What is the difference between psychological counseling and psychotherapy?

The difference between psychological counseling and psychotherapy is fundamental: counseling is neither a substitute nor a watered-down version, but rather a standalone format. The focus is on specific topics, such as an ongoing workplace conflict, a breakup, feeling overwhelmed by everyday life.

Counseling can also serve a preventive purpose: providing support before stressors escalate into clinical symptoms. People who seek help early on may not need therapy later on.

What counseling does not do: It does not make diagnoses or treat mental illnesses. Typically, the cost ranges from 60 to 180 euros per session. I have written separately about which factors determine the price and what an online psychologist costs.

The title “psychological counselor” is not legally protected. It could refer to a professional with extensive training, but also to someone who has taken a weekend course.

Compared to guideline-based therapy, counseling is usually shorter, more flexible, and more focused. Five to fifteen sessions are typical; the frequency depends on individual needs, and the focus is on a specific issue. Counseling tends to aim at resolving a clearly defined problem, whereas therapy focuses on treating a diagnosed condition.

Just as in therapy, the type of care provided in psychological counseling depends on the practitioner and the setting. During my time with the organization “Men Against Men’s Violence” (Männer gegen Männergewalt) in Hamburg, most clients were in dire need of treatment and not infrequently posed a danger to those around them. No clinical diagnoses were made, but with a larger number of sessions allocated and as a psychotherapist in training, I naturally did what I could. And that sometimes included treating clinical symptoms.

Medical and psychological psychotherapy differ in training, not in approach. Both are practiced by medical or psychological psychotherapists. This means: a degree in psychology, several years of postgraduate training, and a state examination. The title is protected by law.

In Germany, four approaches are scientifically recognized and approved for statutory health insurance: behavioral therapy (VT), depth psychology-based psychotherapy (TP), analytical psychotherapy, and systemic therapy. I have described what depth psychology-based psychotherapy involves in a separate article. Diagnosis is based on the ICD-10 or ICD-11 classification system, and statutory health insurance (GKV) covers the costs. Short-term therapy consists of up to 24 sessions, while long-term therapy consists of 60 to 300 sessions, depending on the approach, usually on a weekly basis.

Since April 2025, practices with a statutory health insurance license may conduct up to 50 percent of their treatment cases per quarter exclusively via video. This limit applies per practice (facility number), not per therapist. Psychotherapy consultations and trial sessions may now also take place via video, although at least 50 minutes, and in particular the first contact, should take place in person whenever possible.

The title “psychotherapist” is protected by law. The term “psychotherapy” is not. Alternative practitioners in psychotherapy are permitted to do psychotherapeutic work after passing a review at the public health department. They do not have a license to practice as a psychotherapist, are not permitted to bill statutory health insurance (GKV), and are not subject to any comparable requirements for supervision or continuing education.

That doesn’t mean their work is inherently inferior. Minimum formal standards and actual competence are two different things. Anyone who goes there pays out of pocket and should specifically ask about their training, qualifications, and supervision arrangements. I myself receive support from an alternative practitioner every two weeks and am very satisfied.

Psychosocial counselors, coaches, and life counselors work without authorization to practice healing. Counseling addresses life crises, while coaching focuses on professional development. That is the difference from the treatment of illness. Counseling services offered by social welfare organizations for specific problems constitute a separate category. These counseling services include, for example, addiction counseling, debt counseling, and parenting counseling.

Once a clinically significant mental disorder is present, none of these formats is sufficient. In such cases, treatment by licensed practitioners is required.

Anyone who begins therapy covered by statutory health insurance receives a diagnosis. Statutory health insurance stores it for ten years under Section 304 of Book V of the Social Code (SGB V). Ten years in which it can come back to bite you.

Law and education students avoid therapy out of fear of the medical examination administered by public health officials. This fear is more widespread than it is warranted. Ongoing or completed psychotherapy is generally not a reason for exclusion. Nevertheless, the results vary by state.

It can also hit hard when taking out disability insurance: risk surcharges, exclusion clauses, or rejection.

