Counsellor vs Therapist | How To Know What's Right For You

Everyone has mental health. 

Like physical health, mental health can vary person-to-person and ebb and flow depending on our own unique circumstances – family mental health history, body and brain chemistry, life experiences, traumatic events, and more. Also like physical health, sometimes we can manage our wellbeing on our own, and sometimes we can’t; that’s when it can be beneficial to seek the help of a professional.

Mental healthcare can be confusing to navigate. After deciding to take that first step to look for help—a huge accomplishment itself—it’s normal to be unsure about where to begin, or who to work with. 

Many people start with their own research, often with a search for a therapist online, and come across dozens of types of therapy and professionals to choose from. The Canadian Counselling and Psychotherapy association lists more than 70 mental health professional titles within the “counselling profession.”

One of the first hurdles is to understand the difference between counsellors vs. therapists. 

Generally, these terms are umbrellas. They could refer to many types of professionals and “counsellor” and “therapist” are often interchangeable. Neither “counsellor” or “therapist” are official titles for licensed mental health professionals. These kinds of titles also appear in other fields, like career counselling, physiotherapy, massage therapy. So, it’s important to understand there are specific professional titles for counsellors and therapists in mental healthcare, and to understand that only some of those titles are regulated and licensed for use in Canada. 

Working with someone who is a licensed and regulated mental health professional means you know they have a certain level of education and are held to standards of training, practice, competency and conduct. 

Exploring the Distinctions

Education, training and licensing requirements for counsellors and therapists

In Canada there are four primary categories of regulated health professionals: psychiatrists, psychologists, psychotherapists (or counselling therapists), and social workers. Each has a different level of education and scope of practice. 

Psychiatrists, psychologists and social workers are regulated titles across most of Canada (with exception of some titles in the Yukon and Nunavut). Licensing for psychotherapy or counselling therapy are more varied across the country.

Across Canada, licensed titles for psychotherapy or counselling therapy (at the time of writing) are:

• Counselling Therapist is the regulated title in Nova Scotia, New Brunswick, and Prince Edward Island and is in progress to be regulated in Newfoundland, Manitoba, Alberta, and BC.
• Psychotherapist is the regulated title in Ontario and Quebec and is in progress for Saskatchewan.
• Certified Canadian Counsellor (C.C.C.) is a self-regulated title overseen by the Canadian Counselling and Psychotherapy Association (CCPA) and is a good option for provinces and territories that are unregulated or not-yet-regulated by a Controlled Act.
• Province-specific associations. Some provinces, like British Columbia, have their own self-regulating bodies while they await Controlled Acts. For example, a counsellor in B.C. with a master’s-level education can register with the BC Association of Clinical Counsellors (BCACC) and use the title Registered Clinical Counsellor (RCC). 

Explore more: Therapist and counsellor licensing and education requirements across Canada (CHART).

Depending on the clinic, centre or service, some professionals with the title of “counsellor” or “qualifying” might be available while they work toward their licensing. 

Education and training for licensed counsellors

The education and training that is required for regulated mental health professionals range from a doctoral degree (PhD) to a combination of an undergraduate degree and training to obtain a title and licence.

Psychiatrists and psychologists can diagnose mental illness (others cannot), and only psychiatrists can prescribe medication. Psychiatrists require a doctoral degree and psychologists require, at-minimum, a master’s degree to be licensed.  

Typically, a registered psychotherapist or counselling therapist will require a master’s degree (or equivalent), whereas a social worker may have a diploma or bachelor’s degree combined with training to work in their field. 

It’s a common misconception that social workers only hold roles like community counsellors. That can be true. But, many social workers are educated at a master’s degree level, work in specialized fields in clinics, hospitals or schools, and many are licensed to offer one-on-one counselling therapy/psychotherapy. 

Paula Fernández, a Registered Social Worker and Psychotherapist based in Ontario says, “the way that I break it down is, you have your Psychiatrist, who is focusing primarily on diagnosing and treating through medication, you have a psychologist who will diagnose, then you have a psychotherapist who works with just treating an individual whether they have a diagnosis or not.”

There is a strong distinction between social service workers (diploma), and social workers (bachelor and masters programs). While they're often trained in the same therapeutic practices and modalities, social workers consider the parts surrounding an individual, while psychologists and psychotherapists look within the individual.

The training hours required for each type of professional varies depending on their scope of practice and their licensing as well. Psychiatrists and psychologists are the most extensively trained—psychologists, for example, require approximately 4,000 hours of supervised clinical training plus supervised practice after graduation, and passing ethics, oral and psychology exams before being licensed to work on their own. Registered psychotherapists and counselling therapists, by comparison, depending on where they practice, must complete anywhere from about 500-2000 hours of supervised training and pass an ethics exam to be certified by their college or association. 

Each licensed therapist type is overseen by its own college or association in its jurisdiction (province or territory). These governing bodies take responsibility for the ethics and conduct of their professionals, set practice requirements and ensure professionals are keeping up-to-date on their practice. Often, professionals will continue with supervised training or other development opportunities needed to maintain their licenses, or just to progress professionally based on their own interests and commitment to their field.

Understanding a counsellor or therapists’ title and whether or not they’re regulated is just one way you can feel confident that they are the right fit.

Specializations and areas of expertise

When it comes to common treatment areas or approaches for therapists vs. counsellors, it will again come down to their credentials and training.

