What Is Counseling, Really?

For centuries people have tried to make sense of themselves, and not only in a physical way. We have wanted to understand what moves us emotionally and mentally too. Out of that long curiosity came psychology and, later, counseling, a field aimed at understanding how people feel and behave and how they might shift toward something better.

Two words tend to get swapped around in all of this: "counseling" and "therapy." People used them as if they were identical decades ago, and plenty of people still do. For many, they simply mean the same thing. Both describe a process of working through difficulty and moving toward growth and a steadier kind of happiness. But each word carries its own backstory, and the two are not quite the same.

The best known name in psychotherapy is Dr. Sigmund Freud. He trained as a neurologist in Vienna in the late 1800s, and his earliest patients carried the label "hysterical." Working with them, he built his theories and the method he called psychoanalysis. His psychodynamic model split the mind into three parts: id, ego, and superego. He also argued that people either move through or get stuck in a series of developmental stages he named oral, anal, and phallic.

Dr. Carl Jung studied alongside Freud before branching off into his own ideas about psychology and treatment. Several other analysts shaped therapy into the form we recognize today, among them Alfred Adler, Erik Erikson, Karl Abraham, and Carl Rogers. For most of its history, psychotherapy has concentrated on serious problems tied to internal, intrapsychic conflict, and it leans more toward the past than the present moment.

Counseling got going around the same time as psychoanalysis, in the early 1900s, but it grew out of a different root: the progressive guidance movement. Prevention was the point, along with a sense of purpose. The idea was to help people steer clear of poor decisions and find some direction in their lives. These days counseling also takes in the broader question of overall wellness.

It can support ordinary personal development, and it can address diagnosable mental health conditions. The work happens one-on-one, in groups, with couples, or with whole families. Counselors treat it as a moving, active process; the job is to help a client name their goals and actually get there. The 20/20: A Vision for the Future of Counseling group described it as a dynamic process carried out through a range of theories and methods. So counseling is about making choices as much as making changes.

One old distinction between the two fields had little to do with the work itself and more to do with who did it. Counseling was often handled by nonprofessional staff, while psychotherapy was the territory of master's or PhD level clinicians. That gap narrowed over the years as the counseling profession pushed to define and credential itself.

The 1990s brought a cluster of changes along those lines. The National Academy of Clinical Mental Health Counselors merged with the NBCC to make credentialing easier. Accredited master's and doctoral programs in counselor education multiplied. Publications on counseling grew through the ACA, commercial publishers, and the ERIC/CASS clearinghouse. Licensure laws for counselors were written and spread.

At its core, counseling is a direct working relationship between a counselor and a client, whether a patient or a resident, and it can run individually, in a group, or with a couple. A counselor might work with children, teenagers, adults, or older people, and many specialize in a particular area such as children, autism, or dual diagnosis. Whatever techniques or theories they draw on, the aim stays roughly constant: help the client work through what is troubling them, build coping skills, gain some insight, or change the way they behave. The point is to move toward better functioning, toward whatever fuller version of themselves a person is capable of reaching.

The results people take away vary. Some develop insight or sharper self-awareness. Some shift their thinking patterns. Others see their self-esteem climb, or find they can hold their emotions and behavior more steadily. Assertiveness can grow. Anxiety and panic can ease. Motivation can return. Relationships improve. People recover from alcohol or other substances. Some finally find a way to carry grief and loss.

Put simply, counseling tends to resolve the things getting in the way: mental health struggles, addiction, a hard situation, whatever is draining a person's sense of happiness or success. Working with a trained professional can lift mood and open the door to a better life. Counseling and psychotherapy overlap a great deal, which is exactly why the two words keep trading places in everyday conversation. - Kim B.

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