Difference between Counselling and Psychotherapy

Counselling is where a trained mental health professional helps you overcome/solve a specific/single issue. The counsellor provides you with a range of solutions and helps you choose one of those. Some counsellors will also help you and support you while you are implementing the suggested course of action. Counselling is a passive exercise for the person being counselled. It involves a lot of supporting and encouraging statements by the counsellor and often boosts up your morale and helps you feel able to do things.

Psychotherapy deals with many problems and issues and involves an attempt to help you change your thinking, emotional behaviour and coping capacity. The therapist does not offer tailor made solutions but helps YOU find solutions using your own skills. A good psychotherapist will usually spend 2-3 sessions assessing you and understanding your psyche (way of thinking and behaving). After these initial sessions, a diagnostic formulation will be shared where the possibilities of change will be presented. It is at this stage that the client/YOU will decide how and what you wish to change and why? Usually, one session will be devoted to looking at what is required, what is possible and what is not. After that sessions will start, and will require active participation and effort by the client. The therapist is usually a guide and facilitator, sometimes a teacher (!) and sometimes a listener.

You have to have an open mind and an ability to accept faults (in yourself). You have to work on the suggestions that are generated in session. You have to be regularly in contact with your therapist and attend all sessions, at least every fifteen days.

Differences between psychiatry and psychology

Unlike a psychologist, a psychiatrist is a fully qualified medical specialist who has completed at least 12 years (In India this is 9 years) of medical education in all aspects of medicine, surgery and psychiatry. Psychiatrists have a unique perspective in being able to diagnose, manage and care for people with mental illnesses and emotional problems whilst keeping both their emotional and physical states in perspective. In addition, psychiatrists are able to offer expert psychological and medical help in the balance required for the individual patient.

Does that mean that there is no other way apart from taking medicines?

There are other ways and means of preventing relapses and/or recurrences. Their effectiveness is dependent on the intensity, skill and duration for which you use these strategies.

  • Avoid alcohol, beer, smack, ganja and other illicit substances. This includes party drugs like rave, speed, ecstasy etc.
  • Maintain a regular sleep cycle. This means sleep at a reasonably fixed time, wake up at a reasonably fixed time, sleep for at least 7-8 hours.
  • Have a trusting and sensitive friend with whom you can share your innermost worries and concerns. A spiritual leader/guru can be just as helpful. If neither of these are suitable, then meet a counsellor/psychotherapist at least once a month to discuss your life, thoughts and feelings.
  • Eat light, work light.
How are these illnesses treated?

The biological dysfunction that is causing emotional distress and not allowing you to function effectively, is best treated with medicines and supportive therapy.

Medicines are aimed at eliminating the dysfunction in your brain by enabling better control of your emotions and feelings. They strengthen the functioning of various chemicals/neurotransmitters in your brain.

Supportive therapy is aimed at answering your and your family’s many concerns about the illness, treatment and the future. Giving information, addressing issues related to family, job and social roles along with providing an environment where the illness is looked upon as a challenge in life to be overcome; are key elements of this therapy.

How do I make my visit to the Psychiatrist useful and effective?

Good question! The best way is to organise your thoughts and mention the 3-4 main problems which you want help with. Then try and describe each of those AND the impact of each on your life. Specific examples would be helpful, like I can’t sleep at night and this makes me drowsy and lethargic in the daytime OR I am unable to control my thoughts and this prevents me from concentrating on my work/studies.
Secondly, listen to the Psychiatrist when (s)he is trying to explain to you the possible reasons for your feelings or thoughts or behavior. Ask if you do not understand or disagree with an interpretation or suggestion.
If you have been unwell in the past and have prescriptions and/or blood tests/imaging studies, please bring them with you and arrange them in date order. If possible write down the period when you have been unwell and when you have been well. Sometimes making a graph can be easier and helpful.

How do psychiatrists train?

Psychiatrists are first trained as doctors and undertake six years of university study and training to gain their basic medical qualifications. Some teaching and experience in psychiatry is included in their basic medical qualifications. Having obtained their medical degree, doctors must then work as interns in a general hospital for a further 12 months to gain experience in specialist aspects of medicine and surgery in order to become fully registered as medical practitioners. Following their internship, doctors must complete at least a further year as Resident Medical Officers. Careful selection of psychiatric trainees is conducted by a panel of psychiatrists in each state who directly interview each applicant for entry into the Psychiatric Training Program. Each prospective trainee must also provide extensive references regarding their work performance and suitability for psychiatric training. Only then is specialised psychiatric training able to be undertaken.

