Counselling refers to a practice in medicine in which the therapist involved assists the client in understanding dysfunctional thinking patterns and helps them navigate through the complexities of human psychology using a variety of means and methods.

Counselling is usually a generic term for various forms of psychotherapies employed by trained and certified psychologists to help patients/clients work through various problems.

It’s very important to understand the target audience for these interventions are aimed at:

1. Normal individuals who are not suffering from any psychiatric disorder can avail these services.
2. Patients, who have been diagnosed with a psychiatric illness and have been treated medically for the same and are in a state to comprehend and accept psychotherapy.
3. Patients with very mild levels of psychiatric illness, in which there is no role of active medications.

It’s very important to understand point number 2. Let’s understand it with an example.

Suppose there is a patient who is suffering from moderate to severe depression. In such cases the most common symptoms set is:

1. Sadness of mood
2. Inability to experience pleasure
3. Reduction in the ability to think logically
4. Crying spells and
5. Cognitive inflexibility: meaning that patients even when presented with an alternative positive view of a situation will not be able to process it and in fact will stick with their negative view of the world.

In such cases, psychotherapy as a first line treatment option is not possible. The reasons are very simple:

1. Any psychiatric illness causes alterations in the way the brain functions. These alterations are the reason why symptoms arise.
2. In the absence of the resolution of symptoms, there is no way for the patient to view the situation alternatively.

Consider another illness for e.g. Headache. Most people when they have a moderate or severe headache tend to be very irritable and restless. They cannot be reasoned with at that time. They are in pain and nothing that you will say will reduce their pain. They need to be given medications which can reduce the severity of their pain. Once their pain is less they will be much more compliant with you, they will become more reasonable and they will be able to talk to you about what’s bothering them or any other issue that they might face.

Same is the case with any psychiatric illness. Due to the fundamental changes that it causes to the brain structure and functioning, no amount of talk therapy will help in clinical cases.

They need to be treated first and then they can become amenable for psychotherapy.

Most people tend to get this concept wrong and that’s why I am explaining this with a more relatable example.

Please understand that the role of psychotherapy is not to treat your symptoms, but to help you with the tools to better manage your life going forward. This will reduce your vulnerability to your external environment and increase the brain’s immunity to withstanding stress and pressure.

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