Counselling & Psychotherapy: What's the Difference?

Counselling and psychotherapy serve overlapping, but distinct purposes in mental health care:

• Counselling typically focuses on providing tools, advice, and support to manage everyday challenges and maintain wellbeing. It involves practical assistance like fostering life skills, coping techniques for stress, and sometimes crisis intervention.
  
• Psychotherapy typically addresses significant mental health challenges, which may require a more intensive and longer-term approach. Only registered professionals that have the appropriate training can provide psychotherapy and use the title of “psychotherapist”. The most common psychotherapy providers in Ontario are Registered Social Workers, Clinical Psychologists, and Registered Psychotherapists. For more information see this explanation of Different Registered Mental Health Professionals in Ontario.

Acceptance & Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT - pronounced as the word “act”) is an evidence-based psychotherapy within the cognitive behavioural umbrella. It focuses not directly on symptom reduction but on enhancing life quality through psychological flexibility, achieved via six core processes in the “Hexaflex” diagram. These include being more:

• Present in the moment,
• Defusion (or detachment) from unhelpful thoughts,
• Acceptance of difficult feelings,
• thinking more Flexibly,
• identifying core Values, and
• Committed Action aligned with these values.

Together, these processes foster a more flexible state of being open, present, and value-driven.

Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP), also known as Exposure and Ritual Prevention (EX/RP), is a specialized form of Cognitive-behavioral Therapy (CBT) designed for the treatment of Obsessive-Compulsive Disorder (OCD). ERP involves confronting fears directly to learn that the anxiety or discomfort they cause can naturally lessen over time through repeated exposure, without the need for rituals. This process helps break the cycle of OCD by weakening the urge to perform rituals, thereby improving the individual's quality of life. ERP is composed of four main components:

• In Vivo Exposure: Directly facing real-life situations or objects that evoke fear, anxiety, and distress, such as touching contaminants or disordering possessions, and remaining in those situations for a set period.
  
• Imaginal Exposure: Visualizing oneself in feared scenarios, including the consequences of those situations, to confront fears that cannot be physically replicated or are not triggered by identifiable situations.
• Ritual Prevention: Actively refraining from performing ritualistic behaviors in response to anxiety or obsessional thoughts.
• Processing: Reflecting on the experience and learning from it, including recognizing that anxiety and distress can decrease over time without avoidance or rituals, and understanding one's ability to manage distress.

Successful treatment requires active and emotionally engaged participation in exposure exercises that accurately reflect the individual's specific fears and obsessions. The ultimate goal of ERP is to teach individuals that they can manage their distress and live with uncertainty without resorting to avoidance or ritualistic behaviors.