Therapy, Psychotherapy, and Counseling- What's the Difference?

While laypeople and even some professionals use "therapy," "psychotherapy," and "counseling" interchangeably, specific legal and clinical frameworks—such as the Texas Administrative Code (TAC) and the DSM-5-TR—provide distinct definitions that govern their use in professional settings.

In the professional world, these terms are used as nested concepts: all psychotherapy is a form of counseling/therapy, but not all counseling is psychotherapy.

Counseling

The term "Counseling" is the broad, "umbrella" term. In professional literature, it focuses on wellness, adjustment, and life transitions.

• Texas Administrative Code (Title 22, §681.2): Defines "Counseling" as "assisting a client through a therapeutic relationship... to achieve mental, emotional, physical, social, moral, educational, spiritual, or career-related development and adjustment."

• Professional Use: Used when the focus is on sub-clinical issues. This includes career counseling, educational guidance, or helping a client navigate a specific life stressor (like a divorce or job loss) without necessarily treating a mental illness.

• The ACA Definition: The American Counseling Association defines it as a relationship that empowers clients to accomplish "mental health, wellness, education, and career goals."

Psychotherapy

"Psychotherapy" is a more clinical and specialized term. It is used when the focus shifts from general adjustment to the diagnosis and treatment of mental disorders.

• Texas Administrative Code (Title 22, §681.31): Explicitly defines "Psychotherapy" as the use of specific methods (cognitive, psychodynamic, etc.) to "assist clients in their efforts to recover from mental or emotional issues."

• DSM-5-TR Context: The DSM is the manual used to define the "disorders" that psychotherapy treats. While the DSM-5-TR doesn't define the act of psychotherapy, it provides the medical necessity for it. When a clinician uses a DSM code (e.g., F33.1 for Major Depressive Disorder), the service provided is strictly classified as "psychotherapy" for billing and clinical purposes.

• Professional Use: Used when addressing deep-seated patterns, personality pathology, or chronic mental health conditions. It implies a "medical model" of care where a specific "condition" is being treated.

Therapy

In a professional context, "Therapy" is actually the least formal term. It is a shorthand used by various disciplines (Physical Therapy, Occupational Therapy, Massage Therapy).

• Professional Use: In mental health, "Therapy" is rarely defined in the TAC because it is considered a colloquialism for "Psychotherapy." Professionals should use the term "Psychotherapy" in clinical notes and "Counseling" in broader scope-of-practice descriptions.

Summary Table: When to Use Which Term

Term	Legal/Clinical Source	Primary Focus	Best Used When...
Counseling	TAC §681.2	Development & Adjustment	The goal is solving a specific problem or life transition.
Psychotherapy	TAC §681.31	Mental/Emotional Recovery	You are treating a DSM-5-TR diagnosis or deep-rooted trauma.
Therapy	General Practice	Shorthand for "Psychotherapy"	Conversing with clients (layman's terms).

How to Use Them Professionally

If you are practicing in Texas or referring to professional literature, follow these guidelines:

1. For Documentation: If you are treating a client for a condition found in the DSM-5-TR, your notes should reflect "Psychotherapy" (e.g., "Client participated in 53 minutes of individual psychotherapy").

2. For Scope of Practice: When describing what an LPC does generally, use "Professional Counseling."

3. For Legal Compliance: In Texas, an LPC is legally defined by their ability to provide both "Counseling" and "Psychotherapy." However, if a clinician is working in a school or career center without a clinical license, they should strictly use the term "Counseling" to avoid implying they are treating mental illness.

...supervision matters!