What is the difference between a counsellor, a psychologist, and a psychiatrist?

This is one of the most common questions people have, and for good reason; it seems like there is a lot of overlap between all three of those. Here are some key differences:

Psychiatrists are medical doctors who specialize in psychiatry. A cardiologist specializes in heart functioning, a orthopaedist specializes in bones and surgery, and a psychiatrist specializes in the brain and behavior. Psychiatrists can prescribe medication, give a diagnosis, and do therapy. They usually work in hospitals, clinics, or specialized practices in Canada. It can take anywhere from 8 – 10 years to become a psychiatrist!

Psychologists are mental healthcare professionals who have a masters degree or doctorate degree in clinical or counselling psychology. Psychologists usually work in private settings, but can work in hospitals and clinical as well. Psychologists do usually do therapy and provide diagnoses, and have a wide range of training in psychological theories and its applications. Some psychologists also do research, teach in universities or colleges, and even work in the legal system as a forensic psychologist or an expert witness!

Counsellors are mental health professionals who work in a variety of settings and have a wide educational background. Some counsellors have degrees or diplomas in psychology, counselling, addictions, social work, or pastoral counselling. Counsellors provide therapy to clients and sometimes collaborate with other mental healthcare professionals. Counsellors cannot provide a diagnosis and cannot prescribe medication.

Do you take health insurance?

I do not do direct billing, but your extended health insurance may provide coverage for counselling provided by a Registered Counselling Therapist (RCT), Registered Professional Counsellor (RPC), or a clinical counsellor.

Can you give me a diagnosis?

No. Only a doctor or a psychologist can give someone a diagnosis; this is a protected health service in Nova Scotia. Your therapist can recommend a psychologist if your need a diagnosis, or you can talk to your family doctor.

If I tell you that I have thought about suicide or that I hurt myself, will you have me admitted to the hospital?

Not usually, unless you are in crisis. Being able to talk about suicide, self-harm, and other tough topics is why you are in therapy in the first place. Your therapist does not want to you feel shame or embarrassed to talk about these things, or anything else, and wants you to feel comfortable to talk about these topics. Having thoughts of suicide is not uncommon, and talking about it is the first step toward work through those feelings.

If you have thoughts of suicide or of hurting yourself, the most important thing to do is to make sure you are okay and you have a safe plan in place.

A psychiatrist is the only person who can have you admitted to the hospital, and this is extremely rare. Speak with your therapist for more information.

Is everything I tell you confidential?

In most cases, yes. One of the most important things in therapy is being comfortable sharing your experience without having to worry about your information being shared with others. There are a few times when confidentiality may be broken, such as:

  1. Your counsellor believes you are at immediate risk of taking your own life or someone else’s life;
  2. Your counsellor believes you are at immediate risk of harming yourself (see note on self-harm for further explanation) or someone else;
  3. Your counsellor has reasonable suspicion of child, elder, or vulnerable persons abuse (for example, if you tell your counsellor about a child being neglected or abused);
  4. Your counsellor and/or their files are requested by a lawyer or court of law;
  5. Your counsellor’s professional organization/licensing organization deems there is a need to protect the public.

What kind of therapy do you do?

I use a range of therapeutic approaches; sometimes therapists call this an eclectic approach. I use elements of client-centered or Rogerian (link 2), existential, psychodynamic (ISTDP), and solution-focused models of therapy.

Me or my child is under 18, how does confidentiality apply to them?

In Nova Scotia, we have something called the ‘mature minor‘ doctrine. The mature minor doctrine states that a minor can seek treatment at their own discretion, provided the healthcare provider is confident the person is able to understand the nature of the therapy, informed consent, and confidentiality. The minor (or therapist) does not have to inform the parents or guardians about therapy or their progress. The therapist is under the same ethical obligation to safeguard their information as they are when they work with adults.