Frequently Asked Questions
Counsellors/Psychotherapists, Psychologists & Psychiatrists: What are the differences and what do they do?
Psychiatrists are medical doctors whose specialty is in mental illnesses and conditions. They have extensive training in the pharmacological treatment (using drugs & medication) of mental illnesses. Psychiatrists are the only mental health professionals allowed to prescribe medication to clients/patients. Anecdotal evidence in Singapore suggests that many psychiatrists rely very heavily on medication to treat many mental conditions, while overlooking psychotherapeutic treatment methods. Psychiatrists may or may not be trained in Psychotherapy and can also differ in their training, comfort levels and competencies in Psychotherapy. A good psychiatrist does not mean a good therapist simply because different skill sets are involved.
Psychologists are mental health professionals trained in a specialised field of psychology. There are many different types of psychologists based upon their different fields of specialisation: such as Educational Psychologists, Clinical Psychologists, Industrial & Organisation Psychologists, Counselling Psychologists, Child Psychologists, Neuropsychologists, Sports Psychologists, etc. Psychologists are trained to conduct psychological testing, assessments and evaluation. Most psychologists have general training in psychotherapy; levels of training vary depending on their specialisation.
Counsellors and Psychotherapists are mental health professionals trained to help clients cope with issues and problems in their lives. They have training in psychotherapy. They help clients learn useful life skills, as well as deal with many common life issues and challenges. Some may have received additional training in areas such as hypnotherapy and/or training to administer non-psychological tests such as personality profiles, psychometric tests, lifestyle and habits profiling, etc. Counsellors can also specialise in the type of clients they see. Some specialise in children and adolescent issues, others with adults, family therapy, marriage counselling, trauma therapy, addictions, stress & anger management, etc.
Who is the best person to see?
There is no simple answer to this question because the answer very much depends on your needs and condition(s) (as well as personal preferences). And these can sometimes be very hard to determine and pinpoint in mental health issues.
Psychotherapy, or some form of talk therapy is almost ALWAYS recommended as part of the treatment regime for all mental health disorders, issues and problems. Severe and major mental illnesses (sometimes referred to as psychiatric disorders) such as major depression, bipolar disorders, schizophrenia, obsessive-compulsive disorders, specific chronic and deep phobias, post-traumatic stress disorders, severe substance dependence and abuse - very frequently require medication(s) which only a psychiatrist is qualified to diagnose and prescribe medication for, to control and/or alleviate debilitating symptoms such as panic, anxiety, fear, withdrawal, etc. Reliance upon drugs and medications alone are usually insufficient in improving mental health, simply because mental issues cannot be resolved with just taking pills. Psychotherapy is recommended in conjunction with pharmacological treatment.
It is not uncommon for clients to ‘mix and match’ the mental health professionals they consult. For example, clients can consult a psychiatrist for medication to control their mood, anxiety and sleeplessness symptoms, etc, while seeing another professional (such as a counsellor/therapist, pastor) for psychotherapeutic treatment. There are many reasons for clients to do so beyond the obvious one of different costs. Clients can dislike or be uncomfortable talking to a particular professional because of the latter’s manners (or lack thereof!), or simply because, there is no therapeutic rapport or trust between them.
What is this ‘therapeutic alliance’ or ‘therapeutic rapport’?
Seeking help for mental issues and problems is a really personal thing. For counselling and therapy to work and be effective, there MUST be trust and rapport between the therapist and the client(s). A good therapist will have the empathy, intuition and skills to realise and understand the client’s real problems and underlying issues. In turn, the client(s) must feel comfortable speaking to the counsellor, confiding in him and trusting his evaluations. It is a two-way interactive and sharing process based upon cooperation and collaboration between the client and therapist. That is what the ‘therapeutic alliance or rapport’ means. It is an intangible part of the relationship between the client and mental health practitioner, mutual and built up over time and effort.
It can be regarded as a ‘contract’ or understanding between the client and counsellor where both parties pledge their commitment to addressing the client’s issue(s) and/or problem(s). Some counsellors and therapists actually request their clients to sign a declaration of commitment. This can help to maintain clients’ motivation levels and commitment to the counselling process.
What are the costs for Mental Healthcare?
Costs are understandably a very important consideration to many clients seeking mental healthcare.
Psychiatrists and psychologists are at the top of the price pyramid in private mental healthcare. Their fees range from S$320 and $180 for a single 50 minute session. Medication, if prescribed by a psychiatrist adds further to the costs.
Private practice counsellors/therapists charge between S$120-S$160 per session.
Forking out the most money to see a psychiatrist or psychologist the moment you suspect a mental health issue in yourself or loved ones may not be the most effective, or even the best way to deal with it.
Consider: If you have a fever or flu-like symptoms, the person you would first consult would probably be a General Practitioner (GP) or the nearest polyclinic. If the GP is unable to help you, or suspects a more serious problem, they would refer you to an appropriate specialist as the next step in the treatment hierarchy. You COULD see a specialist every time you are running a temperature, but is it really necessary, or the best use of your time and resources?
The same logic applies to mental healthcare. It makes good sense to first see a GP or qualified counsellor should you have any concerns. Both would at the very least be able to render their professional opinions, and make recommendations and/or referrals to an appropriate or another mental health professional for formal assessment, and/or diagnosis and medication, if necessary.
