Psychological consultation is the same as psychotherapy, the effect is the same

Let’s get straight to the conclusion: This statement is not accurate. There is a lot of overlap between the two in terms of applicable scenarios, and the difference in intervention effect for mild to moderate daily emotional distress is minimal. However, when faced with needs such as diagnosed mental disorders and deep personality adjustment, there are clear differences in intervention qualifications, paths, and effects, and they cannot be generalized.

I have been on the clinical frontline for almost 9 years. When I first entered the industry, I struggled with the boundaries between these two concepts. It was not until I met two patients with similar situations that I finally understood the difference. Last fall, we received two clients at the same time who complained of "anxiety and inability to sleep." One was a new Internet operator who failed to meet KPI standards for three consecutive months. He was afraid of being laid off and was embarrassed to tell his family. Apart from difficulty falling asleep, he had no other physical symptoms. His depression and anxiety scale scores were below the normal threshold, and he was not even qualified for a clinical diagnosis of "adjustment disorder." The other is a middle school teacher who has been diagnosed with generalized anxiety disorder for three years. He stopped taking medication for half a year. Recently, he relapsed because he was leading a graduating class. In addition to insomnia, he also suffered from trembling hands and panic attacks.

For the former, I followed the short-term psychological consultation plan, which lasted 45 minutes each time. I mainly helped him sort out his career plan, break down the current KPI pressure, and taught him some simple mindfulness relaxation techniques. After four visits, he said that his sleep had returned to normal. The last time he came, he brought milk tea bought with the quarterly bonus he had just received. For the latter, I directly sent him back to the psychiatric department for follow-up consultation and medication adjustment, and then cooperated with long-term psychological treatment during the stable period. It took almost 12 times to correct his core cognitive bias of "the student's poor performance is all my responsibility", and it took half a year of intervention to reduce the frequency of panic attacks to less than once a month. If you confuse the intervention effects of these two cases and say that psychological counseling and psychotherapy are exactly the same, it is definitely wrong.

Of course, that doesn't mean the two are completely unrelated. For example, most practitioners with a psychoanalytic orientation feel that the boundary between the two is inherently blurred - long-term dynamic consultation itself is about adjusting the personality level and has therapeutic properties. Many people who have done long-term consultation for one or two years have not only improved their original emotional problems, but also changed their way of dealing with people, which is no different from the effect of formal psychotherapy. A clinical study from Beijing Normal University two years ago also said that for mild to moderate emotional distress without clinical diagnosis, whether practitioners hold a psychological counselor certificate or a psychotherapist certificate, the effective rate of CBT intervention is less than 8%, which is almost negligible.

However, in the domestic practice rules, the boundary between the two is very clear: only practitioners who have obtained the qualification of a psychotherapist or a psychiatric license can provide "psychotherapy", and only they can cooperate with drugs to deal with diagnosed mental disorders. Ordinary psychological counselors are not qualified for diagnosis and treatment. If they receive a visit from someone diagnosed with bipolar or severe depression, not only is the effect not guaranteed, but it is also a violation of professional regulations. I had come across the situation before and found an unqualified "emotional counselor" for three months. Initially I was only suffering from mild to moderate depression, but in the end I didn't come to the hospital until I had a tendency to self-harm. It's a pity to say the least.

In fact, to use an inappropriate analogy, psychological counseling is like a health service station in the community. If you usually have a stiff neck, a cold, or want to know how to control your weight, going here is enough. It is not much different from the effect of going to a large hospital to call a regular number.； But if you are found to have nodules, need surgery, or have long-term chronic diseases that need treatment, you will definitely have to go to a specialist outpatient clinic in a large hospital. At this time, if you insist on benchmarking the results of community service stations, you will be embarrassing.

Nowadays, there are many voices in the industry saying that the boundary between the two should be blurred. After all, many technologies themselves are universal. Methods such as mindfulness, cognitive adjustment, and family system arrangement can be used whether it is dealing with daily emotional distress or treating clinical disorders. Ordinary visitors do not need to dig into the concepts in too detail.

I rarely struggle with these two names when I explain to visitors. Instead, I will first ask the other person's needs clearly: If you have recently had a quarrel with your partner and are not going well at work and want to find someone to talk to for relief, then there is no need to go out of your way to get a psychological treatment number in a tertiary hospital. Finding a matching counselor may be more effective.； But if you have been troubled by a certain problem for several years, or have even been diagnosed with a mental illness in the hospital, then don’t hesitate and give priority to finding a practitioner with treatment qualifications. Don’t rely on the effects of ordinary psychological counseling as a reference. It is a big deal if you delay yourself.