Psychotherapist, Psychiatrist, Counsellor, Social Worker—what gives?!

Finding the right support can be hard, and the sheer volume of designations makes it hard to know where to begin. The following guide aims to demystify these classifications, and clarify just what clinical counselling is and who it’s for.

What is a Registered Clinical Counsellor?

In British Columbia, a Clinical Counsellor is the professional title for mental health practitioners who are registered with the BC Association of Clinical Counselling (BCACC). This registration requires at least 6 years of university education (including a bachelor’s and a master’s degree), as well as a passing grade in comprehensive exams and a rigorous internship.

It’s important that you consider the professional standing of any mental health practitioner from whom you consider seeking help. There are a wide variety of people offering counselling-like services under the banner of “coaching”, etc., for a huge variety of differing rates—from the very cheap to the extraordinarily expensive. Although it may be possible to receive quality care from these types of providers, they do not work under any legislative or binding professional or governmental oversight.

Counselling is a powerful approach to mental health, and the truth is that it is not without risk. Accredited, professional organizations ensure that practitioners adhere to rigorous ethical standards of care, have met recognized standards of education, and are committed to continuing professional development. Further, accredited clinicians can lose their status if they are found guilty of malpractice or ethical misconduct. On the other hand, there is no way to know if an unregistered “mental health coach” has a history that includes malpractice, abuse of power, or causing harm to clients.

 The overwhelming majority of us wouldn’t consider clicking on an internet advertisement for a surgeon or dentist or doctor who hadn’t gone to school, had no supervised experience, and didn’t have a recognized title. At Nightingale Counselling, we think it’s just as dangerous to seek care from unaccredited, unprofessional, or unrecognized mental health care practitioners, and we only include therapists with up-to-date RCC and CCC credentials on our clinical team.

There are lots of accreditations though, how do I tell the different professionals apart?

In British Columbia you may get mental health services from the following:

●     Registered Clinical Counsellor (RCC)

●     Canadian Certified Counsellor (CCC)

●     Psychotherapist, therapist, counselling therapist, psychoanalyst

●     Psychologist

●     Psychiatrist

●     Registered Social Worker

The first three are essentially the same. RCC’s and CCC’s are both clinical Counsellors registered with different organizations—either the provincial or the national organization. Many Counsellors label themselves with terms such as psychotherapist or psychoanalysts: these are popular and socially recognizable words for the kind of work that clinical Counsellors do, and roughly speaking, they are interchangeable with each other.

TitleEducationDiagnosticTask/PopulationCost/Insured?
Social WorkerMSW
Masters level
NoFamilies and childrenSome insurers, out of pocket, $120-$150/hr
CounsellorMA/MC
Masters level
NoPsychotherapySome insurers, out of pocket, $120-$150/hr
PsychologistPhDYesTesting, assessment, and some psychotherapyMany insurers, $200/hr +
PsychiatristMDYesMedical doctor who gives pharmaceutical prescriptionsMSP, referred by GP

Why is diagnosis so important?

For many people seeking Counselling, diagnosis will not be important. The vast majority of the “mental health” work that we do in Counselling relates to everyday problems of living: struggles in relationships, problems at work, questions about our identity, dealing with life transitions, processing grief and loss, etc. None of these ordinary problems require a diagnosis despite the fact that they can leave us with powerful symptoms: we can feel out of control, addicted to powerful coping mechanisms, or dealing with volatile feelings, thoughts, emotions, and behaviours. 

But for some people, diagnosis is very important. If you are dealing with extraordinarily severe symptoms, then a medical label can provide helpful support. For example, a diagnosis of ADHD can help by providing explanation and clarity for a variety of otherwise confusing (and sometimes embarrassing or shameful experiences), while also being a gateway to pharmaceutical regimes, which can be essential interventions. 

Psychologists are trained to provide rigorous tests and to analyze the results to help identify when a diagnosis is necessary. Psychiatrists can provide psychopharmacological (medicine) interventions as they have the legal capacity to prescribe, just like a GP.