Furthermore, as explained earlier in the section "Who is the best person to see?" and "Why clients mix & match mental health practitioners;" deciding whom to consult also depends as much on subjective personal factors as costs considerations. In other words, it's not a question of price, but what or whom works for you in mental healthcare.
Finding a Good Therapist
A good starting point to finding a good counsellor/therapist would be personal referrals or recommendations from family members, friends and colleagues. Consider seriously those with experience in psychotherapeutic treatments, and are qualified with at least a Masters degree in Counselling or Psychology. You could also approach the pastoral leaders in any religious/educational organisations; at the very least, they could assist in finding some one suitable to your needs to help you.
Feel free to shop around for what is available. A good counsellor and psychotherapist doesn’t need to be the most expensive one. Call prospective therapists and speak to them over the phone or in person. Ask the therapist questions. Choose one according to your needs, though he should be qualified, skilled and can interact well with you, and whom you think you can develop a trusting and good working relationship with.
Why Seek Counselling?
In many developed countries, Counselling & Therapy help is well accepted and an integral part of total healthcare - both physical and mental. In recent years, the Singapore government has increasingly acknowledged the importance of mental healthcare and correspondingly increased the funding to this area.
In worldwide statistics, mental health issues affect 1 in 4/5 individuals, frequently affecting their ability to work or lead normal lives. In Singapore, this figure could well be understated because of our cultural propensity NOT to acknowledge or seek treatment for mental health issues. This is mostly because mental health issues have a very bad meaning, are misunderstood, are not accepted, or regarded as a serious loss of face.
The people who do seek counselling, do so because they realise they need help with an issue or problem that is beyond them. It takes a lot of courage to make this first step. Following this, sustained commitment and motivation are essential to the success of the counselling/therapeutic process.
Counselling/therapy is really a very personal thing. It is very important you find a professional helper whom you can work with, trust and form a ‘therapeutic alliance’ with, regardless whether he/she is a psychiatrist, psychologist, or a counsellor/therapist.
How does the Counsellor help?
Many issues and problems have deep-seated roots. Counselling and psychotherapy involves the exploration of these issues - both their origins and present impacts. The breakthrough happens when the real underlying issues are identified; the process of healing begins from that point. Psychotherapy does not require drugs. It is a mental and emotional process that requires commitment, effort and motivation in equal measures to succeed.
The counsellor is trained to LISTEN, EXPLORE and ANALYSE your issues and concerns, as well as PROVIDE you with the necessary TOOLS to help you cope with them and change your life, if that is your objective. This is done in an entirely non-judgmental, and empathetic compassionate manner.
That actually, is why counselling can be so helpful to any-and-every one!
Counsellors are professionals committed to helping you! We are trained to be ‘detectives’ understanding your underlying problems and issues.
It is also the most important reason why talking to a friend is not the same – they do not have the training, or the objectivity to identify your real problems. It helps to have a neutral, objective, third-party's view.
Confidentiality and Privacy
This is a very important issue to every-and-anyone. All of us have private thoughts and secrets we wish not to be disclosed.
Speaking to a counsellor/therapist rather than a friend is actually safer and more ‘face-saving’ because the Counsellor is a professional.
Our job is to listen to you without judging your actions or character.
We are required by law and a professional code of ethics to protect your confidentiality and privacy. All information shared in session is guaranteed to remain entirely confidential and fully private. No information shared in session may be divulged without the expressed consent of the client. Please refer to and read the INFORMED CONSENT section of the Registration Form.
Privacy & Confidentiality are not protected in the following situations:
- An Order from a recognised court of law compelling disclosure.
- Information shared affects the well-being and protection of minors and/or the elderly. (required by law)
- Information shared affects the preservation of life of self; or the threat of life to others. (required by law)
REMEMBER! The Counsellor is a professional committed to helping you with your problems and issues. There is absolutely no face involved/lost because we do not judge your actions or character, and will not reveal your sharings.
The successful Counsellor is one who works himself out of his job because he solves your problem and you no longer need him!
Homework and Getting the Most out of Counselling and your Sessions
Homework given by your Counsellor/Therapist has a purpose and is important. TRUST US! Homework is how therapists help clients learn and reinforce what was identified in session. Doing the homework REALLY HELPS to speed up the healing process.
Counselling/Therapy is most effective if you:
- Turn up and keep regular appointments.
- Spend time on your homework when it is given.
- Be open, honest and truthful in session. Untruths only make the healing process lengthier and more difficult. The Counsellor is a professional COMMITTED TO HELPING YOU. Lying to your Counsellor is counter-productive and the same as lying to yourself!
- You must feel comfortable in session(s). Trust, respect and belief in your therapist is VERY important.
- All change requires equal measures of patience, commitment and motivation. Be firm, yet gentle with yourself. Growth takes lots of: time and effort, time and effort, time and effort, time and effort . . . you get the idea.
How Long does it Take?
Duration of treatment depends very much on the healing and recovery process which differs from individual to individual, as well as to the nature and severity of the problem(s) and/or issue(s). The psychotherapeutic model practiced in developed countries such as US, UK & Australia recommends a minimum of 4 to 6 single sessions.
Clients who had given their wholehearted commitment, motivation, effort and time to therapy, and thus achieved the objectives they had sought, all testified unanimously and unequivocally to how this achievement had vastly improved their lives.
All great endeavours require great effort. Success also commensurates with the effort invested.