Understanding the Differences Between Psychotherapists, Counsellors, Psychologists, and Psychiatrists
When people consider going to therapy, they often discover a whole landscape of different mental health professionals. You might come across psychotherapists, counsellors, psychologists, and psychiatrists. Each profession brings something unique, and sometimes people work with more than one type of practitioner at different points in their journey.
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A guide for anyone seeking therapeutic and mental health support in the UK or Portugal
As a psychotherapist and counsellor, I’m often asked about the differences between psychotherapists, counsellors, psychologists, and psychiatrists. It can feel confusing to know who does what, and how each type of professional can help. I’ve created this guide to help you understand who’s who, what they do, and how they’re regulated in both the UK and Portugal.
What Is a Psychotherapist?
Psychotherapists offer a deeply relational form of therapy. Working with a psychotherapist involves exploring the patterns, emotions, and experiences that shape a person’s life. Psychotherapists, especially those who are depth-oriented, are often concerned with assisting people in an ongoing personal exploration of the mind, life, and its meaning (Mollon, 2009).
Because of this depth, psychotherapy is often longer-term, allowing space for meaningful and lasting psychological change to unfold through the therapeutic relationship (Clarkson, 2003). Clients usually have autonomy around when to begin and end their therapy, and it is common for clients to self-refer to a psychotherapist.
Psychotherapy is a distinct, scientifically grounded profession within the mental health field, recognised by the European Association for Psychotherapy (EAP) in the 1990 Strasbourg Declaration on Psychotherapy (Hunt, 2021). Psychotherapy can be provided within or separate from a medical model of care.
The practice of psychotherapy is typically oriented within a specific modality that encompasses a particular approach and set of philosophies. Evidence-based modalities include psychodynamic psychotherapy (Shedler, 2010), person-centred psychotherapy (Gibbard and Hanley, 2008), and many others.
A diagnosis is not required for meaningful progress in psychotherapy (Yao and Kabir, 2023). Some psychotherapists may use a collaborative case formulation or a classification system tailored to their modality, such as the Psychodynamic Diagnostic Manual (PDM) (Lingiardi and McWilliams, 2025; Macneil et al., 2012).
Psychotherapy often includes:
Exploring emotional patterns and relational dynamics
Supporting long-term psychological growth
Providing a consistent, reflective therapeutic space
Training
Psychotherapists complete postgraduate or master’s level psychotherapy training, which includes advanced clinical training, supervised practice, and ongoing professional development.
Regulation
In the UK, psychotherapist is not a protected title, and the practice of psychotherapy is not regulated (Hunt, 2021; Stevens, 2016). In Portugal, psicoterapeuta is not a protected title, and the practice of psicoterapia is not regulated within private practice. It is subject to regulation within healthcare settings, such as hospitals (Hunt, 2021; Vasco, 2008). There is no single national register in either country. Many qualified psychotherapists register with voluntary associations which set high standards for training, ethics, and supervision.
Professional registers in the UK: United Kingdom Council for Psychotherapy (UKCP), British Psychoanalytic Council (BPC), and other voluntary registers
Professional registers in Portugal: Federação Portuguesa de Psicoterapia (FEPPSI) and other voluntary registers
What Is a Counsellor?
Counsellors offer a supportive, non-judgmental space to explore emotional difficulties, life challenges, and personal concerns. Counselling is often short-term or medium-term, though some counsellors work long-term depending on their training and approach.
The process tends to be more structured and present-focused than psychotherapy, though there is overlap between the two professions. Counselling can be provided within or separate from a medical model of care, and a diagnosis is not required in order for meaningful progress to be made (Yao and Kabir, 2023).
Counselling often includes:
Providing emotional support during difficult life events
Helping clients develop coping strategies
Offering a safe space to explore feelings and experiences
Training
Counselling training varies, but many counsellors complete a Level 4 or Level 5 diploma, with some going on to advanced or specialist training.
