Finally, under the influence of Adler and Rank, a 'third way' was pioneered by the US psychologist Carl Rogers. Originally called 'client-centred' and later 'person-centred', Rogers's approach focuses on the experience of the person, neither adopting elaborate and empirically untestable theoretical constructs of the type common in psychodynamic traditions, nor neglecting the internal world of the client in the way of early behaviourists. Other approaches also developed under what came to be called the 'humanistic' branch of psychotherapy, including Gestalt therapy and the psychodrama of J.L. Moreno. The figure below illustrates some of the historical links between these three main strands which developed from Freud's original contributions.

Freud strongly supported the idea of lay analysts without medical training, and he analysed several lay people who later went on to become leading psychoanalysts, including Oskar Pfister, Otto Rank and his own daughter Anna Freud. He published two staunch defenses of lay analysis in 1926 and 1927, arguing that medicine and the practice of analysis were two different things. When Ernest Jones brought psychoanalysis to the UK in 1913, he followed Freud's preferences in this area, and the tradition of lay involvement continues to this day in the UK, where most psychoanalysts, psychotherapists and counsellors have a lay background.

In the US, however, Freud's analysand A.A. Brill insisted that analysts should be medically qualified even though there were already many lay analysts practising in the US who, like Brill, had trained with Freud in Vienna. Brill prevailed, however: in 1926 the state of New York made lay analysis illegal, and shortly thereafter the American Medical Association warned its members not to cooperate with lay analysts. To this day, almost all US psychoanalysts are medically qualified, and counsellors typically study psychology as undergraduates before becoming counsellors.

It was largely in response to the US prejudice against lay therapists that Carl Rogers adopted the word 'counseling', originally used by social activist Frank Parsons in 1908. As a psychologist, Rogers was not originally permitted by the psychiatry profession to call himself a 'psychotherapist'. Ironically, Rogers himself became renowned as one of the most influential empirical scientists in the fields of psychology and psychiatry, introducing rigorous scientific methods to psychology and psychotherapy that psychoanalysts themselves had long resisted and, in the view of many, still largely resist today. He became a joint Professor in the Departments of Psychology and Psychiatry at the University of Wisconsin as well as Head of the Psychotherapy Research Section of the Wisconsin Psychiatric Institute.

In the field as it now stands, the argument as to whether counselling differs significantly from psychotherapy is largely academic. Those from psychodynamic traditions sometimes equate 'psychoanalysis' and 'psychotherapy' -- suggesting that only psychoanalysts are really psychotherapists -- but this view is not common anywhere else. Others use 'psychotherapy' to refer to longer-term work (even though some psychotherapists offer brief therapy) and 'counselling' to refer to shorter term work (even though some counsellors may work with clients for years). The two terms are commonly used interchangeably in the US, with the obvious exception of 'guidance counseling', which is often provided in educational settings and focuses on career and social issues.

Modern counselling and psychotherapy have benefited tremendously from the empirical tradition which was given such impetus by Carl Rogers, even though the research agendas of psychology and counselling have diverged greatly over the last half century. Additional work in cognitive psychology, learning theory and behaviour has informed many therapeutic approaches. The richness of the bodies of both empirical and theoretical work which are now available, coupled with the raw complexity of human beings, has led to a profusion of different approaches to the field. By some accounts, the different strands of counselling and psychotherapy now number in the hundreds. Mainstream approaches, however, are much fewer in number, and over time it is likely that many of the less well-grounded schools of thought will fade away, while more new ones will emerge to take their place. While the main approaches continue to develop, and others appear and then fade away, clients are left to choose for themselves what might be best for them.
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