Under The Surface:

Therapy: Your Questions Answered

Understandably, most people don't give much thought to the world of counselling and therapy until life gets in the way! Then they can be faced with many bewildering questions: Should I be seeing a psychiatrist or a counsellor? What do all these strange terms mean? What if therapy doesn't help me? I made this page to hopefully answer all your questions so that you can feel better informed about what to do and where to go in order to get the best treatment for you.



As you may already know there are many different forms of therapy out there in the world today. They frequently have colourful or even scary sounding names such as Cognitive Behavioural Therapy, Gestalt Therapy, Psychoanalysis, Psychodynamic Therapy, Adlerian Therapy, Person-Centred Therapy, and so on. Basically all these terms belong under the umbrella term of psychotherapy. Each of these varying approaches to psychotherapy arises from the different theories we have regarding human personality formation and symptom causation, and each possesses its own unique set of therapeutic techniques and clinical skills.



What is the difference between counselling and psychotherapy?



The two terms are more or less interchangeable - though one could argue that counsellors take more of a passive, listening role, while psychotherapists take a more active and dynamic role. Again, the line is so blurred that it makes little difference. You can learn more about some of the different therapies that are commonly available by visiting the NHS website.



What's the difference between a psychotherapist, a psychoanalyst, a psychologist and a psychiatrist?



Psychotherapy is basically 'talking therapy', so a psychotherapist is therefore anyone trained in conversational therapy. For this reason a psychoanalyst is also a psychotherapist, he/she is a psychotherapist who follows the principals of psychoanalysis, which is simply one of the many different forms of psychotherapy mentioned above.



A psychologist is someone who studies and researches the science of mind and behaviour. One way of thinking about psychologists is that they are the guys in the lab coats making rats or monkeys perform strange tasks! A psychologist may also practice as a psychotherapist however he/she is legally entitled to use the term of 'licensed psychologist' due to his/her formal education. Psychotherapists are not permitted to use the term 'psychologist' because they have undertaken a different form of training that is specific to clinical work (fieldwork) as opposed to laboratory work.



A psychiatrist is someone with a formal education in medicine. They have a professional capacity to prescribe medication that is not permitted to psychotherapists or psychologists. Whereas psychotherapists are only permitted to work with neurotic patients, a psychiatrist may work with both neurotic and psychotic patients.



What is the difference between neurotic and psychotic?



Basically a neurotic person knows that their behaviour is a bit odd and is concerned about it to a greater or lesser extent. Whereas, someone experiencing a psychosis is usually blissfully unaware that they are behaving in a totally irrational way (and scaring everyone on the bus!)



It is generally accepted that everyone is at least a little bit neurotic and may have funny little hang-ups or quirks that don't cause a great deal of distress. Neurotic symptoms tend varying in intensity throughout our lifetime or during times of conscious or unconscious stress. Typical neurotic symptoms are anxiety, depression, phobias, obsessions, and so on. Essentially a neurotic individual is a normal person who fits well into society but may experience emotional or psychological distress at sometime or another which is accompanied by an awareness that something is not quite right. It is very likely that if you are reading this and you are considering treatment that you fall into the category of neurotic and are therefore treatable by me or one of my colleagues in the field.



What is madness and insanity?



Madness is a band from the eighties and…only joking…madness is not a term used by the mental health profession. It is an archaic colloquialism  most likely used to describe persons experiencing psychosis or a psychotic episode, or more broadly to denote anyone with mental health issues. Insanity is not a word used by psychotherapists but is used by the medical and legal profession. The word is really only used within a legal context to describe a person who is not cognizant of their actions (following psychiatric assessment). It has no specific meaning outside of that context.



Is someone experiencing psychosis a psychopath?



No. A psychosis is a mental state of impaired thought, judgement, and perception that is sometimes accompanied by auditory or visual hallucinations, paranoia, and dramatic changes in personality or mood. In general the psychotic state is not permanent but rather episodic. There are various different theories and reasons why a person may experience psychosis ranging from a severe psychological reaction to intense stress, drug misuse, a negative reaction to medication, or abnormalities in brain chemistry and so on. Persons diagnosed with schizophrenia, Bi-polar Disorder, and Dissociative Identity Disorder (formally known as Multiple Personality Disorder) are known to experience psychotic episodes.



A psychopath on the other hand is someone diagnosed with the condition of psychopathy. Psychopathy is a personality disorder characterised by such things as shallow emotions, lack of empathy, superficial charm, manipulativeness, lack of guilt and remorse, irresponsibility, and impulsivity to name a few. With these qualities it is easy to see how some psychopaths can be violent and dangerous however not all psychopaths are inherently violent and dangerous.



What is the difference between a psychopath and a sociopath?



Not a great deal. Both are personality disorders and both appear to lack a conscience. Some suggest that sociopaths are generally disorganised, nervous, easily agitated, and tend to live on the fringes of society. Whereas psychopaths are highly organised, charismatic, and charming and are therefore easily involved in social and business life. Both types seem to posses an intellectual awareness of pro-social behaviour, however they appear to lack the ability to form emotional bonds. The sociopath tends to lack impulse control and is therefore prone to extreme reactions to 'normal' circumstances, whereas the psychopath is over-controlled, ruthless, and calculating. Again, such individuals rarely volunteer for therapy so it is very likely that you are neither a psychopath or a sociopath if your are considering getting help.



What is a personality disorder?



