What is the difference between psychological counseling and psychiatry?

The core difference between the two is actually the difference in professional qualifications and service orientation. Practitioners in the psychiatry department are psychiatrists with medical licenses and have the right to diagnose and prescribe. They mainly deal with pathological mental illnesses, while practitioners in the psychological counseling department are mostly psychological counselors or psychotherapists with professional qualifications and do not have the right to prescribe. They rely on systematic psychological intervention techniques to help clients solve non-pathological problems such as emotions, relationships, and personal growth.

Speaking of which, I encountered a very typical example last week. A girl who was in the second year of high school was dragged by her mother to our counseling department. She said that her child had not wanted to go to school for more than half a month. As soon as she entered the school, her heart and hands were shaking, and she could not sleep. Her grades were originally at the top of her grade, but recently she fell directly to the middle and lower reaches of the class in the mock test. When we did the initial assessment, we found that she already had a typical state of being heavy in the morning and light at night. She had lost almost 10 pounds in half a month without dieting, and there were several shallow marks on her arms secretly made with a knife. This condition was an indication of a moderate depressive episode. We did not dare to directly receive a consultation, so we helped her on the same day. She was referred to the psychiatric department next door. After the diagnosis, the doctor first prescribed a small dose of antidepressants to help her stabilize her mood. Two weeks later, her suicidal thoughts basically disappeared and her mood stabilized a lot. Then she returned to our department for simultaneous cognitive behavioral therapy. When she came for a review last week, she was able to go back to school for half a day.

Many people always think that these two departments are completely separated, and they have to choose one or the other. In fact, there are many cases of cooperation between the two in clinical practice. If you are just under the pressure of a recent promotion and cannot sleep for a week, or you are having a conflict with your partner and are about to get divorced, or your child is so rebellious that he doesn't talk to his parents at all, these are not pathological problems, and it is enough to go directly to a psychological consultation department. However, if you have hallucinations or delusions, or are so severe that you cannot get out of bed, eat or wash normally, or you have been diagnosed with a serious mental illness such as bipolar disorder or schizophrenia, you must first go to a psychiatric department for intervention and use medication to control the symptoms. Otherwise, intervention by talking alone will not be effective at all.

There is a vivid analogy. A psychiatrist is like someone who repairs mobile phone hardware. If there is a problem with neurotransmitter secretion in your brain, like a phone motherboard that is burned out or a battery that is leaking, you have to find a hardware engineer to fix the basic fault so that it can start normally. A psychological counselor is like someone who helps you optimize your system, clear your memory, get rid of junk files and stuck bugs that have been accumulated for a long time, and teach you how to use it more smoothly so that it doesn't crash every time.

However, there are now different exploration directions in the industry. Some regions in the country are already piloting the prescription authority of some psychotropic drugs to psychotherapists with medical background and special examinations. This is mainly for patients with mild anxiety and depression. They can get drug and psychological intervention programs at the same time without having to run both ways. However, this model is still being tested on a small scale. In most cities, only psychiatrists still have complete diagnosis and prescription rights.

If you are really not sure which number you should register for, don’t worry. Both departments of the regular hospital will do a basic initial screening assessment first, and the referral will help you connect. You don’t have to worry about registering for the wrong number and making a wasted trip. There is no need to dare to go because you are afraid that “going to the psychiatry department will be crazy.” Early intervention and early recovery are the most important.