Reporter/Du Wei
Liu Qian is a preparatory consultant for the Internet platform One Psychology. In July 2018, she began to attend the Development and Educational Psychology Equivalent Academic Strength Master's Class of the Institute of Psychology of the Chinese Academy of Sciences, completed in March 2020, took the Equivalent Academic Strength National Examination in November, and now begins to contact the tutor. Equivalent academic strength course training class is a form of continuing education, after completing the course, and then participate in the same academic strength national examination, thesis defense, have the opportunity to obtain a master's degree, the equivalent academic strength national examination is the national unified organization proposition of the examination.
However, compared with the students who receive academic education, Liu Qian has more difficulty in finding a tutor. She wanted to go to the official website of the Institute of Psychology of the Chinese Academy of Sciences to search, and then sent an email to the teacher on the page to introduce herself, asking whether the teacher was willing to receive it. So far, she has only contacted one mentor whose research direction does not match her professional direction. Over the past few years, she has attended numerous psychological counseling training courses. She does not deny the model of growing up through training courses, but also admits that if there is a more systematic path for psychological counselors to learn and grow, it will be a better choice.
The development of China's psychological counseling industry is still in its infancy, and this line has embarked on a standardized academic education path in foreign countries and Taiwan and other regions. Qiao Zhihong, secretary of the Party Committee of the Psychology Department of Beijing Normal University, told China News Weekly that in the United States, if you want to become a psychological counselor, you must go through at least two to three years of master's education and training in psychological counseling, and if you want to become a higher-level psychotherapist, you must finish your doctorate, work full-time for a year or two, and then take the license to practice. In Germany, to become a psychotherapist, after graduating from a university psychology major, another 4,200 hours of full-time training lasts for three years.
It is precisely because of the serious shortage of academic education, psychological counseling training has a huge market in China, coupled with the lack of corresponding access norms, the development of China's psychological counseling industry is in a state of chaos and chaos.
In China, or on the way to China
After 1949, under the influence of Soviet academic circles, Western psychological counseling and treatment in China has been in a state of neglect, when Pavlov's theory of higher types of neural activity was prevalent in China. After graduating from Shanghai Second Medical University in 1988, Zhang Haiyin became a psychiatrist at the Shanghai Mental Health Center. He recalled that in the 1980s, there was no systematic training in china for psychotherapy, and if you wanted to learn treatment techniques, you could only read books by yourself, or listen to some sporadic lectures, and then rely on your own understanding and enthusiasm to treat patients.
Another supply station for psychotherapeutic skills, universities, has not played a corresponding role. Qiu Jiankun, director of the Psychological Counseling Department of Shanghai Jingwei Center and chairman of the Psychoanalytic Professional Committee of the Chinese Mental Health Association, graduated from one of the earliest psychology departments in China around the 1990s, the Department of Psychology of East China Normal University, and admitted that clinical psychology was rarely taught in universities at that time, and more skills came from internships or practice at work.
Due to the near desolation of psychological therapy in China, since 1988, Ma Jiali, a German scholar studying in the Department of Psychology of Peking University, cooperated with Wan Wenpeng, a professor at Yunnan Psychiatric Hospital, to introduce a team of top German psychotherapists and held three "Sino-German Psychotherapy Workshops" in Kunming, Qingdao and other places. In 1997, the two sides launched a continuous training program for Sino-German psychotherapists, that is, the well-known "Sino-German Class" in the industry.
The Sino-Durban program lasted for three years, held twice a year, each intensive training for about 5 days, divided into three groups of psychoanalysis, cognitive behavior, and family therapy, which was a rare standardized training system originating from Europe at that time. There were about 130 students in the first session of Durban, and Zhang Haiyin was the first batch of students. "Zhongdeban" has given birth to many leaders in the field of psychological counseling and treatment, and is known as the "Whampoa Military Academy" in china's psychological counseling and treatment community. Qiu Jiankun, who was a student of the second "Zhongdeban" and is now the general head of the "Zhongdeban" Chinese side, said that the establishment of the "Zhongdeban" directly promoted the clinical practice of Chinese psychotherapy and even had an impact on the cultivation of university talents. After the "Sino-German Class", the "Sino-Norwegian Class", the "Sino-American Class" and the "Sino-French Class" were successively opened. In the nearly two decades since the opening of the National Psychological Counselor Vocational Qualification Examination in 2002, various types of training have emerged in an endless stream.
In contrast, there has been a shortage of psychotherapy and counseling talents in China through academic education. Qiao Zhihong explained that this is because clinical and counseling psychology, as a third-level discipline under the second-level discipline of applied psychology, has few teachers itself, and it is more academic talents that are cultivated. At present, there are about 100 units in colleges and universities across the country that have master's training points in applied psychology, but only about half of them have opened psychological counseling directions. In addition to Beijing Normal University, these colleges and universities only cultivate two or three hundred psychological counseling talents every year, that is to say, the annual supply of psychological counseling talents in the national academic education is less than 500 people, and the scale is very small.