It is an enduring pattern of maladaptive behaviour that causes distress to the self or others. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists serveral classifications such as Antisocial, Paranoid, Histrionic, Schizoid, Obsessive-Complusive,and Narcissistic to name a few. The usefulness of these terms is debatable and there is argument about whether such terms do more harm than good. The 'disorders' are perhaps better thought of as 'personality types' which clinicians might use to help them understand their client's behaviour, motivations, and likely responses to therapeutic interventions. In reality anyone could be described by one or more of the personality disorders so it isn't as scary as it sounds. For those interested, a great resource on personality theory can be found at the website of the psychologist Theodore Millon



Why do they make it all so confusing?



I really have no idea - it's best to just bake some nice cakes and forget all about it!



What happens in therapy? What does a therapist actually do?



Therapists work in different ways, some structured, some unstructured. Sometimes the focus of the therapy will be your past experiences, sometimes the focus will be your present life situation. Sometimes the therapist will ask questions, sometimes they will just listen, sometimes you will be ask to undertake certain tasks and so on. It largely depends on the background of the therapist how they approach your case.



Is therapy scary?



No, however the therapeutic process can be both emotional and challenging. Human beings frequently employ unconscious psychological defence mechanisms in order to protect themselves from something that may - or already is - hurting them. In therapy we seek to understand those defence mechanisms and resolve what lays behind them in order to cure the emotional conflict within the person. You can learn more about the many coping and defence mechanisms at It can be difficult to allow those defences to come down in order to be truly vulnerable and explore your pain or fear. Therapy is about a dynamic, trusting and supportive relationship between the people involved. Within the relationship you are able to explore your emotional and psychological nature in an effort to get the resolution that you seek. Naturally this can be a difficult process for some. Therefore the phrase 'nothing worthing doing is ever easy' is apt here and is a good mind-set with which you can face the challenges and hurdles in therapy.



Are all therapists good? What should I watch out for?



Sadly not all therapists are good. There are unfortunately 'cowboys' in every industry and therefore some initial caution is healthy. Most of the time though it is not unscrupulousness, but rather the therapist's naivety or lack of personal insight that causes problems. Some good things to look out for are:



•  Do they belong to a long standing organisation or professional body?



•  Are they in professional supervision?



•  Are they engaged in on-going professional development?



•  Are they engaged in an on-going professional support program?



•  Have they undergone their own intensive therapy?



•  Do they have verifiable testimonials?



•  Are they CRB checked?



Perhaps the two most important things on this list are: 'have they had their own intensive therapy' and 'are they in supervision'. Unfortunately the above pointers are only guidelines and can't guarantee a good therapist. Therapists work in isolation and cannot be watched 100% of the time. To protect yourself stick with the principal 'if in doubt, opt out'. You can find more useful info at



Curiously, in some cases it may not be that the therapist is 'bad', only not suitable for you. For example your friend may have had a good experience with a therapist and speak very highly of them, whereas you may find it difficult to get along with the same therapist - this is due to the mysterious and idiosyncratic nature of human relationships and human interaction!



What can therapy help with?



All sorts of things, ranging from psychological issues, emotional issues, behavioural issues, and even physiological issues.



Physiological issues?



Yes. The brain that is responsible for your mind and emotions is also responsible for the regulation of your bodily processes and functions. Sometimes there may indeed be an overlap and therefore a psychological component to physical symptoms. Psychological and emotional stress for example can have a dramatic affect on your physical health and physiological functions.



Will seeing a therapist go on my personal records?



Seeing a psychiatrist - or sometimes even a psychologist - may go on your records, particularly if medications have been prescribed. Seeing a counsellor, psychotherapist, or hypnotherapist however will not go on record. Persons in these professions may make case notes but these are mainly for the therapist's personal use to help keep them on track with your sessions and will therefore not be shown to anyone other than yourself should you request.



So who should I consult with my problem?



In many ways it is simply a matter of personal preference. It may be a good idea to check out a few different people before you decide on the one you would like to go ahead with. Perhaps the most important thing is just to find someone that you think you might feel comfortable 'opening up' to.



What if I can't be helped?



Often people worry before therapy that their particular problem is hardwired and cannot be altered or improved. After therapy many people are surprised to find that their problem has either disappeared completely or has been significantly improved and made bearable or manageable. It is important to remember that where one therapist draws a blank another therapist may know exactly what to do to help you out. This could be due to their training, their level of experience, or simply their personal insight. The profession of psychotherapy sits rather frustratingly somewhere between the realms of art and science and therefore it is often a case of seeing a different therapist or trying a different approach. More often than not there will be something that can be done to help.



What will happen if I come to see you?



Firstly I would be delighted if you chose to consult me with your problem, issue, or symptom as I'm very passionate about helping people to get better and grow beyond their difficulties. If you chose to come for a free initial consultation with me we would simply arrange a date and time for you to come to my office where we can have a tea or coffee and chat about your situation in private. At the consultation we will discuss a potential course of action and then you are at liberty to decide whether or not you would like to go ahead with the sessions. From then on the sessions will usually last an hour, spaced at weekly intervals. Most people who come to see me successfully complete their sessions in about 4 to 10 weeks depending on the case. To help prevent treatment from going on too long however, and to save you money, I implement a 12 session review so that we can openly discuss the progress of treatment and decide together whether to continue or whether finding an alternative may be better.


Back to Top