Psychological counseling and psychotherapy are essentially different

The essential difference between psychological counseling and psychotherapy lies in the completely different underlying logic of the psychopathological level of the intervention objects and the work goals. It is by no means superficial differences such as "just different qualifications of practitioners" or "different length of consultation" as misunderstood by the outside world. The working background of the former is "developmental support", while the core of the latter is "pathological correction". The working boundaries, applicable scenarios and operational logic of the two are fundamentally different.

I previously worked in the clinical psychology department of the Municipal Mental Health Center for half a year. What impressed me most was a 22-year-old girl. After failing the postgraduate entrance examination, she didn’t want to go out for three months and often forgot to eat. At first, she found a psychological counselor from a commercial institution. After four conversations, the counselor kept guiding her to “accept the emotion of failure and don’t be harsh.” She blamed herself." As a result, the more she talked, the more she felt, "I'm a useless person, I can't even adjust my emotions well." When she came to the doctor, she already had shallow scratches on her wrist. The final diagnosis was a moderate depressive episode. She switched to cognitive-behavioral psychotherapy, combined with low-dose antidepressants, and was able to go out and find a job normally in less than 2 months. To be honest, if she had found the right direction from the beginning, she would not have taken that detour at all.

Many people cannot tell the difference between the two, which is actually related to the current chaos in the industry: many consultants in commercial institutions have not received systematic training in pathological identification. In order to earn tuition fees, they label patients who have reached clinical diagnosis standards as "emotional problems" and reserve them for consultation. I have seen no less than ten cases of delayed medical treatment. Let’s use a less rigorous analogy: Psychological counseling is like when you usually find a fitness personal trainer. You are healthy, but recently your posture is out of shape, your weight has gained, and you want to practice a waistcoat line. The personal trainer can make plans for you, correct your movements, cheer you up, and help you achieve a better state; Physiotherapy is more like rehabilitation training after orthopedic surgery. You have already suffered organic/pathological damage. It cannot be cured by just practicing. The doctor has to keep an eye on your recovery and adjust the plan. You must also take medicine and review. If you do the wrong movements, it will cause secondary injuries.

Of course, the boundary between the two is not without controversy in academia and industry, and the views of different schools are quite different. For example, practitioners with a cognitive behavioral (CBT) orientation are particularly hard on boundaries: Conventional CBT psychological consultation is only for ordinary people without clear clinical diagnosis, and solves developmental problems such as workplace stress, marriage and love conflicts, and career planning, using short-term cognitive adjustment. The whole technology; and CBT-oriented psychotherapy must serve people with clear ICD-11/DSM-5 diagnoses, such as depression, anxiety disorders, and obsessive-compulsive disorder. Standardized treatment plans must be used, and symptom changes must be regularly evaluated and synchronized with psychiatrists. However, many practitioners with a psychoanalytic and humanistic orientation feel that there is no need to draw such a rigid boundary. As long as the practitioner has sufficient pathological recognition ability and meets the standard of competency, even if the client has mild neurotic symptoms, he or she can help the client through long-term work. However, no matter which school, there is a consensus that cannot be escaped: Practitioners who are incapable of identifying psychotic symptoms or severe mood disorders must not handle cases beyond their ability. The referral must be made. This is the professional bottom line.

I have been doing related work for more than 7 years, and I have encountered many unclear visitors. A young man who works in the Internet came to make an appointment before. He said that he had only slept 2 hours a day for the past month. He also felt very energetic. He couldn't stop talking and his thoughts jumped very fast. One second he was talking about the project, and the next second he was talking about traveling around the world. I felt something was wrong at the time and asked him if he had ever been in a situation where he didn't want to do anything for half a month. He said that he had done it half a year ago, when he quit his job and stayed at home for a month. I did not consult him that day and advised him to go to a psychiatrist for diagnosis first. Later, he sent me a message saying that he was diagnosed with bipolar disorder and that he was already receiving medication and psychotherapy, and his condition was now much more stable. If I had taken this case on a whim and tried to help him with his emotions, I might have had something happen.

Oh, by the way, ordinary people don’t need to dig into those complicated terms. Just remember the simplest judgment standard: If your problem is just "I haven’t been going well at work recently, I have had a quarrel with my partner, and I want to find someone to talk to and think about my thoughts." You don’t have to delay eating, working, and socializing, and it is enough to find a formally trained psychological counselor; If you have felt for more than two weeks in a row that "life is meaningless, you don't want to do anything, and your whole body aches so much that you can't bear it." It's difficult to even wash up, go to work, and talk to people, or even have thoughts of self-injury or suicide. Don't hold it in your arms. Go to a psychiatric department to register first. You should get treatment and take medicine when you should. There is really no shame in that.

In the final analysis, whether it is consultation or treatment, the core is to help people overcome the current hurdle. You don’t have to worry about whether the name is nice enough. Finding the right path that suits you is better than anything else.