At the end of the article, there are experts who answer questions about online psychological counseling
How to judge whether online psychological counseling is suitable for you?
What can help me determine whether the psychological counseling service provided by the other party is professional and compliant?
What should I expect from online counseling?
When exposed to online counseling, what situations may be a red flag?
At the beginning of the epidemic in 2020, Shanghai Jiaotong University did a survey that showed that when the epidemic was at its worst, more than one-third of the people in the country experienced depression, anxiety, insomnia and acute stress... Under the blockade, self-care has become a topic that almost everyone cannot avoid.
I have been doing mental health knowledge on the Internet for many years. In the past two years, enthusiastic netizens have pushed a lot of Internet rescue resources, including psychological counseling tips sorted out by key universities, and free consultations organized by groups and institutions. To some extent, the pandemic has changed the face of mental health, and the entire industry has become more dependent on the network to provide services.
However, the rapid development of technology, the pace of improving the industry mechanism has "slowed down". Recently, there has even been a "live broadcast" psychological counseling, which is an obviously problematic way.
Chaos is rife, making many people suspicious and discouraged. So, how did psychological counseling develop from the "doctor + recliner" in most people's impression to the current mode of dialogue along the network line?
Image credit: Giphy
Regular consultation is difficult to achieve
For me personally, online and offline counseling starts at almost the same time.
In 2014, because of a very serious depression, I had to take a break from school and receive treatment. At that time, the mental health resources in my hometown of Chengdu were not very rich, and it could even be said that some doctors' understanding of mental illness was still very backward - I still remember that during a consultation, a doctor at West China Hospital pointed at me and scolded me and told me to get out.
Therefore, I chose to go to Shanghai for treatment.
Most friends in Shanghai are familiar with the joke, "No. 600 Wanping South Road, this is the call of home." For me and many patients at that time, it was an irresistible routine to report to the Shanghai Mental Health Center (hereinafter referred to as "Jingwei") regularly.
I was living in an old public housing complex, and the nearest subway station was Qibao Station on Line 9. Several large old public housing communities are gathered here, the rent is relatively low, and there are many workers living here.
In the impression, there was no perfect online registration channel at that time, and could only rely on offline number snatching. The two gentle doctors I regularly see are only in the morning, and if they want to hang up the morning number, they have to get there at ten o'clock at the latest. That means having to leave the house at eight o'clock and trying to squeeze in a subway in the middle of a heel rub. I still remember waiting for four or five subway breaks to load away the people in front of me during the morning rush hour before it was my turn to squeeze into the car.
Image credit: Unsplash
Undoubtedly, for me, who was very depressed at the time, this journey was not so easy. If for office workers, waiting for four or five subways to go to the company is just painful, for me at that time, it was difficult. Severe depression is often accompanied by insomnia, and the hardships of this journey will make my insomnia the night before aggravate, and I will not be able to go out "naturally".
Several times, I missed even the follow-up consultation to get medicine, let alone the less rigid psychological counseling. If I can't get up, I can only contact the consultant and say let's go online.
What electronic screens can't do
Whether online or offline, my consulting fee was the same. But a student who has experienced depression and sought help for psychological counseling once told me that her counselor only charges half of the price offline online, after all, "compared to face-to-face consultation, the effect of online is worse."
This is a very common perception. The obvious reason is that counseling is not just about chatting, it also includes a variety of ways to communicate.
The most typical example is sandplay therapy. The counselor will prepare a large sand table and various doll toys for the client to place freely; in many cases, the counselor will ask the client to draw freely on a piece of paper or do some physical activities in the consultation room.
These behavioral expressions are beneficial for analyzing one's own psyche.
I once punched one of her yoga balls with a counselor. Because part of my depression was due to having endured violence, I had a complicated mentality in the face of my anger - I didn't want to be a violent person, so I could only bury my anger in my heart. Punching her yoga ball in front of a counselor is a relatively healthy way to get rid of anger.
When the consultation is turned online, none of this can be carried out.
At the same time, when consulting online, the screen usually only captures the client's upper body and the environment behind it. Nowadays, video software can even set up virtual backgrounds.