In Australia and New Zealand, specialist training for doctors to qualify as psychiatrists is conducted by the Royal Australian and New Zealand College of Psychiatrists (RANZCP). The College’s program for post-graduate training in psychiatry takes a minimum of five years, during which time the doctors work under supervision in hospitals and community clinics. They gain wide experience in dealing with the full range of psychiatric problems, including those of children and families, adults and the elderly.

Training in psychiatry requires mandatory supervision by experienced, qualified psychiatrists. Rigorous examinations are conducted throughout their training during which their experience and competence are tested. Only if these strict training and examination requirements are completed can doctors be elected as Fellows of The Royal Australian and New Zealand College of Psychiatrists (RANZCP). With this qualification they can achieve recognition as Consultant Psychiatrists and can practice in Australia and New Zealand.

How long would I need to take medicine?
This depends on various factors.Your family history, the number of times you have had emotional and behavioral problems in the past, the intensity of distress and suffering that the illness has caused and your personality before you became unwell are some of the important markers.

Importantly, the level of recovery also guides the period of continued medicines. A partial recovery means relapses can be prevented only with consistent medicines. A full recovery may mean use of medicines for the minimum period of time. This is usually 2 years after depression has completely lifted (if it is the first episode).

If you have been unwell in the past and the symptom free period is not very long, it is better to keep taking the medicines for as long as possible.

I am a foreign national in India. I was prescribed Ritalin by my doctor in my home country and I now need a refill/repeat prescription. Can you help?
I have been asked by foreign nationals for filling prescriptions of Ritalin.
I follow the following protocol/procedure as a minimum.
1. Kindly provide your doctor in US/your home country, consent to share information about your health (physical and mental), via email (doctor@drmaneeshgupta.com) with me. Then ask them to email me your health records for the last 6-12 months and a note as to the reason for the prescription of Ritalin. The email should contain the office’s phone number and letterhead.
2. Kindly then ask your doctor to send me relevant details including your identifying details (passport number, social security number or visible marks) that can help me identify that it is you who I am seeing/consulting in my office.

3. I will then communicate by phone or Skype with your doctors office and/or your doctor and further confirm that they have you as a patient.

Once all the above has happened, I would be very happy to meet you, assess your condition/mental condition and consider a prescription that would be in your best interests. Please note that if I do prescribe Ritalin, I will need to see and note your passport/social security number.
All the above details will be confidential and will not be shared with either the Indian or your govt (except where a court of law orders me to do so).
Apologies for the inconvenience. I hope you realize that this procedure is for the protection of your health and for assuring you of the best possible standards of professional conduct.
I am in my 20s. Yet you are advising me to take medicines for a long time! Why?

The younger you are, the more difficult it is for you to accept taking medicine. Most young people tell us that they want to get better using their own mental resources and strength rather than taking the help of a medicine. I accept that and will support you wholeheartedly, if that is in your best interest.
However, if it is clear that the emotional and behavioral problems which are troubling you are due to an illness/biochemical dysfunction in the brain, and if there is no single identifiable cause of this distress/illness; then medicines have been shown to be the best way forward. Research across the world, both in developed as well as developing countries, has clearly shown that persons who take medicine even after getting better have upto 80% reduced chances of having the same problems again in future. That is 4 times less than those who choose to leave the medicine when they get better.
With your whole life/ career before you, would you choose to prevent any further chances of problems by taking medicines or would you take a calculated risk and stop medicine?

I want Gender Reassignment Surgery (GRS). My prospective surgeon has asked me to meet a Psychiatrist first and get ‘clearance’ from the Psychiatrist. What is this about?

Gender Reassignment Surgery (GRS) is one part of the treatment that persons who have gender identity disorder, are offered. Endocrine treatment/hormonal treatment is another part. However, the identification of GID and whether (and when) a person with GID is ready for change in his/her sex, is done by a Psychiatrist.