What do Clinical Counsellors do to help if they don’t diagnose or provide medicine?

Clinical counselling is a unique relationship between the therapist and the client. Although some people think it is “just talk”, therapeutic conversation uses powerful, evidence-based techniques and strategies to discover, distill, and shift a wide variety of problems in everyday living. Many practitioners are trained in diverse theoretical and practical frameworks for both understanding mental and relational health problems and creating effective interventions.

 In popular culture and the newspapers, there are few widely known therapeutic modalities such as CBT (Cognitive Behavioural Therapy), DBT (Dialectic Behaviour Therapy), and EMDR (Eye Movement Desensitization and Reprocessing). However, there are actually hundreds of modalities that have been developed over the past 130 years. Many less well known therapies are in fact incredibly productive and useful. EFT (Emotion Focused Therapy), Existential Therapy, and Somatic Experiencing may be some less familiar names that are well worth considering and are all therapies that we employee at the Nightingale Clinic.

At Nightingale Counselling, we rely on non-manualized therapies—approaches to therapy that don’t have a strict rule book. We find that conversations which are empathetic and client-driven are the most beneficial. We also find that good clinical counselling should occupy a sweet-spot between the goal-focused and the open-ended. Being too goal focused can lead the client and therapist to miss the forest for the trees—our goals need instead to be flexible as our deepening conversation leads to more knowledge about what’s going on, what works, and what doesn’t. Being too open-ended, on the other hand, can leave clients and therapists feeling lost, like we don’t know where we’re going, like there’s no plan beyond “see you in two weeks.” Open-ended therapies help us stay agile and follow the most important and powerful pathways that present themselves in the moment, while being goal-focused ensures that client and therapist both recognize they are working on a particular project together, to solve whatever problem of daily living has brought you into the room in the first place.

Some of the outcomes of therapy include:

Renewed sense of hopefulness

Clarity and insight into the inner workings of your life

More power over compulsive thinking or behaviours

Better quality relationships with friends, family, children, and lovers

Increased understanding about the givens of existence

Is counselling safe for everyone?

It’s worth recognizing that counselling is not entirely free of risk. Our conversations will lead us to sometimes difficult truths and insights, and at first these can sometimes be hard to bear. For example, dealing squarely with grief and loss experiences can lead us into powerful feelings of sadness, anger, and pity, feelings which we may have been led to avoid in everyday life. Hard feelings, however painful, are not inherently unsafe.

For some people, especially those with significant trauma symptoms (or diagnoses of PTSD), powerful and painful feelings can in fact be harmful and unsafe. It is very important that counsellors be trained in trauma-informed approaches, so the risk of re-traumatization is minimized and appropriately managed. 

Finally, counselling can create changes in our behaviour which can be distressing. For example, if you decide to stop continuing with a compulsive or addictive habit, the change can be very disarming and difficult to deal with (even if it is ultimately something you feel is in your best interest!). 

Counsellors need the skills, training, and experience to recognize these potential sources of distress, struggle, and pain, so that you can feel confident that this is the right person to take these risks with.

Is counselling private?

Counselling is 100% confidential, and a Counsellor cannot tell anyone who their clients are or what is said. Records are only accessible by the Court through an official subpoena. If friends, doctors, lawyers, police, children, parents, bosses, or spouses call a Counsellor or Clinic and ask for information, the Counsellor will deny knowledge that the person being discussed is even their client!







Who is counselling for?

Many people wonder if counselling is right for them. They think maybe they should be able to handle their problems on their own, or that their problems aren’t big enough to get support for. Or maybe they worry that they will get in trouble—or get someone they care about in trouble—if they tell a professional about their difficulties. 

Counselling is a productive and safe place to get help with many of the challenges we have in life, from everyday coping to majorly stressful events; from embarassing ideas and feelings to big questions about our identities; for seeking comfort in a time of loss to seeking reassurance in the face of anxiety. If you’re thinking about Counselling but not sure, you can always call a Counsellor up and ask them if your reason for coming is a good one: there’s no cost in asking.