But communication between people is not only based on language, and physical performance also accounts for a large proportion. According to my consultant (former psychiatrist of the Sixth Hospital of Beijing Medical College, later abandoned the medical consultation), physical performance accounted for more than half of the expression.
When people express themselves in language, they often conceal something and can easily "lie"; and the movements of the body are difficult for most people who have not received acting training to disguise. For example, I say, "I feel safe now, I feel happy," but I actually have my hands clasped and my legs together in a defensive posture, so I'm obviously lying.
Image credit: Unsplash
In face-to-face consultation, the counselor can easily make a judgment, notice that I am lying, and analyze what needs I am saying by lying; if online, the counselor cannot see how my legs are placed, how my hands move, and there is no reference, I may really believe this sentence.
Online consultation is an effective supplement
But the presence online still has its meaning.
Having lived in Shanghai for nearly a year, I have done many consultations online. It can be seen that even if you have moved to the city where the consultant is located, regular and punctual consultation is not so easy to achieve.
Regularity is an important factor recognized by almost all genres in the development of psychological counseling for so many years, and can ensure the effectiveness of counseling. Online is a remedy for the inability to do offline.
For short transition periods, online counseling is also important. During the referral period, the presence of online can keep the consultation from being out of file. For example, where visitors want to go, it is difficult to find a local counselor; I also have some friends who have gone to small language countries to study, and their language ability cannot support local consultation. In both cases, remote consultation is also an option.
And it is undeniable that even if there will be some discounts, online psychological counseling will have a certain effect.
The aforementioned student sister, during depression, only relied on online and offline parallel counseling, but also solved her own problems; my counselor used to be remotely supervised by the tavistock center. This is all the increase in the amount of Internet technology brought to traditional practices.
Image credit: Giphy
It's just that online consultation in this period still has a certain degree of conservatism, which is a variant of the line, and has not given up the core form of "face-to-face" - in order to ensure a certain degree of mutual understanding, the general consultant will still require that the first four consultations must be done in person; some will also require that after switching to online, they still have to consult in person at least once a year.
This two-line coordination lasted for some time. Until "Internet thinking" entered the field of psychological counseling, it sowed the seeds of change; and the arrival of the epidemic greatly promoted the growth of change.
My friend of psychology majors, Little C, has stepped into the door of psychological counseling with one foot and has more resources than the average person. But when he first tried consulting in 2019, he still chose to use the Internet platform to find a consultant.
He said this is because the platform provides more convenience, allowing him to more easily and intuitively compare various resources and make choices.
During his time in China, he chose one of the most mainstream platforms. The platform implements the entire process of finding a consultant: the app offers options for price, region, training background, and when he makes the appropriate selection, he will automatically select several alternative consultants.
After going to the United States to study, because he was in the suburbs and there were basically no psychological counselors around, Little C chose video counseling again. This time he used an American website called betterhelp. The way that site is that users answer 10 or so questions before they start; based on the answers, filter out a wave of consultants on their own, and then you make your choice.
Image credit: Unsplash
But there is also a bit of a flaw, because the algorithm replaces the client to make some decisions, and the client cannot achieve it if he wants to know whether the consultant who has been "filtered" out is probably suitable.
"Online + Offline" becomes "100% Online"
To a certain extent, the development characteristics of the Internet platform break the barrier of time and space, allowing people to dock to a wide range of consultant resources no matter where they are.
The overall development of the mental health field in the mainland is backward and the horizontal distribution of resources is uneven. The "hospital-community-consultant-individual support model" established in Shanghai has reached the world's leading level, and perhaps three hundred kilometers away, the locals have just been out of "locking up crazy patients" for a few years.
For another example, I am from Sichuan, and Chengdu is definitely a place with better mental health resources; at the same time, less than a hundred kilometers away in Deyang, the psychiatric department of the best local hospital can only temporarily change the internal medicine department to the direction of psychiatry because it cannot recruit people.
The web gives everyone access to the best medical/psychological counseling resources. At this point, we might actually be able to say that technology has made the world a better place.
But Internet-based psychological counseling services are not without drawbacks. The platform breaks the past model and makes psychological counseling a thing that can be completely disconnected from the offline. At this time, the importance of face-to-face consultation is often overlooked.
