Who would study psychology unless they had some issues?!

As Director He began to speak, Nan Zhubin’s expression turned somewhat peculiar.

Director He’s question at this moment was evidently an open-ended question in psychological consultation, a type of question that can guide the visitor to think broadly, helping the consultant collect as much information as possible from different angles.

Contrasting with this are closed-ended questions. By comparing this recent "how have you been" question from Director He, a closed-ended question would be "how many days in the last week did you feel uncomfortable," "how many times have you had a headache recently," etc., where the purpose of the question is to probe deeply in a specific direction.

But the dispersal effect of open-ended questions presumes that the visitor has sufficient motivation, or that the consultant and the visitor have already established a sufficiently solid consultation relationship.

At present, the situation makes it seem like Director He was just making a habitual opening remark.

Sure enough, before the patient had a chance to reply, Director He was already focusing on the computer, opening the electronic medical record while quickly skimming through and asking.

"I see you had an examination at the psychosomatic department last week, right?"

The girl nodded, her voice very soft: "It was a simple check, and after that I left because I had to attend classes. Then the doctor over there suggested it would be best to see you this week."

Director He also nodded, not commenting much on such a referral, and instead continued asking, "How did the examination go over there?"

Nan Zhubin’s eyes moved past Director He’s shoulder to see the electronic medical record on the computer.

Actually, from this, one could objectively see the girl’s condition. Nan Zhubin guessed Director He would ask again, probably wanting to hear the visitor’s own account, that is, to compare the subjective evaluation of the visitor with the previous doctor’s objective diagnosis.

Of course, it might also be to check the girl’s self-awareness while preventing any discrepancy between his diagnostic habits and those of the previous department’s doctor.

"Just like that." The girl’s answer to Director He’s question was very brief.

Director He’s tone softened a bit as he immediately followed up, "Have you shown any suicidal or self-harming behavior recently?"

Nan Zhubin blinked, was it this direct?

The girl paused, as if in memory.

But she only hesitated for a breath before responding: "Yes, self-harming."

Director He glanced over the girl. Although she pressed on her skirt, scars were still visible on the exposed skin of her thighs.

However, Director He still asked, "How did you hurt yourself? Where were the injuries?"

The girl paused, slightly pulling up the hem of her skirt: "Here."

Director He nodded, then said, "Let me see your wrist."

This request was very direct.

And the girl cooperated fully, extending her hand immediately.

There were scratches there too, but they were shallower and older compared to those on her thigh.

Director He nodded, leaned back a bit and asked, "Any injuries elsewhere?"

The girl did not answer, only shook her head.

"Do you remember when you last cut yourself? Was there something that triggered it?"

The girl lowered her eyes: "It was when I... couldn’t play the piano well no matter what, and I thought of self-harm. As for the time... it was probably the week before last."

Director He nodded: "Hmm, I see your injuries are all a bit old, so does that mean you’ve been better over the past week, better than before?"

The girl nodded.

She lowered her eyes, then shook her head: "Last week... I went out for a trip. But as for improvement... actually, no, still feeling unhappy."

...

If this girl were a visitor, she would actually be quite motivated.

Despite the self-harm, the psychological reasons behind cutting the wrist and cutting the thigh are different.

The primary difference is in visibility and psychological motivation.

Cutting the wrist is a highly exposed area, more easily seen by others, thus often a combination of emotion regulation and passive help signals; while cutting thigh areas is private, easy to cover, typically used for pure, long-term emotion regulation or self-punishment, avoiding shame or intervention.

In terms of risk implication, cutting the wrist requires more caution due to risks of accidental artery or nerve injury, and shifting from hidden areas to the wrist often indicates elevated suicide risk, more common in acute explosive distress; cutting the thigh, being concealed, is more prone to develop into chronic, addictive self-harm patterns associated with long-term diffuse emptiness, numbness, or dissociation.

Similar to the case with Chen Lizhou, whom Nan Zhubin encountered during EAP projects, if left unchecked, he might develop into a "thigh-cutter" type of self-harmer, needing pain to confirm "life is real" or even "I am alive."

Aside from the choice of self-harm areas, this visitor patient is able to give minimal responses to the doctor’s questions and can even simply express her own emotions.

If it were Nan Zhubin, he might go into detail about the visitor’s so-called "unhappiness," guiding the visitor to recall the scene at the time, to deeply experience specific types and intensities of emotions, and then responding according to the visitor’s answers.

But that is the habit of psychological consultation, while currently, this is a psychiatric outpatient visit.

"Why did going out to play make you feel worse?" Nan Zhubin heard Director He ask, "Didn’t you have fun?"

The girl’s mouth moved slightly, and after considering for two breaths, she slowly said: "Originally, I thought going out to play, eating a lot of things, could make me relax a little."

"In the end... what I wanted to play, I couldn’t; what I wanted to eat, I couldn’t enjoy... so I was really unhappy."