Counsellors or therapists (i.e., psychologists, psychotherapists, social workers or counselling therapists) who are licensed to provide psychotherapy will likely specialize in a few areas:

• In therapeutic modalities (techniques), such as cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT), solutions-based therapy, or somatic therapy (body awareness focused), to name a few. 
• Working with types of clients, like couples, kids or teens, men, 2SLGBTQIA+ or BIPOC clients 
• Common mental health challenges like anxiety, depression, trauma, abuse, etc. 

Explore more: Learn about mental health professionals, modalities and specializations in First Session’s Therapy 101 Guide

Unlicensed counsellors or coaches, by comparison, could offer some forms of active listening and advice service as a component of their work, but it doesn’t mean they are able to offer psychotherapy or counselling therapy. 

Even with licensed professionals, the above specializations can intersect and overlap. You’re not expected to be an expert when it comes to understanding all of these specializations and offerings, but it’s beneficial to understand how to review your chosen counsellor’s credentials.

Selecting the right mental health professional

It can be helpful to first review the therapy or counselling options available to you in your area, consider what you can afford, and think about when and how you can make appointments.

There are differences between short-term and long-term therapy. Short-term options might involve more structured techniques, like cognitive behaviour therapy, which can be time-specific and more like a workshop process. This could be a determined number of weeks under the guidance of a trained professional. Long-term therapy tends to dive deeper into root issues and can be ongoing, depending on your needs.

Factors to consider when selecting a mental health professional

1. It might take some time to find the right therapist fit. The relationship with a therapist is the number one predictor of success. It’s more likely you’ll benefit from therapy if you and your therapist are a strong fit. This is more important than their specialization, their approach or technique. You might have to work with a couple of therapists for a few sessions before really finding someone that works for you.
   
   
2. Look for alignment. Part of finding a good fit is feeling like they understand you. They will likely ask good questions to learn about your background and your goals, and their recommended plan for an approach sounds like something you can work with. This could mean their education, area of interest in their practice, or their personal background (e.g., they share common demographics with you) fit with your unique experiences.
   
   
3. Mind your budget. Generally, if someone is being treated for a mental health crisis in a hospital, their therapy is covered by provincial healthcare plans because it’s considered medical intervention. Outside of this, there are some publicly funded counselling centres across the country, or free phone lines dedicated to supporting Canadians for low or no cost. These can be limited in availability and breadth of service. Otherwise, licensed professionals are an out-of-pocket expense, or are covered by workplace insurance plans if you have one.
   
   Fees for one-hour can range anywhere from $65 to $300 and up, depending on the education, training and years of experience, and their location. Keep in mind that therapist and counsellor are general terms, so your benefits booklet will clearly outline which type of professional are covered. Some designations are more likely to be covered, such as psychologists, counselling therapists or psychotherapists. Often, social workers are included, and if they offer psychotherapy it’s likely they’re covered under that title too. Call your benefits provider to clarify if you’re unsure.
   
   
4. Consider your location. Counsellors are licensed to work in one or more provinces. They might be available for in-person or online therapy or both. Online appointments can take place over secured video platforms, or over the phone. This can offer flexibility and privacy (you don’t need to leave home to attend your sessions). Conversely, you may prefer to leave home to safely and securely attend your sessions. Ask your chosen therapist what options they offer. Be sure to double check they are included in your workplace coverage, especially if they operate in a province other than the one you live in.

Taking the step towards mental wellbeing

Taking the first step to better mental health is a courageous undertaking, and beginning that process is an accomplishment. Seeking support from others takes commitment and energy, which can be especially difficult when you’re not feeling at your best to begin with. You might start with listening to a few podcasts, reading online articles, or calling a helpline before deciding to try a one-on-one therapy session. That’s all progress. Improvement is often the result of incremental small steps.

It might feel daunting, but the work can be worth it; therapy can literally change your brain. How our brains react to stress, process information and respond emotionally is programmed during various stages of development, and it can be changed positively through practices like therapy. 

First Session recently heard from several people who have told their story of how therapy impacted their lives.

Recap: Counsellors vs. therapists – how to know what’s right for you

This decision is as personal as you are. Don’t be afraid to start and stop and continue as you need, and to find someone who is a great fit for your mental health goals, and to be open to something new.

Here’s a quick summary of what you need to know:

• Counsellor vs. therapist. While counsellors and therapists might be general terms, they refer to a world of variety and choice for mental health support. 

• Regulated titles in Canada: Therapy and counselling professionals are regulated across Canada under the titles of psychiatrist, psychologist, psychotherapist, counselling therapist and/or social worker. 

• Licensing bodies: Licensed professionals are overseen by governing bodies called colleges and associations in the jurisdiction (province or territory) in which they operate. These ensure training requirements are met, they oversee ethics guidelines and address related concerns, and maintain oversight over the law outlined in their province’s Controlled Acts.

• Regulations vary across the country: Psychiatrist, psychologist and social worker are consistently regulated titles across each province and territory. From there, some provinces regulate the title psychotherapist, others regulate the title counselling therapist, some have no regulations at all—in those cases, it requires a little more diligence on the part of the client to ensure they’re receiving care from a trained professional (the Certified Canadian Counsellor title is a good option).

• Refer to your health benefits: Check your workplace benefits to see what titles are covered by your health insurance—this is important when considering cost, and it can help you select a trusted and trained professional where you live.

• Relationships matter: Each professional is going to bring their own unique approach, training, specialization and personality to your therapy sessions. Finding someone who has training in an area aligned with your goals and needs is important, but more important is how you feel when you’re talking with them. The client-therapist relationship is the number one predictor for positive outcomes in therapy. 

Ready to start your search? Look for a therapist on First Session. You can filter by location, specialization, modality or therapy type and browse videos to get to know the therapist before you reach out.