What psychotherapy is, and is not
A definition that does work, and the boundary cases that test it.
Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances, derived from established psychological principles, for the purpose of assisting people to modify their behaviours, cognitions, emotions and other personal characteristics in directions the participants deem desirable.
What each clause excludes
| Clause | What it rules out |
|---|---|
| Informed and intentional | Accidental help; a good conversation that happened to be useful |
| Clinical methods and interpersonal stances | Purely pharmacological treatment |
| Derived from established psychological principles | Practices with no theoretical grounding or evidential basis |
| Assisting people to modify | Coercion, and treatment done to rather than with |
| Directions the participants deem desirable | Social control, conversion practices, and treatment aimed at goals the patient does not hold |
The boundary cases
- Counselling
- In most jurisdictions the distinction is regulatory and historical rather than substantive. Where it is drawn, counselling is framed as shorter, more focused on adjustment and less on personality, and delivered by a differently regulated workforce.
- Coaching
- Distinguished by target population and goals rather than by method. Coaching addresses performance and development in people without clinical difficulty; the methods overlap substantially, which is why the boundary is frequently crossed in both directions.
- Peer support
- Help from someone with lived experience of the same difficulty. Not psychotherapy, and effective on its own terms.
- Traditional and religious healing
- Frequently addresses the same problems by other means, with a rationale and a ritual and a healing relationship. Frank’s framework predicts it should sometimes work, and it does.
- Self-help
- Guided self-help with brief support is psychotherapy delivered efficiently, and performs accordingly. Unguided self-help is materially less effective.
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