The difference between psychological counseling and psychiatry

Psychiatry is a branch of clinical medicine. Its core function is to diagnose pathological mental disorders, prescribe or adopt physical therapy methods. It mainly serves patients who meet clinical diagnostic standards. Practitioners have legal prescription rights.； Psychological counseling is a psychological application social service. The core is to deal with developmental distress and mild psychological problems through non-drug interview intervention. The service is mainly for the general population with complete insight. Practitioners do not have the right to prescribe.

Last week, I met a young man who had just failed the postgraduate entrance examination. He had been suffering from insomnia for more than three months. He couldn't help but think "Am I going to be useless in my life" every day while lying down. He couldn't eat and went to a local psychiatrist first. The doctor spent five minutes asking about his symptoms, made a scale, and said it was not severe depression. He prescribed some mild sleeping pills and added, "If you really can't get over the difficulties in your heart, you can talk to a counselor." When he came to me with the medicine, he was still confused: Why do the two sides do different jobs? I explained it clearly to him directly, which also served as a reminder to many friends who couldn’t tell the difference.

Let’s first talk about the threshold differences that everyone can’t see. Psychiatrists are all serious clinical medicine graduates. After five years of medical studies, they need to undergo training and obtain a medical practitioner certificate before they can work. Their first judgment logic is to "rule out physiological problems first" - if you say you are depressed, you must first check whether there is abnormal thyroid function, whether it is a hormone disorder, whether there are organic lesions in the brain. After ruling out, they will then compare it with the ICD (International Classification of Diseases) diagnostic standards to determine whether you have met the clinical standards for mental disorders, and then provide a medication or physical therapy plan.

The threshold for psychological counselors is now the mainstream registration system in the industry, or those with professional backgrounds in psychology, social work, or psychiatry. They need hundreds of hours of systematic training, case supervision, and personal experience before they can accept a case. Our judgment logic is "Where do you get this emotion?" - Could it be that the insomnia caused by failing the postgraduate entrance examination is because you have been asked by your parents to "can only win and not lose" since you were a child? Could it be that you equate the results of the postgraduate entrance examination with the value of the entire person? Psychiatrists don’t have the energy to dig into these issues with you, so our 50-minute consultation time is dedicated to this.

Of course, here we also need to talk about the chaos in the industry: many consultants on the market who have not received formal training label people as "depression" or "anxiety disorder" and trick them into buying dozens of treatments. This is actually a serious violation of the line - only psychiatrists have the right to diagnose, and consultants can only make assessments. If they find suspected pathological problems, they must be referred to a psychiatry department. If you encounter the kind of consultant who diagnoses you immediately, you can just leave directly, which is unreliable.

What many people are most confused about is “which one should I go to?” In fact, it’s really not difficult to tell. If you have already experienced hallucinations or delusions, for example, you always feel that someone is talking in your ears, someone is trying to harm you, or it is so severe that you can't get out of bed for a week, you don't want to eat, or you even have thoughts of suicide or self-harm, don't hesitate to go to a psychiatrist directly. The symptoms at this stage are already pathological, and you must rely on drugs or physical therapy to suppress the symptoms first. Psychological consultation can only be used as a supplement, not as the main force. I once met a girl who suffered from severe depression. She was dragged by an unreliable counselor to do "inner child healing" for three months, which became more and more serious. Later, I forced her to go to the Jingwei Center. After taking the medicine prescribed by the doctor for two months, she was able to go out to buy groceries normally. Then she came back for further consultation to sort out the trauma of being ignored by her parents for a long time in her childhood. Now she is recovering well.

If you are not at this level, you are feeling upset because of the recent infighting in the workplace, you have been arguing with your partner for half a month and cannot be resolved, your child is rebellious and confronts you every day, or the elderly person in your family has been gone for more than half a year and still cannot get over it. These are all developmental problems. , it does not meet the standards for clinical diagnosis. If you go to a psychiatrist, the doctor may at most prescribe some mild mood-regulating drugs and say, "It's not a big problem, go back and relax." But there is no place to talk about the panic in your heart. At this time, it is just right to talk to a counselor.

Interestingly, there have always been different opinions on the positioning of the two in the industry: psychiatrists who are more biologically oriented will feel that as long as emotional problems have affected normal social functions, medication intervention should be used first, and psychological counseling is only supplementary, and the effect is too slow.； Consultants who are more psychodynamically oriented will feel that many mild forms of anxiety and depression are essentially problems of relationship or growth issues. Medication only suppresses the symptoms without solving the root cause, and it is easy to relapse after stopping the medication. However, the consensus has become increasingly clear in the past two years: moderate to severe mental disorders must be treated primarily with medication, supplemented by psychological counseling. ； For patients with mild psychological distress or in recovery, psychological consultation is more effective. The two are never antagonistic, but complementary.

Many people complain that psychiatrists are too indifferent, prescribing prescriptions and sending people away within five minutes of entering. It’s not that the doctor has a bad attitude. If you go to the psychiatric outpatient clinic of a tertiary hospital, a doctor will answer thirty or forty calls in the morning. He really doesn’t have time to sit down and listen to you talk about the details of your quarrel with your boyfriend for two hours. Their core task is to quickly identify risks and provide corresponding medical plans. This is determined by the diagnosis and treatment setting. The consultant's 50-minute setting originally leaves enough room for you to express yourself. This is the functional difference between the two, not who is better or worse.

To be honest, you don’t need to make these two black and white. They both help people solve their pain. One takes care of the “illness” and the other takes care of the “heart.” If you are really not sure, you should either go to a psychiatrist to check for pathological problems first, or find a reliable consultant to do a preliminary evaluation. If you really need medication, the consultant will give you referral suggestions as soon as possible. Stop guessing and find the right person, which is better than anything else.