The Harry Benjamin Protocol (now updated to WPATH SOC v7 2011) and various guidelines of Endocrine and Urology societies across the world have reinforced this.
A Psychiatrist would help a person understand, deal and manage his/her gender dysphoria, accept that it is a disorder and discuss what can be done. Since GRS is a major operation, a decision to go ahead with it is usually taken after several meetings  and often after life as a member of the opposite sex has been carefully thought off and practiced for at least a year.  I would also support you during the transition phase and the post op period when you start your new life.
Once you start taking medicines, you become dependent on them! True or false?

The answer to this depends on your perception of ‘dependence’. 15 years back, life without a mobile was as good as it gets. Today, without my mobile, I can’t do anything. I am dependent on it. Good or bad! . . . .

If taking a few pills allows you to achieve what you want in life, then maybe its not so bad. The reason we advise long term medicines to many patients (even after they get better) is because the risk of the illness coming back is often quite high and the most effective way to minimise that risk is to continue to take appropriate medicines at an appropriate dose. If side effects are what is bothering you, then by all means discuss this with your psychiatrist and look for a medicine which will effectively keep you well and also not have any worrisome side effects. But do take your medicine!

Specialist areas of psychiatry

Some psychiatrists gain additional training and experience within the field of psychiatry. The specialties that have developed include child and adolescent psychiatry, psychiatry of old age, forensic psychiatry (concerned with legal, compensation and criminal cases), psychoanalysis and psychotherapy. Psychiatrists also act as consultants in drug and alcohol programs and to community services. Within hospitals they are commonly involved in liaison with other areas of medicine and surgery, for example as consultants to pain clinics.

Treatments used by psychiatrists

The psychiatrist’s choice of a particular treatment is based on its proven effectiveness in treating the symptom or illness. Psychiatric treatments are tested and researched in the same rigorous way that other medical treatments are scrutinized. Treatment methods can be physical, psychological or involve medication, or may be a combination of these approaches. In some cases, an admission to hospital is required for investigation and treatment.

Medical psychotherapy is an important method of treatment in which the psychiatrist and patient discuss problems during regularly scheduled sessions. The psychiatrist assists the patient to understand the basis of his or her problems and works with the patient to find a solution. Depending on the extent of the problem, such treatment may take a few sessions over several weeks or many sessions over a longer period of time. Psychotherapy, which means talking treatment, may be conducted with an individual patient, a group of patients or a family, and may be aimed at behavioral change or the gaining of emotional understanding.

A wide range of medications is now available for use in psychiatric illnesses. Medications can now effectively remove symptoms, alter the course of illnesses and commonly return patients to a normal life. In some instances, medications can be life saving, for example, in a case of a severe depressive illness. Psychiatrists are highly experienced in prescribing and monitoring these medications.

What can a Psychiatrist NOT do?

Very good question! Even though Psychiatrist have undergone training to assess and manage disorders of the mind, there is still much to learn and know. As responsible professionals we are and should be aware of our limitations.

a. We cannot change your temperament. If you have been an introvert before you became unwell, we cannot make you an extrovert (or vice versa).

b. We cannot make changes within days. It takes us weeks and often months to bring about realistic and palpable changes. Be patient!

c. We cannot always explain or solve all your problems. We can take it step by step. Work with us, believe in us and YOU shall succeed.

d. We cannot explain the actions of other doctors, hospitals or mental health professionals. Their decisions may have been based on information that I do not have at hand, and hence my comment may be wrong and therefore inappropriate.


e. We cannot, in one session, make your child eat vegetables or rice or egg or even chapati, if (s)he has had this habit for long. We can help the parents use behavioral measures to encourage the child to accept non-junk food, but it will take time!!

f. If your family member is unwell and has been indulging in asocial habits like not brushing, not taking a bath, not meeting relatives, please do not ask us to “counsel” him/her regarding this. Once recovery starts, these will change by themselves.

What is mental illness?

One in four people suffer from emotional and/or behavioral problems sufficiently distressing to justify seeking professional help. Their symptoms can range from relatively mild feelings of depression and anxiety to severe distress and dysfunction which threatens life itself. Unfortunately, many people with mental illnesses fail to seek the professional help that they need.

Scientific, medical and social research is enabling a better understanding of the nature and cause of psychiatric illnesses and symptoms, and improved ways of diagnosing and treating them are constantly being developed. Psychiatrists are at the forefront of this exciting phase of research and development and are thus able to offer the best available diagnostic and treatment approaches.