Regulation
In the UK, counsellor is not a protected title, and the practice of counselling is not regulated (BACP, 2018). Similarly, in Portugal, the title terapeuta is not protected, and the practice of counselling is not regulated. There is no single national register in either country. Many practitioners belong to voluntary associations.
Professional registers in the UK: British Association for Counselling and Psychotherapy (BACP), National Counselling and Psychotherapy Society (NCPS), and others
Professional registers in Portugal: Voluntary registers, often based on therapeutic approach
What Is a Psychologist?
Psychologists study how people think, feel and behave. There are many types of psychologists, including behavioural, clinical, educational, forensic, organisational, and research psychologists; not all are qualified to deliver mental health support. (Castelnuovo et al., 2023; Denissen and Rauthmann, 2024)
Those seeking treatment for mental health issues would typically meet with a clinical or counselling psychologist. Support with a psychologist is often medium-term and focused on specific psychological difficulties or diagnoses. Psychotherapy or counselling can be practised by psychologists with appropriate training. Evidence-based modalities include cognitive behavioural therapy (CBT) (Hofmann et al., 2012) and many others.
Treatment may be tied to a medical model of care, in which a diagnosis may be offered using systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD).
Clinical and counselling psychology often includes:
Psychological assessment
Evidence-based treatments
Structured therapeutic approaches
Training
Clinical psychologists typically complete a doctoral degree in clinical psychology. Counselling psychologists typically complete a master’s degree in counselling psychology.
Regulation
In the UK, specialist titles such as clinical psychologist and counselling psychologist are legally protected. In Portugal, psicólogo/a is a protected title, and all practising psychologists must be registered with a regulating body.
Professional register in the UK: Health and Care Professions Council (HCPC)
Professional register in Portugal: Ordem dos Psicólogos Portugueses (OPP)
What Is a Psychiatrist?
Psychiatrists are medical doctors who specialise in mental health. Treatment happens within a medical model of care, in which a diagnosis is made using systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD).
In some cases, drugs may be prescribed to alleviate or manage symptoms (Baldessarini, 2014). Appointments with psychiatrists are often brief and focused on diagnosis and medication management.
In addition to psychopharmacology, psychotherapy can be practised by psychiatrists with appropriate training. Psychotherapy is a biological treatment that changes the brain, and some advocate for its integration into clinical practice (Gabbard, 2007; Gabbard, 2014).
A psychiatrist can:
Diagnose mental-health conditions
Prescribe medication
Manage complex mental-health needs
Training
Training in psychiatry includes a medical degree followed by specialist psychiatric training.
Regulation
In the UK and Portugal, the practice of psychiatry is regulated as a medical profession, and the titles psychiatrist (in the UK) and psiquiatra (in Portugal) are protected.
Professional register in the UK: General Medical Council (GMC)
Professional register in Portugal: Ordem dos Médicos (OM)
Image by Jonathan Sanchez
How These Professionals Work Together
Psychotherapists, counsellors, psychologists and psychiatrists each bring different areas of expertise to mental health care. Because of this, people may sometimes work with more than one professional.
For example, someone may:
be referred to a psychotherapist for depth-oriented therapeutic work (including making a self-referral)
be referred to a counsellor while receiving medical care or needing short-term support
be referred to a psychologist for a psychological assessment
be referred to a psychiatrist for a psychiatric evaluation when medical input is needed
This collaborative approach relies on communication and mutual professional respect, and it can be incredibly supportive for clients who need a combination of relational, psychological, and medical care.
Which Professional Is Right for You?
There’s no one best option. It depends on your needs and what you’re looking for:
If you want to explore your inner world, patterns, relationships, and long-term emotional well-being, psychotherapy may be the right fit.
If you’re seeking emotional support around life events or short-term challenges, counselling may be helpful.
If you’re seeking structured assessment or interventions for specific difficulties, a psychologist may be helpful.
If you need medication or medical oversight, a psychiatrist is the appropriate professional.
Many people start with one and move between them as their needs evolve.
