreisman and Hal Straus.   

In any event, people will such severe difficulties or personality disorders often cannot be helped. However, psychoanalysis, which is kind of like “super-intensive” psychotherapy for lack of a better description, promises to help people who have such personality disorders, such as Borderline or Narcissistic or Obsessive-Compulsive or Dependent personality disorder.  One Danish study showed that psychoanalysis was effective at relieving symptoms for people who had Borderline Personality Disorder. Here is the link:



Psychoanalysis can also be extremely helpful for people with severe trauma or PTSD. A quite famous French psychiatrist by the name of Boris Cyrulnik, 

 a Jewish psychoanalyst of Russian, Ukrainian and Polish émigré parents, is known in France for his coining the concept of psychological resilience – the ability to bounce back from all kinds of trouble and trauma in life. And no one should know more than he, as he lost both his parents during World War II after they were arrested and murdered. 

Cyrulnik went on later to become the famous psychoanalyst who worked with Samira Bellil. Bellil, pictured here:   was famous in France as she was a high-profile case of a young woman who was sexually assaulted multiple times. Her book: Dans l’enfer des tournantes  described her experience with the multiple rapes she suffered and her journey to overcome her very severe trauma.  I can think of no better argument and proof for the use and need for psychoanalysis than this. However, Bellil, who has since died, poor soul, founded a national organization, Ni Putes, ni soumises, which functions to this day.

If anyone is interested the link can be checked out here, (note though, that the website is in French):


However, the average person does not usually experience the types of trauma that Bellil encountered in their day-to-day life. But in the media, at least here in Canada, there is a growing awareness that many soldiers, serving in the Canadian Armed Forces, come back from tours of Afghanistan often with
PTSD, which leads them to very destructive, reckless behaviour: drinking, drugging, fighting, etc., and oftentimes to suicidal thoughts if not suicide itself.


So on that pleasant, happy and joyful note!!! (not!)


Mental health workers run the gamut from counsellor to psychoanalyst. What you want to do is find the professional that you feel most comfortable with and that will work for your needs. You probably won’t want to go into 3 years of four times weekly psychoanalysis in order to deal with an alcohol problem or conflicts you are having with your husband about the housework.


But now at least for some of you, dear friends, hopefully the idea of what a counsellor, psychotherapist, psychologist, psychiatrist and psychoanalyst does is a little clearer.


I welcome comments, questions for clarification and dialogue respectful to this post and any others.
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Take Care,



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