Understanding Counselling Vs Counseling

Medically reviewed by Karen Foster, LPC
Updated September 19, 2023by BetterHelp Editorial Team

You may have seen the words "counseling" and "counselling" around the internet while looking for support. Knowing the difference between these words may help further your understanding of what support is available to you, depending on your location, nationality, and mental health needs. However, note that anyone can utilize counseling, regardless of mental health diagnoses or concerns. Depending on your location, there may be various options available to you.

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What Is The Difference Between Counselling And Counseling? 

There is no difference between counselling and counseling. Both terms refer to the same service offered by mental health professionals like licensed counselors, therapists, psychologists, or social workers. However, counselling with two Ls is considered the UK English form of the word. Counseling is the American English version.

Although the word "counseling" may look different when published in the UK compared to in the US, both services offer mental health and well-being support to clients and community members.

What Are Counselors' Main Responsibilities?

Counselors focus on providing mental health support, guidance, and advice in the UK and the US. They might teach clients about various coping mechanisms personalized to their symptoms. Although there are many cultural mental health stigmas in both countries, counseling has become more prevalent in recent years, and anyone can take advantage of it. 

In the US, you do not need to develop a mental illness to receive support, and many types of therapy are available. In addition, over 41.7 million US adults saw a therapist in 2021, with the number growing each year. 

In the UK, over 635,000 adults saw an NHS (National Health Service) therapist in 2021, a 5% increase from previous years. However, this number does not factor in the number of adults seeking treatment under a non-public mental health provider or with insurance. In addition, the population of the UK is lower than the population of the US.  

What Kinds Of Therapies Do Counselors Utilize?

A few common types of therapies that are practiced within the UK and the US include the following: 

  • Cognitive-behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT) 
  • Guided self-help counseling or counselling 
  • Eye movement desensitization and reprocessing therapy (EMDR) 
  • Mindfulness-based cognitive therapy (MBCT) 
  • Psychodynamic therapy
  • Couples therapy 

Is There A Difference Between UK And US Counseling? 

There are a few differences between the counseling you might receive in the US versus that of the UK, including the following. 

Diagnostic Coding For Insurance Billing 

Both US and UK therapists can diagnose clients with mental illnesses. Not all therapists choose to, but those who do may use a diagnostic manual to ensure the correct diagnostic coding on client paperwork and insurance claims. The two most commonly used diagnostic manuals include the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, and the International Classification of Diseases, Tenth Edition (ICD-10) by the World Health Organization. 

Many providers in the UK use the ICD-10 to diagnose mental health conditions, although they can use both manuals. In the US, the DSM-5 is most commonly used. However, therapists might also use the ICD-10 to code for insurance purposes. 

Insurance Options For Mental Health Care Coverage & Beyond

Insurance options for mental health coverage differ in the US and the UK. As the UK has free mental healthcare for all citizens through the NHS, finding non-public insurance can be costly and complicated. In addition, non-public insurance may have higher co-pays. These plans could also require that an individual is already diagnosed with a mental illness or has a diagnosis that fits under the accepted condition list for that insurance company. 

In the US, non-public insurance is commonplace, as there is no free healthcare system. Government insurance plans are also available, such as Medicaid and Medicare. Insurance plans can be costly for many Americans, but many options are available. When signing up for insurance in the US, you can check to see if mental health services are covered. Some US mental health plans offer telehealth counseling reimbursement as well. 

NHS Vs. The US: Government Provided Healthcare

The National Health Service in the UK is the country's government healthcare plan. It involves groups of hospitals, clinics, and providers registered to provide support to UK citizens and residents. Mental healthcare is offered for free to all those eligible to receive support through the NHS.

NHS assigns all clients to a therapist based on their doctor's referral, symptoms, and needs. According to the NHS website, many clients have a right to choose which provider they receive for their first appointment. However, talk to your doctor if you're unsure about the process. The NHS can be an efficient option for any UK resident looking for support, as the average cost of individual therapy in the UK is 200 to 300 pounds a session. 

In the US, there is no similar system to NHS. However, the US government does offer Medicaid and Medicare, which can fully cover some mental health services for eligible individuals. However, Medicaid and Medicare are not available to all US citizens. One difference in available mental healthcare in the US is that clients may have more significant control over the type of treatment they receive when looking for highly specialized care. 