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Beginning Therapy
I am a psychotherapist and counsellor working with individuals and couples.
Initial consultations are 20 minutes and take place by Zoom or phone. They offer a contained space to explore whether this way of working is appropriate for your situation and whether there is a mutual fit.
The consultation is not a therapeutic session, but an opportunity to clarify what you are seeking and to discuss how the work would be structured.
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References
BACP (2018). Ethical Framework for the Counselling Professions [Online]. Lutterworth: BACP. Available from: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/ [Accessed 07 May 2026].
Baldessarini, R.J. (2014). The Impact of Psychopharmacology on Contemporary Psychiatry. The Canadian Journal of Psychiatry, [online] 59(8), pp.401–405. doi:https://doi.org/10.1177/070674371405900801.
Castelnuovo, G., Di Nuovo, S.F., Lingiardi, V., Madeddu F. and Salvatore, S. (2023). Psychology profession, clinical psychology, psychotherapy. Specificities and boundaries. Rivista di Psicologia Clinica, [online] (1), pp.7–25. doi:https://doi.org/10.3280/rpc1-2023oa16357.
Clarkson, P. (2003). The therapeutic relationship. 2nd ed. London: Whurr.
Denissen, J.J.A. and Rauthmann, J.F. (2024). A comprehensive scan of psychological disciplines through self-identification on Google Scholar: Relative endorsement, topical coverage, and publication patterns. PloS one, 19(1), pp.e0296421–e0296421. doi:https://doi.org/10.1371/journal.pone.0296421.
Gabbard, G.O. (2007). Psychotherapy in psychiatry. International Review of Psychiatry, 19(1), pp.5–12. doi:https://doi.org/10.1080/09540260601080813.
Gabbard, G.O. (2014). Psychodynamic psychiatry in clinical practice. Washington, DC: American Psychiatric Publishing.
Gibbard, I. and Hanley, T. (2008). A five-year Evaluation of the Effectiveness of person-centred Counselling in Routine Clinical Practice in Primary Care. Counselling and Psychotherapy Research, 8(4), pp.215–222. doi:https://doi.org/10.1080/14733140802305440.
Hofmann, S.G., Asnaani, A., Vonk, I.J.J., Sawyer, A.T. and Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: a Review of Meta-Analyses. Cognitive Therapy and Research, [online] 36(5), pp.427–440. doi:https://doi.org/10.1007/s10608-012-9476-1.
Hunt, P. (2021). EAP Statement on the Legal Position of Psychotherapy in Europe. [online] Available at: https://www.europsyche.org/portals/0/media/docs/Legal-Position-of-Psychotherapy-in-Europe-2021-Final.pdf [Accessed 07 May 2026].
Lingiardi, V. and McWilliams, N. (2025). Psychodynamic Diagnostic Manual: PDM-3. New York: The Guilford Press.
Macneil, C.A., Hasty, M.K., Conus, P. and Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, [online] 10(111), pp.1–3. doi:https://doi.org/10.1186/1741-7015-10-111.
Mollon, P. (2009). Fitness to practise what. In: Are you fit to practise? From ethical framework to model of good behaviour, 6 June 2009, London. London: The College of Psychoanalysts Conference. Available from: https://www.researchgate.net/publication/281284531_Fitness_To_Practise_What [accessed May 08 2026].
Shedler, J. (2010). The Efficacy of psychodynamic psychotherapy. American Psychologist, [online] 65(2), pp.98–109. doi:https://doi.org/10.1037/a0018378.
Stevens, E. (2016). Counselling and the Law, Counselling Tutor. [online] Counselling Tutor. Available at: https://counsellingtutor.com/professional-practice-for-counsellors/counselling-and-the-law/ [Accessed 08 May 2026].
Vasco, A.B. (2008). Psychotherapy integration in Portugal. Journal of Psychotherapy Integration, 18(1), pp.70–73. doi:https://doi.org/10.1037/1053-0479.18.1.70.
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