Dr Richard Fox

Counselling and Psychotherapy for individuals and couples

Counselling & Psychotherapy

This section gives a very brief overview of what counselling and psychotherapy are, how they work, and describes the different modalities: counselling, psychotherapy, psychology and psychiatry.

Some definitions

Psychotherapists want to help people who are troubled, when internal conflicts are preventing them from enjoying life - to relieve their distress and to build a more satisfying life. They want to help people move towards greater mental well being: which, as defined by Daniel Siegel, shows the following dimensions:

  • Life energy and vitality
  • Stability and flexibility
  • Coherence and adaptability
  • A balance of independence and connectedness

A more formal definition of psychotherapy follows:

'Psychotherapy is well established and accepted as a treatment for a spectrum of psychological and relational disturbances. Psychotherapy uses an interpersonal relationship to enable people to develop understanding about themselves and to make changes in their lives. The time frame may be a matter of weeks or years. Neuro-scientific investigations are beginning to verify some important tenets of psychotherapy such as: how development and personality unfold, how problems occur, the nature of unconscious processing - and the way in which psychotherapy works.'

How does therapy work?

Counselling and psychotherapy work on a number of levels. For a start, most people find that being able to speak to someone who is paying full attention - and not coming in with judgements - helps them to clarify their thoughts and feelings.

Most models of psychotherapy see self-awareness as the goal: when we fully understand ourselves and the different pulls within us, we can make better choices. Therapy is often about helping people relate to their inner feelings and to approach them with more understanding and acceptance - which lessens the inner tensions and troublesome patterns.

Research into the workings of the brain is a rapidly developing and fascinating field. From a brain science perspective, psychotherapy makes sense as it strengthens the connections between different areas of the brain, in particular between the emotional and rational parts of the brain. The research is helping us hone our techniques, hopefully to be more effective and speed up this process.

There are some fascinating books on this:

  • The Brain that Changes Itself - Stories of Personal Triumph from the Frontiers of Brain Science, by Norman Doidge MD. 2007
  • Mindsight - Change Your Brain and Your Life, by Daniel Siegel MD. 2009
  • The Neuroscience of Psychotherapy - Healing the Social Brain, by Louis Cozolino PhD. 2010

Interestingly, the deepest transformations often come about with the person having little understanding of how they happened: they just feel a whole lot better - with more energy, a positive mood - and they find they are handling things quite differently!

Counselling, psychotherapy, psychology and psychiatry - what's the difference between them?

What follows is a quick description of each these groups. They each have their own training, but at the end of the day 'all roads lead to Rome' and there are many similarities in how they work.

Psychiatrists are medical doctors with extensive training in working with mental illness. They work predominantly with medication and have access to community mental health resources. So if someone clearly has a significant problem and is not coping, a psychiatrist is the best person to see.

Psychologists have a lengthy academic training and know the latest research and statistics. Their professional bodies are the NZPsS and NZCCP. Psychologists tend to prefer short term common sense approaches like cognitive behaviour therapy (CBT) which is often really useful, but 'barely touches the sides' when it comes to more ingrained problems. For this reason, a number of psychologists have gone on to train further in psychotherapy.

Psychotherapists see therapy with humans more as a craft than a science, so the focus in training is more practical. Training is most commonly at postgraduate level and the professional body is the NZAP. Psychotherapists see themselves as working with people at the underlying level of the core beliefs they hold about life and relationships. Changing these can transform the way we see and deal with the world. This is my preferred modality as it can be deeply satisfying work.

Counsellors work by fully listening to what people have to say, providing support and helping with problem solving. The work load of many counsellors working in agencies means they have to adopt a more practical problem solving focus. However, many counsellors in private practice have the time and inclination to work in a more psychotherapeutic way. Training varies from diploma to degree level, and the professional body is the NZAC.