Having received my copy of the recent letter from the Chair of BACP, Dr Lynne Gabriel, regarding the proposed differentiation between counselling and psychotherapy in the lead-up to statutory regulation, I thought I might use this space to reflect further on whether there is a difference between the two activities, and if so, the nature of that difference.

As a ‘warm up’ I thought I might start with something a little easier to contemplate; a ‘way-in’ if you like before stepping into the quagmire; by comparison, something simple, uncomplicated and straightforward... like a three-step guide to splitting the atom, for that seems relatively easy. Or perhaps, making your own particle accelerator using a cereal box and two elastic bands... By comparison, they seem like a walk in the park.

The debate about whether there are differences between psychotherapy and counselling has been around for a very long time. It had already been going on for a long while when I started my training in the 1980s. Whether it is possible (or right) to differentiate between the two activities, either at the point of training or in what is delivered to the client, is a discussion that has never seemed to lose energy. This isn’t a new scuffle, but now (as the film trailers say) ‘it’s getting serious’.

As we know, the proposal is for two protected titles, ‘counsellor’ and ‘psychotherapist’. While the standards of proficiency are near enough the same across the board, the proposed point of differentiation between the two activities seems to rest on one group being competent to work with complex ‘mental disorders’ (psychotherapists), while the other will understand the theories of ‘mental health and wellbeing’ (counsellors).

Herein lie profound philosophical differences in how we view the human condition: is distress the symptom of madness and insanity, a biochemical dysfunction with biological foundation; or is distress instead one aspect of a mental health continuum along which we all journey? Having worked in secondary care services (psychiatry) for many years, I would prefer to opt for the latter explanation (which, I guess, makes me a counsellor), rather than the former which, to me, consigns us to a ‘them and us’ medical model of illness. Some might assert this is a naive position – how, for example, could I argue that conditions such as bipolar disorder or schizophrenia do not have medical explanation? Well, of course I wouldn’t. I do believe that mental health distress has biological implications, but that distress is better placed on a continuum of mental health rather than mental disorder. This perspective would make the proposed differences between counselling and psychotherapy a little redundant.

Of course there are many clients who present with challenging and profound mental health distress. We need to be competent to meet those challenges in meeting the needs of our clients. Are counsellors competent to do that on qualification? My experience would strongly support the notion that they are certainly not. That said, are psychotherapists? Again, no, I really don’t think so. The fact is that no core training can ever fully equip the practitioner – counsellor or psychotherapist – with that level of competency. Likewise, the most skilful and empathic psychiatrists and clinical psychologists I have worked with over the years would argue the same for their own profession – competency comes through experience, supervision (of whatever form) and further learning. There are many counsellors and psychotherapists who undertake profoundly imaginative and skilful work with people experiencing deep distress, but this ability does not come simply on the back of a qualifying programme.

I can’t imagine that the great and the good who come up with these sorts of proposals don’t know this already. Surely it is a position of common sense? I can only imagine then that differentiation is ultimately about power and status. In this frame, I do not believe the current proposed differentiations are defensible, and remain unconvinced that, in application, there are many differences at all. So, back to something a little less complicated (and contentious), how to split an atom: first take an atom, and then apply a sledgehammer.

Andrew Reeves is a counsellor at the University of Liverpool Counselling Service and editor of Counselling and Psychotherapy Research (CPR).