On August 22, 2020, the 14th China Psychologists Conference was held in Henan. Photo/Visual China
At the other end, the employment situation of graduates in this direction is not optimistic. Taking psychotherapy as an example, in hospitals, psychotherapists belong only to the technician title series, not the physician series. Because psychotherapy is "talk therapy", there are no consumables, drug bonuses, and it is not welcome. There are no government departments to purchase services, and there are few positions in the community for psychotherapy or counseling. From both the supply and demand ends, the motivation for the cultivation of psychological talents is insufficient.
The lack of academic education has made the psychological counseling training that should be a "supporting role" become the main mode of education for beginners in China. Qiu Jiankun said that compared with the limited and transparent training market abroad, China's psychological counseling market is huge. At that time, most of the teachers of the "Zhongdeban" came to China with low remuneration and a sense of public welfare, but now, foreign experts are more for huge commercial interests. These experts call themselves sacred, "either already in China or on the way to China", working with training institutions, and as soon as the admission notice is issued, classes begin, and the quality of teachers is uneven.
On a public name called "China-Australia Gestalt CAGA", a 6-day course of 18,000 yuan taught by "Gestalt Master" Steve Wiener was repeatedly pushed. Gestalt therapy, also known as Gestalt therapy, is one of the main schools of modern psychology in the West. In the introduction of Steve Wiener by the public account, it is written that "the top master of the world's Gestalt psychology, the president of the China-Australia Gestalt Association, who has insisted on meditating and eating vegetarian for more than 40 years, 60,000+ hours of individual consultation hours..." Lin Fang is a psychological counselor from a science class on a certain platform, she told China News Weekly that Steve Wiener is not the best expert in this genre, and his training fees in other countries are lower than in China, "and the domestic is like a god."
Qiao Zhihong said that the development of psychological counseling in China is basically driven by the training of various genres, "Most of the domestic bigwigs mainly accept short-term training of various genres, resulting in the characteristics of domestic genres." "Everyone is easily kidnapped by the commercial interests of training, claiming how great their genre is, and there are a group of masters.
An expert from the China Mental Health Association, who did not want to be named, said that there are more than 2,000 psychological counseling schools and techniques around the world, the vast majority of which have found the soil for survival in China, and even produced indigenous schools, but these therapies are actually similar. A therapy called "NLP (Mind-Body Language Programming)" emerged in the United States in the 1970s and later introduced to China, but the core concept of this therapy, cognitively led behavior, is actually the most basic consensus in the psychology community. At the end of the last century, the booming "image dialogue" therapy founded by Zhu Jianjun, a professor at Beijing Forestry University, was actually born on the basis of psychoanalysis and "NLP therapy" and inspired by Chinese Confucian and Taoist culture.
"The development of this discipline direction in recent years has looked vigorous, but in fact, teachers cannot be found, experts give lectures everywhere, and they have not sunk down to do case analysis and research, but have weakened the professional accumulation", showing a false prosperity. The aforementioned expert, who did not want to be named, said.
Lin Chun, vice chairman of the Psychological Counselor Working Committee of the Chinese Psychological Association, in an interview with China News Weekly, called the talents cultivated by the academic school "vertical entry" and the social enthusiast practice "horizontal entry". Due to the lack of "vertical entry" talent supply, in his view, for a long time in the future, the cultivation of Psychological Counseling talents in China will still be a combination of horizontal and vertical trends, but it will eventually go to the road of academic education.
Irregularities and ethics
If the training system is not standardized and complete, the cost of the growth of psychological counselors will be passed on to the client.
Compared with overseas, the Chinese mainland psychological counseling market has higher fees. In Taiwan, because the market is mature, senior consultants who have been engaged in the industry for more than 20 years are only equivalent to the charges of mainland newcomers, about four or five hundred yuan. The fee for a psychological counselor who works in China for 1,000 or 2,000 hours can reach 700 to 800 yuan, while the maximum charge abroad cannot exceed 600 yuan. "Part of the reason why mainland China is expensive is the cost of growing counselors and the higher cost of acquiring clients," said Li Songwei, a counselor.
Before Liu Qian planned to do psychological counseling, she interned at a psychological counseling institution called Jingshi Psychology for nearly a year to help the counselor do initial interviews. But every time she pre-consults, the agency asks her to finally guide the client to place an order, and in the end, she can only choose to leave the agency.
