What’s the difference between clinical and counselling psychology?

A counselling psychologist’s reflection on the training routes

Following my last post, asking for questions to consider here, someone asked:

‘What’s the difference between clinical and counselling psychology training?’

This is a great question and one that comes up quite a lot. It is certainly a perennial question that arises during the open evenings for the doctorate in counselling psychology programme I work on - Are counselling psychology and clinical psychology like comparing apples and pears? or are they essentially the same thing? Unfortunately, having only completed and worked on counselling psychology training programmes, it is a question that I only have a good understanding of half of the picture of. Below, however, I attempt to answer the question, with my answers being based upon my working knowledge of the different worlds. In doing so, I primarily share some of my thoughts about the things that counselling psychology training courses prize and attempt to make some comparisons with my understanding of similar clinical psychology training expectations.

The money

Let’s get this one out of the way. Whenever our trainees meet the clinical trainees (in shared classes or placements) this is usually a hot topic of conversation. Essentially, clinical trainees get a pretty generous chunk of cash to complete their studies, whilst counselling psychology trainees typically get nothing. Sometimes counselling psychology students get lucky and get funded by educational institutions (although I think this is only the University of Manchester - and is only one or two places), charities, employees, or the governments of home countries. This is however very rare. Students on counselling psychology studies may find that they end up paying out for:

• Course fees

• Clinical supervision - although this depends

• Insurance - we encourage all trainees have their own professional indemnity insurance

• Rent

• Food and drink!!!!

While the latter points may seem trite, it is so important to consider the impact of studying full time (usually for a minimum of three years, without the potential of earning any cash). One silver lining we have noticed at Manchester is that some of our final year trainees (or those with existing therapy qualifications) start to get paid work before they finish the programme. Typically this is at a lower salary band to a qualified psychologist, but this increases on completion of their training.

The Training

This is a bit that I can only speak in an informed way about the counselling psychology training landscape in the UK. Below I unpack some of the areas that are valued highly by counselling psychology. I’ve divided these up into philosophy/theory, research, practice and personal development for ease, but clearly they all overlap a bit. I have some awareness of the clinical psychology world, and make reference to it, but if someone from the clinical psychology world wants to chip in (in a more informed fashion), feel free to drop me a line or create a discussion below.

For those completely new to this discussion, it might be helpful to know that both clinical and counselling psychology are generally doctorate level studies in the UK - you can search a list of providers here. The exception is that the British Psychological Society (BPS) offer their own qualification for those who might prefer to develop a portfolio outside of a traditional academic institute. Whilst counselling psychology programmes generally accept applications from around the world, many clinical programmes do not (I found this blog about this here but cannot vouch for its accuracy).

Philosophy/Theory

Counselling psychology has historically aligned to humanistic psychology (which is, in turn, often linked to more existential perspectives of therapy). This is an approach that is holistic in its viewpoint - meaning that it tries to see people as whole individuals, rather than as a series of parts (i.e. a therapist works with the person, not treats the depression etc). Individuals seeking support are therefore viewed as just that, individuals. Whilst the more dominant medical model of psychological support, in which concepts such as ‘psychopathology’ and ‘diagnosis’ can be so prevalent, is used to inform the work that trainees engage in, it is acknowledged to be only part of the story. It is not uncommon for a therapist to have to be creative in their way of working with those seeking support. There are certainly approaches that seem well aligned to different types of issues (and have been well researched), but it is accepted that there is no single approach of therapy that works for everyone. Plan A may therefore turn into Plan B, C or D. Working with clients to devise a best way of working can therefore be vitally important in developing a constructive working alliance.

Another area central to the world of counselling psychology is the interest in social justice. This does vary from programme to programme, but it is certainly an area of interest for many counselling psychologists. It is also an area that applied psychology has historically been a bit rubbish at - when you define norms in a context where those creating the rules are predominantly from the same background, things are going to get a little skewed! Challenging oppression, discrimination and inequality can therefore be an important role for counselling psychologists. Maybe take a look at this brief American Psychological Association piece, including comments from my colleague Laura Anne Winter about this type of stuff.

Outside of this, much of the theoretical content that counselling psychology training programmes focus upon aims at supporting trainees to become competent therapists. This can involve in-depth training in approaches such as psychodynamic therapy, cognitive-behavioural therapy (CBT) and humanistic therapy (e.g. person-centred therapy). All courses have to focus upon at least one main approach and a second model. Typically they therefore provide a significant training in two approaches and dip their toes in the water of numerous other approaches, such as third wave CBTs, making use of expressive therapies and working with different modalities (e.g. group, family, couple, community interventions). There’s lots to fit in and realistically the training is really just the start of a life long process of learning about how to work therapeutically with people.