Where do psychiatrists work?

Psychiatrists work in a variety of settings including general and psychiatric hospitals, universities, community mental health services and public and private clinics. Many psychiatrists have a predominantly private practice. Others work mainly in hospitals or in prisons, or in a variety of public health facilities. Some psychiatrists work in more than one area, such as combining part time work in a public hospital with a private practice. Psychiatrists are also involved in a broad range of community issues and organisations, and are often called upon to assist both government and non-government agencies in the development of mental health policies and services.

Who are at risk?

Everybody! Just as an accident, no person can claim that they will never have a mental illness. Over 60% of the population has or will, at some time or the other suffer from a psychiatric illness. It does not discriminate between rich and poor, educated and uneducated, or skilled and unskilled. Such illnesses occur all over the world, in both developed and developing countries. Incredibly, the recovery from psychiatric illnesses is better in developing countries, possibly due to the support our family and society give to the patient. There is of course some difference in the risk of specific illnesses. Depression is 3 times more common in females than in males. Anorexia and bulimia is more common in young females ( but not necessarily in city dwellers). Attempted suicide due to personality disorder is more common in young females around 15-25 yrs. Sexual dysfunction is found in over 60% of males but in 30% of females. Childhood behavior and academic problems are more common in families with multiple caregivers. Most importantly, a family history of psychiatric illnesses is the strongest risk factor for an individual.

Who is a psychiatrist?

A psychiatrist is a qualified medical doctor who has obtained additional qualifications to become a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems. Because of their extensive medical and psychiatric training, psychiatrists are able to view illness in an integrated way by taking into consideration the related aspects of body and mind.

Psychiatrists are trained both to recognize and treat the effects of emotional disturbances on the body as a whole, as well as the effects of physical conditions on the mind. This is particularly important, as many emotional disturbances affect various parts of the body and physical illnesses can certainly affect the mind. A psychiatrist’s medical and psychiatric training allows both the physical and emotional to be kept in perspective.

Why do such illnesses occur?

A difficult question to answer!

Most psychiatric illnesses do not have an identifiable cause. While we have delineated the dysfunction that occurs in mental illnesses, we are as yet unaware of the mechanisms that trigger this abnormal function. Illness can occur at any time of your life; though they are more common in the age group 15-25 yrs. There is also an increase at around 45 yrs in females. The stressful life that we lead & our family and social environment, can be contributory but are not independently strong enough reasons for causing an illness. A positive mind, an encouraging family and a supportive and caring society can help speed up the recovery and enable the patient to realize his full potential.

Current scientific thought supports the biopsychosocial model as being the mechanism that causes someone to have a psychiatric illness. This model suggests that biologically, we are all susceptible to an emotional or behavioral disorder. The start of this disorder requires a unique (to each individual) mix of psychological and / or social stress. Once triggered, the illness will then continue until treated appropriately, even if the stress is reduced or eliminated.

मेरी दीदी डिप्रेशन में है और वो एक्सेप्ट नहीं कर रहीं हैं की वो डिप्रेशन में है। उन्हें लगता है उसके मित्र, पड़ोसी और कोउसिंस उसके अगेंस्ट है और वो उन्हें देखना भी पसंद नहीं करती। इसके लिए हम क्या करें?

It can be very frustrating for a family member to see one of their close ones suffer from emotional problems and not accept that she needs treatment. This is getting increasingly common these days. However, there are steps that you can take to help convince your didi to meet a Psychiatrist.

First. do not criticise your didi. Do not try and convince her that she should talk and interact with neighbours and cousins who she doesn’t like.

Second, try and identify what it is that is hurting your didi. Is it fear, is it restlessness, is it anger or is it ghabrahat? Most commonly, it is fear and/or ghabrahat. Talk to your didi about this and advise her that despite all that is going on around her, there is a way her fear and ghabrahat can be overcome. Once that happens she can cope, with these people she doesn’t like, much more confidently.

Thirdly, talk to her about the things she wanted in life and try and present those as goals that she can re-aspire for, once she feels stronger and better.e.g. If she wanted to be a teacher, make sure you point out that taking a doctors help for concentration would help her become a better teacher than what she can become without help.

Once she agrees, speak to the Psychiatrist and give your perspective before your didi meets him. Let the Psychiatrist assess and then follow through with the treatment.