The difference between psychological counseling and psychotherapy

The core difference between psychological counseling and psychotherapy focuses on the three dimensions of service recipients, problem severity, and intervention qualifications and depth. However, in clinical practice, there are no absolute rigid boundaries between the two, and there are even a large number of overlapping gray areas.

When I first entered the industry, I was obsessed with the definitions in the textbooks. It was not until the first day on duty at the college counseling center that the tutor threw me two appointment forms: one was for a junior student who was working on a paper during the final week + had a conflict with his roommate. He had insomnia for three days in a row and self-regulation was useless before I came to ask for help.； The other picture is of a second-year postgraduate student with a history of severe depression. He has been taking medication as prescribed by the doctor for one year and has entered a stable period. He wants to solve the problem of adapting to returning to school after taking a leave of absence. At that time, I still corresponded to the knowledge points in a rigid manner, saying that the former was psychological counseling and the latter needed to be combined with psychotherapy. The teacher in charge smiled and said, "I'll take it first and then talk about it. In practice, there is no such clear dividing line."

Let’s start with the hard standards that cannot be touched in the industry. These are objective facts and there is no dispute: Under the current domestic practice system, psychotherapists are health technicians who need a medical or psychology-related background, pass the unified examination organized by the National Health Commission, practice in medical institutions, and have the right to cooperate with psychiatrists to carry out symptom intervention and functional restoration for patients with diagnosed mental disorders.； The service scope of psychological counselors is clearly limited to general psychological problems - such as short-term emotional distress caused by real-life triggers such as academic pressure, workplace distress, and intimate relationship conflicts. They do not have the right to diagnose, and they cannot individually treat patients with diagnosed mental disorders. This is a red line written in the regulations.

However, regardless of the rigid division at the policy level, the academic and clinical circles have always had different opinions on the difference between the two. Most psychoanalytically oriented practitioners feel that the two are essentially the same thing, but differ in the depth and duration of the work. I used to study with a supervisor who has been doing psychoanalysis for 20 years. He said that he never labels the services he provides, "It's like digging a well. You have to solve the surface irrigation problem. Just dig two or three meters to clear the blockage. This is what everyone calls psychological consultation." ； If an underground water pipe breaks, you have to dig more than ten meters to find the source of the damage and repair it. That is the so-called psychological treatment. In essence, it is to help people solve their problems. There is no distinction between high and low."

Practitioners with a cognitive behavioral (CBT) orientation mostly recognize the value of boundary division. After all, the intervention of this school is short-term and has clear goals: psychological counseling is to solve specific practical problems. For example, if you are afraid of speaking in public, we will do 8 consultations, practice cognitive adjustment and exposure training, and it will end when you can go to the stage to complete the work report normally.； But if you are not only afraid of speaking in public, but have also developed to the point where you are afraid to go to crowded places and cannot socialize at work normally, and this state has lasted for several years, which is a clear damage to social function, then you need to take the path of psychotherapy and adjust your lower-level core beliefs. There is no right or wrong in the logic of the two divisions, it’s just that the intervention ideas of the schools are different.

A visit I received last year happened to be at the intersection of the two: when she first came, she just said that she wanted to solve the problem of frequent quarrels with her boyfriend, which was a typical psychological consultation. After four sessions, she hesitantly told me that she had been fostered with relatives since she was a child. , I have never dared to express my true needs. Not only in love, but also in getting along with colleagues and friends, I have a please-like personality. I even have frequent headaches and chest tightness. I went to a general hospital for a checkup and found no organic disease. In fact, it is somatic symptoms caused by long-term emotional depression. At that time, our work naturally shifted from surface consultation of "resolving love conflicts" to deep therapy of "adjusting personality patterns and repairing attachment trauma". I also contacted her psychiatrist, and the whole transition was natural. There was no clear point to declare "from today on, what we do is therapy, not consultation."

I usually explain the difference between the two to friends outside the circle, and I always like to use a less rigorous metaphor: psychological counseling is like going to physical therapy for shoulder and neck pain when you work overtime recently. It means that your muscles are tense and tired. Just press the button three or five times to adjust your work, rest, and sitting posture. It will not affect your normal life at all.； Psychotherapy is like if you accidentally fall and break a bone. After the operation, you need to undergo long-term rehabilitation training to regain your mobility bit by bit. The process is longer and requires more patience. Of course, metaphors can never fully correspond to complex psychological states. To be more realistic, many people find out that their pain is caused by old injuries after undergoing "physical therapy", and naturally they switch to the process of "rehabilitation training".

In the past two years, more and more practitioners have called for weakening the conceptual distinction between the two. The core reason is that they are afraid of causing unnecessary stigma to patients: many people feel that they are "mentally ill" when they hear the words "psychotherapy", and would rather endure it than ask for help, which delays the best opportunity for intervention. In fact, even for patients diagnosed with depression or anxiety disorders, if they take medication as prescribed by their doctor and also cooperate with psychological intervention, the recovery effect will be much better than simply taking medication. There is no need to worry about whether they receive "counseling" or "treatment."

To be honest, for the general public, there is no need to spend time playing word games on the definitions of the two. If you really encounter emotional distress, you should first judge your own state: If you have just encountered a specific troublesome thing recently and are in a bad mood but can still eat, work and socialize normally, you can find a reliable and matching psychological counselor. ； If the emotional problems have lasted for more than two weeks, have affected normal life and work, or even have thoughts of self-harm or suicide, first go to the psychiatry or psychology department of a tertiary hospital and follow the doctor's instructions to cooperate with intervention. After all, whether it’s consultation or treatment, the ultimate goal is to help you live more comfortably, right?