I can’t really comment how this looks on a clinical programme I’m afraid.

Research

Following on from the theory element, I’d highlight that counselling psychologists in training are encouraged to value quantitative, qualitative and mixed methods research - being well versed in different methodologies is vital for being able to make use of the vast array of research out there. Trainees are encouraged to critique all methodologies and to question the assumptions behind them. This includes randomised controlled trials, which play an important role in assessing the quality of therapeutic interventions but, due to the controlled conditions (and reductionist assumptions), can have limited transferability to real world settings.

In practice, many trainee counselling psychologists complete qualitative research projects during their studies - e.g. at Manchester a majority of students complete qualitative projects and a few complete mixed methods ones. We hope that our trainees complete projects that provide a detailed reflection of the territory that they are interested in. This is not universal within the counselling psychology world, and other programmes have much more of a quantitative focus however. Further, whilst I anticipate that quantitative research has more of place in student theses on clinical programmes, I am not sure whether this is actually the case (I have certainly assessed a few excellent qualitative projects conducted by clinical psychology trainees).

Practice

This is an area that often looks quite different to clinical psychology work. Counselling psychology places a great emphasis on completing work as a therapist. During a students period of study, they have to complete 450 hours of therapy as a trainee counselling psychologist. Our trainees find this equates to LOADS more hours than this. They have training to attend/deliver, audits to complete, clinical supervision, meetings to take part in and notes to write (to name but a few of the tasks). It does however mean that, when they finish their studies, they are very experienced practitioners.

When choosing the settings that people may want to work in, we start with the question:

‘What do you want your CV to look like when you finish your studies?’

This then creates a conversation, that helps to guide the type of placement diet that trainees complete during their studies. These may include placements in the third sector, NHS, forensic settings, educational settings and, well, anywhere else you might find therapists working. This contrasts to the clinical psychology training, which has a more set pathway through certain setting types. As a side note, it might be helpful to know that counselling psychologists often work in exactly the same settings as clinical trainees.

Personal Development

Another expectation of counselling psychology training is that trainees have to attend a minimum of 40 hours of personal therapy. Counselling psychology talks about being both a scientist-practitioner AND a reflexive practitioner. As the therapist is the major tool in therapy, it is essential that they learn about themselves and how they may respond to different people and the different life events that people talk to them about. Whilst 40 hours of personal therapy only scratches the surface of such an endeavour, alongside course activities directed at personal learning, it helps to set this in motion. Oh, and it puts the therapist in the shoes of someone seeking support, making a choice of therapist, and sitting in a therapy room as a client. Such experiences should certainly not be underplayed as important learning.

Employment

The final point of comparison I’d raise is about the end game,

‘What jobs can people do with each qualification?’

The answer to this seems to be, pretty much the same thing. Both are what the Health and Care Professions Council (HCPC - the regulatory body for applied psychologists) call Practitioner Psychologists and both can obtain Chartered status with the British Psychological Society (BPS). Despite it being pretty common that jobs get advertised solely as Clinical Psychology positions in the BPS’s Psychologist magazine (despite the BPS explicitly asking employers not to), most applied psychology jobs are actually open to both clinical and counselling psychologists. Employers have to recruit with competence in mind, rather than professional title, and, as both applied psychologies share so many standards of proficiency (essentially the HCPC term for the syllabus needed to become a Practitioner Psychologist), clinical and counselling psychologists might be viewed as interchangeable on an employment front. This is good news as, from our experience, there seem to be more jobs being advertised, than psychologists to fill them - as noted above, these come in all shapes and sizes and are not just in the NHS.

Is Counselling Psychology better than Clinical Psychology then?

So, that’s it. That is some of how I see counselling psychology differs from clinical psychology. Social media is commonly quite popular when it is divisive. With this in mind, and given the above, maybe I should say that counselling psychologists are much better than clinical psychologists (except the access to funding bit at least). Whilst I do think there are some real strengths to counselling psychology as a profession, I wouldn’t go this far however. Both sets of training vary from institute to institute and, whilst there are distinct differences in the way people get to become an applied psychologist, the end professional can be quite similar. This is even more notable if you factor in professional development activities after the doctorate.

To revisit the apples and pears question, maybe the clinical and counselling psychology worlds are best considered as different variants of apples, rather than apples and pears.

Photo by James Yarema on Unsplash