On February 12, 2020, Shenyang Anning Hospital in Liaoning Province opened a psychological counseling hotline to provide psychological counseling and psychological rescue services to the whole society free of charge 24 hours a day to help the masses solve psychological panic, anxiety, depression, sleep, compulsion and other problems caused by the new coronavirus pneumonia epidemic. Figure/New
Psychological counseling is a kind of "talk therapy" that "does not sell treatment", and according to regulations, there is a fee for each consultation. But Lin Fang has met some clients, all of whom have had the experience of being pre-charged by other consultants for 10 or 30 consultations at a time. When the visitor thinks that the consultation is invalid, the consultant will do everything possible to obstruct it. Qiu Jiankun said that for clients with serious mental illness, psychological counselors should send them to a psychiatrist for treatment or cooperate with psychiatrists for treatment. However, according to her understanding, some counselors cannot recognize the symptoms, and some even leave the client around for the sake of profit, delaying the treatment of the patient, resulting in irreparable consequences such as the patient's suicide.
In order to regulate prices and frequency, in countries such as Europe and the United States, psychotherapy and counseling will be included in the insurance payment. "The fees are high, the insurance companies don't agree, the fees are low, the whole consulting industry can't survive, so the most reasonable price will be found." Qiao Zhihong said that because of insurance, the cost of psychological counseling in foreign countries is also very small, "one or two dollars at a time."
In the United States, the efficacy of each genre is evaluated because of the effectiveness of insurance payments. Cognitive behavioral therapy (CBT) has become the most mainstream method in the insurance coverage genre because of its fixed operation process, easy to study with scientific paradigms, the most abundant clinical evidence and short treatment course. In Germany, the theory, empirical research evidence and efficacy of various schools must be evaluated by the German Scientific Committee for Psychotherapy and the Social Security Commission before they can be included in the treatment program paid by the national health insurance, and at present, psychoanalysis and CBT are included in it.
Zhang Haiyin said that in some parts of the country, psychological treatment or consultation in hospitals can enjoy medical insurance. Taking Shanghai as an example, all medical institutions will include psychotherapy and counseling into the scope of medical insurance payment, a treatment fee of more than 100 yuan, medical insurance can pay a part, but there is no assessment of which genre can be included in medical insurance payment, and there is no limit on the number of times visitors can use medical insurance payment. Qiu Jiankun said that because of the limited medical resources, for patients who seek medical treatment, hospitals usually use short-term treatment methods, and if the client wants to have a longer and in-depth experience, they often need to choose a social psychological counseling institution at their own expense.
For clients, there is often a huge information asymmetry between what genre of treatment and consultation to receive and how long to receive. "A lot of consultants don't have a plan for counseling, they don't regularly check whether the goal is achieved, they keep doing it, and if the client has any objections, the counselor will say, next time we will discuss it again." Lin Fang said, for example, cognitive behavioral therapy can generally be completed more than a dozen times, and some postmodern therapies may see some effects five or six times. The data of Simple Psychology on the anonymous random sampling of paid clients in 2019 showed that about 29% of clients would have 5 to 20 psychological consultations, and 23% of clients had more than 20 medium and long-term counseling sessions.
Zhang Haiyin stressed, "We can't expect to rely on the consultant to make the client fully recover as before, the visitor can first live the day, with the life experience, the accumulation of various feelings, one day suddenly touched, there will be a qualitative leap." Zhang Haiyin said that the consultant should be able to understand the client without overly satisfying the other party.
Xiao Li is a trainee counselor in Simple Psychology. In her observations, many clients receive counseling for a year or two, and the counselor doesn't talk about the core issues, but simply provides a good relationship. The counselor is the only person in the world who is willing to respect and talk to the client, "sometimes it is not how effective the consultation is, but the relationship between the client and the counselor itself is enough to make the client willing to continue to engage." In reality, there are also cases where clients rely too much on the counselor or are induced by the counselor, resulting in a relationship other than counseling or even a sexual relationship between the two parties.
At present, the Institute of Psychology of the Chinese Academy of Sciences, the Chinese Psychological Association, the Chinese Mental Health Association, and the Chinese Social Psychology Association have jointly launched the "Development of Professional Level Evaluation Specifications for Psychological Counselors" project, which is expected to be introduced this summer. According to this norm, it is possible to carry out a joint examination for the evaluation of the professional level of psychological counselors in the next two years, issue a certificate of "three associations and one institute", and regulate the access of psychological counselors. The Chinese Psychological Association is planning to launch the "Psychological Counselor Registration and Registration System", which will explore the existing 1.5 million people who have obtained the qualification certificate of psychological counselors, and evaluate and register competent counselors.
(In the text, Liu Qian, Lin Fang, and Xiao Li are pseudonyms, reference to "My Road to Psychotherapy")