She did the work. He bought the noun
Why the loose word 'psychotherapist' robs the good counsellors first
People call me a psychotherapist. On my Substack, in emails, at parties where somebody is generously attempting to explain me to somebody else. They mean it warmly, they mean it as a synonym, and I have largely stopped correcting them, because a man who corrects that sounds like a man with strong feelings about his own business card.
Psychologist. Psychotherapist. Therapist. Counsellor.
One of those four words has a regulator. The other three have a vibe.
The analogy, and where it stops flattering anybody
The closest comparison I have is accounting, which sounds like an insult to both trades until you look at it properly. A management accountant, a bookkeeper and an accounts clerk all handle your money. They are not one profession in three moods. You would not hand a bookkeeper your company’s tax position, and you would not ask a chartered accountant to reconcile the petty cash, chiefly because he would invoice you for the conversation about whether he should.
The difficulty is that accounting emerges from the comparison looking magnificent.
Here is what Australia requires of somebody who wants to fill in your Business Activity Statement for money. Registration with the Tax Practitioners Board. A Certificate IV or higher in accounting or bookkeeping. One thousand four hundred hours of relevant supervised experience. Professional indemnity insurance to a specified standard. A fit-and-proper-person test, which is an actual assessment and not a figure of speech. Between forty-five and a hundred and twenty-five hours of continuing professional education every three years, audited. And conduct governed by a statutory Code of Professional Conduct with a regulator standing behind it holding a clipboard.
That is the machinery a wealthy nation has assembled around the question of whether you have correctly declared the income from your shed.
Now the same question, asked of somebody who wants to call themselves a psychotherapist and sit in a room with a woman whose husband died in March.
Nothing. No qualification, no supervisor, no insurance, no register, no code, no complaints line, not one hour of continuing education, and nobody anywhere with the authority to tell them to stop. She can hand him the worst thing that has ever happened to her and he is, in the eyes of the Commonwealth, a man having a conversation. If he wanted to lodge the woman’s GST afterwards he would need a Certificate IV.
We have been burying our dead for something like three hundred thousand years and filing tax returns for about five thousand. One of those two activities now has a statutory code of conduct. Evolution had an enormous run-up in which to prepare us for grief and no time at all to prepare us for the Australian Taxation Office, and Parliament has legislated accordingly.
What the regulated word costs
On my side of the vocabulary the tariff runs like this. Six years minimum before you may use ‘psychologist’ at all: an accredited degree sequence, supervised practice, registration with the Psychology Board of Australia through AHPRA. ‘Counselling psychologist’ sits above that again as one of nine endorsed areas of practice, gated behind a postgraduate qualification and a two-year registrar program. Annual registration. Mandatory professional development. Indemnity insurance. And a complaints process that ends, if it goes badly enough, with the registration cancelled and the career over.
Six years to earn the right to say one word. The word is twelve letters long. You can see the appeal of the vibe.
I set the tariff out not to impress you but because it is the only part of this whole arrangement that gives you anywhere to go.
The people this actually robs
Now the complication, because the version of this essay where I look down my nose at psychotherapists would be cheap, lazy and wrong.
Most counsellors and psychotherapists in this country are properly trained and take it seriously. A Diploma of Counselling costs somewhere between fifteen hundred and twelve thousand dollars depending on the provider, takes one to three years, and includes a hundred hours of supervised placement. Plenty go further, into degrees. Two voluntary bodies, PACFA and the Australian Counselling Association, maintain registers with real entry requirements, real supervision expectations and real codes, and every single person who joins one is volunteering to be accountable at a moment when nothing on earth compels them to.
Those are the people the loose word robs, and it robs them blind.
Somewhere out there is a woman who gave three years, twelve thousand dollars and a hundred placement hours to becoming a counsellor. Somewhere else is a bloke who saw an advertisement on Facebook between a mattress sale and a man doing pull-ups, and bought a certificate. It arrived as a PDF. It has a border. The word ‘Diploma’ appears on it in a serif that came free with the template, and ‘Diploma’ is not a protected word either. He printed it. He framed it. He hung it on the wall behind the chair, at the height where a client’s eye naturally goes while they are working up to the difficult part. And he has broken no law of any description, because in this particular corner of Australian life there is no law of any description to break.
Same word for both of them. Same website design, more or less. Same position in the same search results. She cannot prove the difference and he is under no obligation to raise it.
She did the work. He bought the noun.
What I am not claiming
I am not claiming that six years of training makes me better in a room than a good counsellor with a diploma. The evidence does not support it and I would lose the argument in public. What predicts whether therapy helps is mostly the relationship, the warmth, and whether the person felt heard, and those qualities distribute themselves across qualifications with a maddening indifference to how much anybody paid. Some of the finest therapeutic work I have watched was done by people carrying far less paper than me. Some of the worst was done by people carrying more, and one or two of them had lanyards.
The claim is narrower than superiority and much harder to argue with. It is about what happens when it goes wrong.
If I harm you, you have somewhere to go. A register with my name on it. A regulator obliged to investigate. A code I can be found to have breached, insurance sitting behind the finding, and a genuine prospect that I never practise again. The machinery is slow and imperfect and I hold opinions about how it treats practitioners that would fill an essay. It exists, and it can end me.
If an unregistered psychotherapist harms you, there may be nothing whatever. No register to be struck from. Nothing to be struck from. Where they hold no voluntary membership, your options reduce to the courts, which is to say your options reduce to money and years. He can be practising again on Monday under the identical word, with the identical PDF on the identical wall, because the word was never his to lose.
The question
None of this makes the conflation malicious. People use the words interchangeably because the words behave interchangeably, and the fault sits with a regulatory settlement rather than with anybody’s vocabulary.
My own profession has done very little to clear it up, and there is a reason for that. The confusion flatters us. It has been standing quietly behind the profession for decades, holding our coat, and every time somebody assumes the psychotherapist has been checked they are borrowing credit built on the registered side of the fence. We have never once sent an invoice, which for a profession this fond of paperwork takes some explaining.
So when I am told the two are the same animal, what I feel is not wounded pride. It is closer to dread, and it is not on my own behalf. It is on behalf of whoever goes looking next week, in the worst month of their life, and picks a name off a website on the entirely reasonable assumption that somebody, somewhere, has checked.
Nobody has checked. That is the whole of it.
Take the question with you, then, because it is short and it works on anybody: Who are you registered with, and what happens to you if I complain?
A good practitioner answers that in one sentence. A bad one answers it at length.
Sources
Tax Practitioners Board. Qualifications and experience for BAS agents. https://www.tpb.gov.au/qualifications-and-experience-bas-agents
Tax Practitioners Board. BAS agent registration. https://www.tpb.gov.au/bas-agent-registration
Psychology Board of Australia. Endorsement. https://www.psychologyboard.gov.au/Endorsement.aspx
Psychotherapy and Counselling Federation of Australia (PACFA). https://pacfa.org.au