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Psychologist, Councillor or Coach? Who does what?

Updated: Apr 11, 2023

A long but hopefully useful post about mental health service providers in SA.

I read a post this morning in which the poster was distressed upon finding out that a counsellor recommended to them did not provide a service that could be claimed from a medical aid. I thought that it might be helpful to provide a rough guide to the therapy, counselling, and coaching landscape in South Africa to help people make informed choices in the future. In this post, I've described the different types or categories of therapists, counsellors, and coaches and give you an idea of who is and who is not registered with the HPCSA (and from whom you should be able to claim from medical aid)

Different mental health needs have different requirements and the South African mental health landscape reflects this. Depending on your needs, different kinds of counselling and coaching exist. Whether you have received a formal diagnosis of a mental health condition, have experienced a major life trauma, are struggling with day-to-day issues, need some direction, or simply want to work towards being the best version of yourself will determine what kind of help might be useful for you.

**So what is the difference between psychologists, registered counsellors, counsellors, and coaches?**

The difference between a counsellor, registered counsellor and psychologist essentially relates to their experience, scope of practice and ethical code. They may be registered with different bodies and are trained in different areas and to various levels. The rates they charge can also vary widely regardless of their professional registration (or lack thereof).

A **psychologist** is a mental health professional who has a minimum of a masters degree in psychology, has completed a comprehensive practicum and a community service year, and is registered as a clinical, counselling or educational psychologist with the HPCSA. This determines their area of expertise, scope of work and limitations. Most of them are able to claim back from medical aid. Clinical psychologists are best trained for dealing with mental health conditions including depression and anxiety – they perform psychotherapy and develop treatment plans; counselling psychologists focus on everyday struggles and difficulties such as stress, divorce and other life events; educational psychologists usually focus on children experiencing learning challenges. Anyone who unethically frames themselves as a psychotherapist or calls themselves a psychologist without the prerequisite qualification should be reported to the HPCSA. (If you are a research psychologist, you also register with the HPCSA but cannot practice as a clinical psychologist.)

A **registered counsellor**, will have a BPsych (Counselling) qualification that permits them to provide basic counselling and assessments per their scope of practice. Registered counsellors are often the first point of counselling for individuals and families. These counsellors refer clients to psychologists if there is an issue beyond their scope of practice. Registered counsellors are registered through the HPCSA and most are also able to claim back from medical aid. **Psychometrists** also have a BPsych (Psychometry) qualification and can undertake a wide rage of testing to aid in various diagnoses. They are also registered with the HPCSA.

In South Africa, we also have other counselling bodies that acknowledge other fields of study and experience in the field of psychology. Such counsellors may be registered through CCSA, CPSC or ASCHP. A counsellor that is registered with the ASCHP focuses on holistic healing and may be referred to as a wellness counsellor. They cannot claim back from medical aid, which normally means their fees are lower. A counsellor registered with the CCSA is similar to this, although they may use different counselling methodologies. A counsellor that is registered with the CPSC is a pastoral counsellor. Pastoral Counselling uses faith-based resources as well as psychological understanding and these counsellors usually have a pastoral or theological background.

**Coaching** has some parallels with counselling but it is not the same thing. Counselling usually focusses on past issues or current challenges. In contrast coaching is shorter term and future focused. Its aim is to help a client achieve a defined goal or maximise their potential. Coaching is client-led with coaches playing a supporting role in helping people to generate their own solutions. Coaching is largely a non-regulated industry in South Africa, and coaches cannot register with the HPCSA (or claim from medical aid). There is however an international coaching federation (ICF) where coaches can be accredited if their training meets the requirements.

None of these mentioned above can prescribe medication – if the need for medication is indicated, you would be referred to a psychiatrist.

**Do I need a psychologist, counsellor or coach?**

If you:

· are looking for ongoing long-term therapy

· have a diagnosed mental health condition (or a suspected mental health condition)

· want to claim from your medical aid

· are suicidal or very depressed

· are under 18 years of age and struggling with your mental health

it may be best to seek an appointment from an HPCSA registered professional, such as a psychologist or registered counsellor.

If you:

· are looking for short-term counselling

· are looking for a safe space to talk about your life challenges

· need marriage, family, relationship, or grief support

· want to focus on one (or a few) specific factors

· need support in making decisions about the future

· would like some helpful tools for coping with day-to-day stressors

· need trauma debriefing

· can afford to pay for counselling yourself

or if you would like to speak to someone with a spiritual (faith based) background about your daily life challenges, sessions with a CCSA , CPSC or ASCHP counsellor may suit you better.

If you:

· want to aim, set, or clarify personal goals

· need help moving your business forward

· struggle with procrastination, time management etc.

· would like to work on skills such as conflict resolution or anger management

· want to address the habits that prevent you from achieving your goals

· need help in becoming a better communicator · are looking for someone to help you align your goals as a couple or family

then a life, family, parenting, or business coach may be just what you need.

When you enter into a contract with any of the above the onus is on you to confirm details such as rates, qualifications, and accreditations if they are not provided by the service provider. You are also entitled to know whether you will be able to claim from your medical aid (and whether their rates are higher than the medical aid rate or not). Most counsellors will provide you with this information before your first session and should inform you about the code of ethics they ascribe to as a professional.

It's worth noting that in South Africa, there are only approximately 11,000 psychologists in a country of approximately 60 million people – fewer than 3 psychologists per 100,000 people (compared to the U.K. which has around 37,000 psychologists for a population of about 67 million people), and very few new psychologists enter the profession each year as there are an extremely limited number of spaces in clinical programmes. As such, HPCSA registered counsellors and counsellors registered with other bodies form an important part of the mental health landscape in the country.

I hope that this provides those searching for support with some insight to the various types of therapies, counselling, and support available in SA, and gives some guidance as to who can or can’t claim from medical aids for their services.

This post was originally written by a Group Member on The Village Facebook site

Picture of two women talking bodies facing each other as in psychology or coaching session

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