The platform chosen by Xiao C provides three options, only online, offline, or online and offline consultation at the same time; some other platforms, will also provide telephone, text and other consulting channels; and some of the main business is for "instant talk" online "light consultation".
Image credit: betterhelp's official website
As far as I know, some traditional psychological counselors still insist that offline cannot be replaced by online. In addition to the inaccurate assessment brought about by facial information alone, the transportation and time cost of offline meetings also reflect the stronger motivation and attention of visitors. In the past, clients with stronger motivation have generally benefited better from counseling.
But from another professional point of view, such as Small C, it is believed that there are indeed differences between online and offline, but not necessarily as big as everyone thinks. On the one hand, this difference comes from the fact that most of the domestic counselors are psychodynamic backgrounds and will relatively need a face-to-face setup to provide the amount of information required.
In China, he maintained 12 offline meetings with consultants. When he left Beijing to go to school in the United States, he also asked whether he could continue by video, but considering the possible impact of the time difference and switching to online on the consultation, the other party still suggested a temporary end.
Live psychological counseling violates the principle of confidentiality
In my opinion, the real damage of Internet thinking to the industry lies in the breaking of the original foundation of consulting ethics by some nascent models. This is also a point that visitors need to pay special attention to.
In the long process of development, psychological counseling has gradually found a model. This model contains many criteria, such as charging, preferably regular, preferably face-to-face, in a private environment, and the consultant has a strict obligation of confidentiality...
Guidelines exist to maximize the protection of both the client and the consultant. However, in some chaos, it can be seen that these guidelines are not strictly adhered to, and the platform puts the visitor in a very passive and vulnerable situation in order to create a more profitable business model.
Image credit: Unsplash
Two years ago, a psychological science popularization platform that started very early in China was exposed, and the supervision video was secretly videotaped and put out on an external website as a material for brand promotion. This greatly violates the privacy of both parties to the consultation. The public itself has certain concerns about psychological counseling, and such incidents have further damaged the public's confidence in the entire industry.
The same platform actually engaged in live broadcast gimmicks this year, and did a live broadcast of online psychological counseling.
This clearly violates the principle of confidentiality of psychological counseling. For training purposes, the model of analyzing film and television dramas as materials is very mature; the open classes of psychological counseling usually invite actors to perform, rather than having real visitors appear on camera. Aside from the "real people and real things" gimmick, I can't think of any reason to have to do live counseling live broadcasts for real people.
Finally, I would like to remind everyone that in the mainland, psychological counseling is only a service, and only industry regulations restrict it, which is far less stringent than medical treatment. If someone illegally practices medicine, his own criminal law will pick him up; but if someone "illegally conducts consultation", the law will most likely have nothing to do with him. Instead, unlicensed counseling has become a regulatory vacuum.
Nowadays, some unrelated services are beginning to rub the edges, suggesting that the clients themselves are providing something similar to the effect of psychological counseling.
I hope that everyone must be vigilant in this regard. However, although there is no strict legal provision, psychological counseling has its own set of rigorous ethical systems. As long as they claim to be counseling, the counselor must have the relevant qualifications and abide by these ethics.
Image credit: Giphy
So, for ordinary people who want to try psychological counseling, how to judge whether online counseling is a suitable option? How can ordinary people protect themselves? I asked several professionals to respond.
Ah Five: The biggest difference between online and offline psychological counseling is two points:
First, offline can ensure a private space, but it is a challenge for online. Especially during the lockdown period, the family is locked in a room, privacy is not well guaranteed, and may be forced to suspend consultation.
The second is network fluency, online consultation usually needs to open the video, if the network speed is not enough, speaking will be more stuttered, so that it affects the fluency of thinking and emotions, weakening the effect of consultation.
So I think that if you can ensure a smooth network and a private personal space, you can try online psychological counseling. Although offline counseling is more conducive to building a relationship of mutual trust between counselors and clients than online, the proper use of consultant technology can make up for this deficiency.
Alex: What can you do: How do you make yourself more comfortable and relaxed when you attend a consultation, so that it is easier to "get into the state"? For example, how to sit more comfortably, do you want to hold a pillow? Do you want to have tissues ready? Have a cup of tea or a favorite drink when you ask? Are there any distractions that need to be removed (such as work information on your phone)?