Referrals In The United States Vs. The United Kingdom

In the UK, clients must be referred to a provider by their general practitioner (primary care doctor) to see a therapist. That means a diagnosis or medical necessity is required to see a therapist. In 2023, it may be possible to "self-refer" to a provider through NHS. However, to see a psychologist or psychiatrist, it may be required to have a general practitioner first. 

In the US, referrals can work similarly. However, you do not have to have a referral to see most therapists unless your insurance plan requires it. You can also choose your therapist on many insurance plans, even if it's from a list of in-network providers. 

Counselling Licensing: Differences And Similarities

In the UK, counselling is not controlled as it is in the US. Counselors in the UK are not required to have a specific educational path as in the US. However, many employers seek those registered with a counselling organization like the British Association for Counselling and Psychotherapy (BACP). They recommend that UK individuals looking to become counselors have the following education: 

  • An introduction to counselling course
  • A certificate in counselling 
  • An undergraduate, graduate, or postgraduate degree in psychology or a similar area
  • At least one year of courses and at least 100 hours of supervised experience

In the UK, becoming a counsellor takes three to five years. In the US, it can take over six years, and the career is controlled. The US requirements for becoming a counselor include the following: 

  • Four years of undergraduate study for a bachelor's degree in psychology or a similar field 
  • One to two years of study for a counseling or clinical social work master's degree
  • Two to four years of postgraduate studies in a doctoral program like a Ph.D. or PsyD 
  • Over 1000 hours of supervised clinical experience
  • A passing score on a state licensing exam after all other requirements are met
  • A commitment to take continuing education courses each year 

In the US, counselors cannot practice without meeting the above requirements. The laws are less strict in the UK, which is a significant difference between the two. In the UK, counsellors make around 36,000 pounds a year. In the US, counselors make around $70,000 yearly (more or less), depending on experience. 

Exploring Mental Health Options For People Living In The UK 

In the UK, clients have several options for mental healthcare, including the following: 

  • The National Health Service (NHS): A free government-sponsored health program that includes counseling, crisis services, and inpatient hospitalization. 
  • Individual Therapy: Individual therapy involves a pay-per-session option for those seeking more control over their therapy experience. You can choose this option with some insurance plans, with or without co-pays.
  • Online Therapy: Online therapy may be cheaper than in-person counseling for those in the UK.

Exploring Mental Health Options For People Living In The US

In the US, counseling options may be similar. If you're an American, you may be able to get support from the following: 

  • Individual Practice Therapists: Individual practice therapists offer support for a specific cost per session, with or without insurance coverage. 
  • Counseling Clinics: Some mental health clinics work with specific providers and offer support, with or without insurance coverage. Colleges and universities often have free clinics available for their students.
  • Inpatient And Outpatient Therapy Centers: These may involve hospitals, treatment centers, and rehabilitation centers that offer therapy, psychiatry, and other mental health services, with or without insurance coverage. 
  • Online Therapy: Americans can also have online therapy for a cheaper rate than many in-person therapists. 
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Internet-Based Therapy Worldwide

You're not alone if you are a UK or US citizen looking for internet-based counseling. Studies have found that online cognitive-behavioral therapy (CBT) has been one of the most popular and effective treatment options for common mental health conditions like anxiety, depression, and social anxiety disorder. 

Many UK citizens cannot personalize their counseling experience through government health programs, so online therapy can provide a helpful alternative. Through a platform like BetterHelp, you can fill out a quick questionnaire upon signing up for services about your preferences for a therapist, including whether you want a same-sex, BIPOC, LGBT, or religious therapist. You can also change your therapist at any time. 

In addition, online therapy can allow those in the UK to take advantage of the cheaper rate exchange and the option to meet with a therapist without requiring a doctor's referral. Americans can also benefit from online therapy, as it is often cheaper than the $100 to $200 session fee that many personal practice therapists charge. 


Counseling and counselling are terms for the same services. However, there can be differences in how mental healthcare is handled in the US versus the UK. If you're interested in meeting with a counselor, consider contacting a provider in your area or asking your primary practitioner for a referral. If you're looking for online options, you can also contact a worldwide provider like BetterHelp.

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