With private health insurance (PKV), even a single note from a primary care physician is enough to result in a denial. Anonymous preliminary inquiries illustrate the range of responses. For example: The Bavarian Civil Servants’ Health Insurance Fund (Bayerische Beamtenkrankenkasse) rejects applications if the illness was not symptom-free for at least two years. Gothaer offers coverage with a premium surcharge of about 36 percent. Hallesche rejects all such applications across the board.

Less well known: A mental health diagnosis can also make it harder to get a loan, because for real estate or business loans, banks often require term life insurance, which is difficult to obtain with an F code. Psychopathological findings are not listed in the SCHUFA. However, they prevent applicants from meeting a requirement that many banks impose.

Counseling does not leave a record of this kind. No diagnosis, no health insurance file. For young, working professionals, aspiring civil servants, or anyone about to take out disability insurance, this can be the deciding factor.

The consequences of F-coding are real, and I recommend knowing them before you start therapy. But I do not recommend letting them paralyze you and postponing necessary therapeutic work because of them.

If you’re specifically planning to take out disability insurance or term life insurance in the coming months (for example, because you’re about to take out a mortgage), make sure to get the insurance in place first. That’s a practical order of steps, not fraud. Then you can begin your therapy with a clear head.

But beyond such concrete steps, I often see something else: people who put off therapy and generally avoid many things that might get in their way later on.

But the price to pay is high. In my private practice, I have worked with many patients and clients who work in the public sector. It was not uncommon for them to experience existential fears rooted in family tradition and culture.

Fears like these rob us of our freedom, and it’s worth addressing them in counseling or therapy. Avoiding therapy in order to protect a certain life plan often ends up offering less protection than it costs. And sometimes it’s worth allowing yourself to ask in therapy whether the plan you’re so determined to safeguard is truly your own.

Many people fall between these categories. Daily life still works, but something’s not right. Poor sleep, irritability, a feeling of emptiness. It is not always possible to tell right away from the outside whether this is “just” stress or the onset of depression. The differences are not always obvious, but they have implications for the course of treatment.

Counseling is the more appropriate setting when a specific issue is the focus and daily life is not significantly disrupted. You are seeking reflection, guidance in making a decision, or support during a transitional phase.

Therapy is indicated when symptoms persist or worsen. For example, when anxiety, sleep disturbances, or low mood dominate daily life.

To get help with finding your bearings, you can go to a consultation with a psychotherapist. I explain how a psychotherapy consultation works and how to find a psychotherapist in this article.

Three questions can help you find your bearings.

Who is sitting across from you? “Licensed psychotherapist” means psychotherapeutic care. “Psychological counselor” or “psychologist” without completed training as a psychotherapist means counseling. “Alternative practitioner in psychotherapy” means: psychotherapeutic work without a degree in psychology and without state-recognized training.

What are you paying for? Counseling is always a self-pay service. Therapy can be billed through statutory health insurance (GKV) if the treating practitioner is licensed and has a statutory health insurance license. Services provided by alternative practitioners are occasionally reimbursed on a pro-rata basis by private supplemental insurance plans.

Private health insurance covers private psychotherapy at a private practice. For people who have statutory health insurance, the reimbursement procedure is required, which, unfortunately, is not always possible.

What is the goal? Strengthening psychological resources, solving problems, finding direction: counseling may be enough. A diagnosed mental illness requires psychotherapy.

If you feel like there is no way out, or if you have thoughts of harming yourself, please contact one of the following organizations immediately.

Telephone Counseling Service (TelefonSeelsorge), free, anonymous, around the clock: 0800 111 0 111 or 0800 111 0 222

On-call medical service and appointment service center: 116 117, also for short-notice crisis appointments with up to ten approved sessions

Emergency number in case of immediate danger to life: 112

The appointment service center at 116 117 arranges a therapy spot covered by statutory health insurance.

A good overview of crisis contact points is offered by the German Depression Support.

Help is available. That's true even if it doesn't feel that way right now.