Medically reviewed by Karen Foster, LPC
Updated May 14, 2024by BetterHelp Editorial Team
You may have seen the words "counseling" and "counselling" around the internet while looking for professional support. Knowing the difference between these words may help further your understanding of what support is available to you, depending on your location and mental health needs.*

Read on to learn more about counselling vs. counseling, and which option might be best for you.

*Generally speaking, anyone can use counseling, regardless of mental health diagnoses or concerns.

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What is the difference between counselling in the UK and counseling in the US?
There is no difference between counselling and counseling at an education or program level. Both terms generally 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, while counseling is considered by many to be the American English version.
Although the word "counseling" may look different when published in the UK compared to in the US, both services are thought to offer mental health and well-being support to clients and community members at home, or via different locations across the state or region.
What are counselors' main responsibilities?
Counselors generally focus on providing mental health support, guidance, and advice across a broad range of mental health issues in both the UK and the US. They might teach clients about various coping mechanisms that are personalized to their symptoms. Although there are many cultural mental health stigmas in both countries, mental health 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 from American counseling professionals, and many types of therapy are available to diverse individuals. 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 use?

Many counselors are a part of a counseling association, in which they complete continuing education and build on skills learned through their counseling program. As a result, there are many types of therapies that are practiced within the UK and the US. Some of the most common can 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 

UK and US counseling 

There are a few differences between the counseling you might receive in the US versus that of the UK:

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 generally 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 (including marriage and family therapists) might also use the ICD-10 to code for insurance purposes. 
Insurance options for mental health care coverage and 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—especially for more specific conditions and diagnoses, such as substance use disorder (formerly known as substance abuse). 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

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 through the American Counseling Association and the BACP: 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, education and training 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, tailored to career goals
  • 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, and must be licensed through the American Counseling Association. Both groups are held to certain strict ethical standards in the practice of mental health care. 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 counseling 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. This can include counseling families, and group counseling sessions. 
  • 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. An online platform like BetterHelp empowers diverse individuals to find the help they need. 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 professional counselors 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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The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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