Clinical work is about treating mental health problems that meet the criteria for a formal diagnosis and/or that have a serious negative impact on your life, such as impacting your work, basic functioning like eating and sleeping, making it hard to do activities in your daily life, causing you significant emotional distress on a continual basis. If you have any diagnosed mental health condition, clinical work is more likely to offer relief for you. If you don’t have a diagnosis we could say that the more serious or impairing your mental health problem is, the more likely it is that clinical work is going to be the most helpful therapy for you.

Clinical work usually involves assessment and making a diagnosis and specific treatments that are matched to that diagnosis. The therapist is likely to be quite active in your meetings, and will spend time sharing knowledge and specific skills. The therapist has a big role in setting the agenda for meetings, and is likely to have in mind a specific treatment plan for you. You will likely work on the same problem across many sessions rather than a new problem every time, and that problem is likely to be a specific illness. There most often are things that you need to do or change between meetings for the treatment to work. Talking to the therapist is just part of the treatment.

Therapists doing good clinical work can read and understand research, place a high value on research, and make decisions about treatments based on science. They almost always have specific advanced clinical training beyond their graduate school courses (fun fact: most psychologists don’t learn specific treatments for things like OCD or PTSD in graduate school at all - training to treat these conditions happens after university). Therapists doing clinical work usually believe in “treatment specificity”, which means they believe that certain treatments are better for certain diagnoses, and they tend not to believe that having a good therapeutic relationship will be enough to heal a serious mental health issue.

Clinical therapists can still do counselling work - they will simply establish that a person doesn’t have an illness and instead of the clinical skills of diagnosis, assessment, and treatment, they will use counselling skills. That said, many therapists have a preference for one or the other of these types of work and people who do a lot of clinical work might do more active and skills based counselling when counselling is appropriate.

Counselling work is also called “talk therapy”, though there are some types of counselling that are body based or somatic as well. Counselling is primarily for psychologically healthy people. It is best for problems that are a difficult part of a healthy life, that are caused by factors external to the person, or for work meant for spiritual or personal growth. Grief, breakups, making career decisions, stress around life transitions or temporary crises, low intensity relationship issues, and minority stress due to racism or sexism are all good examples of issues for which counselling is not just acceptable, but is likely preferable to clinical work. Counselling work usually does not involve assessment or diagnosis. This makes sense, because in cases where a person seeking treatment is not mentally ill they should not receive interventions designed to identify and treat illness.

Goals of counselling are often quite flexible, and because of this different topics can be addressed each session. Work is client directed, and the therapist may emphasize listening as an intervention in order to make space for the client’s thoughts, opinions, and preferences about how they should solve their problems.

There is a counselling theory of practice called “common factors” that is the opposite of treatment specificity, and this is the theory most counsellors are taught in school. Common factors theory places a lot of emphasis on the therapy relationship, client factors, and other contextual factors in therapy, and makes strong arguments AGAINST using specific treatments. For counselling as defined above this theory makes sense, but common factors theory does not apply to clinical work. There are many clinical diagnoses for which there are very clear treatments that are much more effective than counselling.

People who mostly do counselling, even if they are called psychologists, may not have the ability to diagnose or treat mental illnesses. All clinicians are trained in counselling skills, but NOT all clinicians are trained in clinical skills. That said, people who mostly do counselling therapy are probably going to be better at counselling than people that mostly do clinical therapy. Both types of work are legitimate specialties.