Small C: There are some groups that are not suitable for online psychological counseling: people with severe mental illness, visits at risk of suicide, and people with family conflicts and lack of privacy. In other cases, I think the effect is similar online and offline.
When exposed to online counseling, what situations may be a red flag?
Ah Five: The biggest risk of online consultation is privacy leakage. When you find that your counselor is shy about your environment, that other people are present in the environment, or that you are recording without your consent, you may need to be wary of your privacy concerns.
Alex: Psychological counseling services sold as packages, especially the practice of paying several consultation fees at once and not clearly explaining the refund rules for early termination of counseling.
Emphasize the need to participate in psychological counseling in an "anxiety marketing" way, such as emphasizing "how many consultations you have to do with our teachers, otherwise how serious your situation will become, and how effective our teachers can bring".
Small C: You feel that the consultation is not effective, so ask the consultant, but ask you to increase the frequency of consultation; use discounts to lure you to buy multiple consultation services at once; change the consultation settings (price, time, frequency, location, mode) without fully discussing with you; do not use the contact information of the work, but give you a private phone number, QQ, WeChat, etc.
What can help me determine whether the psychological counseling service provided by the other party is professional and compliant?
Alex: There can be a clear description of the consultation settings: such as confidentiality principles and exceptions, the length of each consultation, the fee and when to pay, the rules for canceling and modifying the appointment time, etc.
The consultant can briefly introduce his or her professional background (e.g. academic qualifications or training experience, relevant work experience) and not exaggerate.
When you ask questions in a consultation or express feedback on the consultation process, the consultant shows an open and cooperative attitude, such as listening, asking for clarification, initiating a discussion, etc.
If the consultant evaluates and decides that the video consultation (as opposed to face-to-face consultation) is not suitable for your needs, or the consultant's own competence is not sufficient to provide services for your consulting needs, the consultant can be frank and provide support on the referral.
What should I expect from online counseling?
Alex: The counselor will need time to ask questions and get to know you comprehensively from all sides, especially in the first consultation.
If you have a preference or expectation for how often and the number of times the consultation will last, or if you have any ideas about the goals of the consultation, you can express and discuss them directly with the counselor.
The specific appearance and difficulty of achieving counseling vary depending on the situation, but there may be several general situations: feeling heard, understood, and supported, gaining a new perspective on oneself or external things, and experiencing more substantial changes (such as weakening of an emotion that bothers you, starting to use new self-regulation skills, making it easier to do something you want to do but find difficult, etc.).
A five: There is a lot of evidence that online psychological counseling is as effective as offline psychological counseling, so this question can be expressed as what kind of expectations should be held for psychological counseling.
Human psychological characteristics are a long-term accumulation process, so change does not happen overnight. In my personal experience, after 3 or 4 or so consultations, you may see some changes in yourself, after which you may regress a little and then go up again.
Alex: American Master of Counseling, holder of massachusetts practicing qualifications, currently returning to China to practice online
A V: 985 Master of Clinical and Counseling Psychology of Normal School, Psychological Counselor of Shanghai School (Intermediate), Psychological Counseling and Service Ability (Intermediate)
Little C: 985 Bachelor of Psychology, currently studying for a Doctor of Counseling in Psychology overseas
bibliography
[1] https://gpsych.bmj.com/content/33/2/e100213.full
[2] https://mp.weixin.qq.com/s/4JqKI6JR5xiJzYsg9eIgsg
[3] https://www.infzm.com/contents/208674
Author: sciencecat
Editor: Weng Yuan
Why do children read so much, but they still can't learn Chinese?
This time, the Children's School Invited Zhu Xinna, an independent children's book curator and an outstanding reading promoter in Beijing, to talk about the "reading and language learning" in the live broadcast room of the Fruit Shell Children's School:
* What is the reason for the child's frequent typos, slow literacy, and poor reading comprehension?
* There are too many books at home, children have no patience to read books, frequent replacement, do you need guidance?
* Children always like to read "useless" books, should parents interfere?
* In this case, should I still give my child a lot of reading?
May 10th (today) 12:00-13:00 noon, come to the live broadcast room of the Fruit Shell Children's School, ask your questions, we will look for answers together~
This article is from the fruit shell and may not be reproduced without authorization.