Have you been referred to a psychologist, psychiatrist or GP for counselling, psychotherapy or other treatment for a mental health issue?
What does all this mean?
Recognising That We Need Help
We are often faced with difficulties that we manage ourselves or with the help of our family or friends.
However, at times we may feel unable to manage and decide to find outside help. It may not be a crisis, but a feeling that things could be better, or a loss of interest in things we used to enjoy. Sometimes we may just feel overwhelmed with our responsibilities and find it difficult to cope with life.
To help us decide whether we could benefit from seeking professional help we can ask ourselves the following questions:
- What is distressing me now?
- Are my usual ways of dealing with this issue/crisis working?
- What resources have I used?
- What resources do I think I need?
- What help is easy to ask for?
- What help is difficult to ask for?
If answering these questions is not easy or makes you feel quite negative or even panicky, you could probably benefit from seeking help.
What type of help and from whom?
Understandably, there is often confusion as to what particular professions do and how they differ from each other. Following is a brief explanation of each of the professions involved in the mental health field.
GPs are often the first point of contact and the first line of treatment for anxiety and depression. GPs can have a key role in managing mental illnesses. They can diagnose some mental disorders, conduct tests to eliminate physical causes for the symptoms, and provide referrals to other services including psychologists or psychiatrists. GPs can provide medical treatment, such as antidepressants, for conditions affecting mental health and prescribe medication for symptoms associated with the problem, e.g. sleeplessness or loss of appetite. GPs can also provide support.
Psychiatrists are specialist medical doctors who diagnose and treat mental disorders. They offer a comprehensive assessment of psychological functioning and focus on interactions between medical conditions and psychosocial disorders. Like GPs, psychiatrists can prescribe, administer and monitor medication. They may also offer psychotherapy. A referral letter from a GP is necessary to claim the Medicare rebate. Clients do not pay out-of-pocket to access psychiatrists through Community Mental Health Centres although they may be required to pay psychiatrists in the private sector who do not bulk bill. Psychiatrists do not advertise their services so it is up to your GP to refer you to someone appropriate.
Psychologists help people with a mental health problem find ways of functioning better. They specialise in the assessment and treatment of psychological disorders, generally using various forms of ‘talking’ therapy. Although psychologists cannot prescribe medication, they can suggest the client sees a GP for a referral to a psychiatrist if they believe they could benefit from medication.
You can claim a Medicare rebate for up to 10 sessions with a psychologist if your GP develops a management plan for your condition and refers you. To find a psychologist in your area either speak to your GP or contact the Australian Psychological Society on 1800 333 497.
Social workers specialise in working with individuals and families where mental health problems exist in connection with social problems such as family distress, unemployment, disability, poverty and trauma. They consider the client’s total situation, including their relationships, financial resources, employment, housing and health. A social worker can offer case management to people with a mental illness to coordinate the services they need. They often work in community services and organisations.
There are also a number of accredited mental health social workers who work in private practice. They are qualified to work with individuals who are experiencing a range of mental health disorders, including depression, mood and personality disorders, trauma and family conflict. You can claim a Medicare rebate for up to 10 sessions with a mental health social worker if your GP develops a management plan for your condition and refers you. To find a social worker in private practice you can look on the website of the Australian Association of Social Workers www.aasw.asn.au
Counsellors are professionals who build a therapeutic relationship with clients to assist them to develop understanding about themselves and to make changes in their lives. Counsellors do not give advice but help their clients to find their own solutions using existing personal strengths and resources, as well as helping the client develop new ones. Currently the counselling profession is unregulated, meaning that anyone may advertise themselves as a counsellor, even if they do not have appropriate qualifications. To ensure that you access a qualified counsellor obtain a referral through the counselling professional organisations below.
Alternative therapies are sometimes used to help with mental health problems. Alternative therapy is a term that loosely covers therapies other than traditional western medicine. It includes homeopathy, western herbal medicine, traditional Chinese medicine, acupuncture, yoga, tai chi, meditation, reiki, reflexology, shiatsu, aromatherapy, kinesiology and Feldenkrais.
These approaches may be useful in helping with mild problems and are often helpful adjuncts to other treatments. The benefits of exercise in relieving disorders such as depression, are now widely accepted.
What types of therapies are used?
Just as there are a number of mental health professionals, there are also a wide range of therapies. Some of the commonly used approaches are outlined below.
Psychotherapy is a broad term describing help for mental health problems that use forms of therapy other than medication. It usually involves longer term therapy. Long term psychotherapy seeks to unveil the deeply rooted issues from where the client’s current problems or symptoms develop. Psychotherapists use either an eclectic approach, (combining several therapies) or master one or two.
The different models of therapies could be Psychodynamic Psychotherapy, Psychoanalytic Psychotherapy, Jungian Analysis, Cognitive-Behavioural Therapy, Narrative Therapy, Family Therapy, Transpersonal Psychotherapy etc.
The therapeutic relationship here is of great importance, as it is the vehicle via which the healing is being delivered.
Psychoanalysis and Psychodynamic Therapy
Psychoanalytical therapists focus on the client’s inner experiences; their thoughts, feelings, emotions, fantasies, and dreams. Traditional psychoanalysts stay close to Freud’s theories of personality and change but some work from more modern approaches, such as those of Jung, Adler or Lacan. Psychodynamic therapy focuses on unconscious processes as they are manifested in the client’s present behaviour. Psychoanalytic therapy tends to be time-consuming and expensive and is usually only offered by private psychiatrists and psychologists.
Cognitive Behavioural Therapy (CBT)
CBT is a widely used type of client-centred ‘talking’ therapy. It is practised in Australia mainly by psychologists. The aim of CBT is to help clients identify and correct negative thinking.
Some of the techniques used include:
- Training the person to self-monitor behaviours they want to change
- Assisting the person to identify unhelpful thoughts that occur automatically
- Questioning the person’s basic irrational assumptions; and
- Helping the person try out new ways of behaving and coping between sessions.
CBT is commonly used for depression and many other disorders such as drug and alcohol problems, anxiety, eating disorders, gambling, etc. Many research studies have shown CBT to be one of the most effective psychological treatments for depression, sometimes in combination with anti-depressant medication. CBT can also be effectively used in conjunction with medication for severe disorders such as bipolar disorder, anxiety disorders, and schizophrenia.
Hypnosis can be used in different ways in mental health care. It can help clients remember and process events that have been hidden from the conscious state, and is also used in changing behaviours. Suggestion is used when a person is in a hypnotic state to change their behavioural patterns. A hypnotic state is really a state of raised awareness and increased focus on a particular area. The hypnotherapist assists the person to achieve a state of relaxation, which allows the focused hypnotic state to occur. Not everyone who is hypnotised appears to be asleep; some people achieve the state with their eyes open. A hypnotic state cannot be achieved unless a client wants it to happen and therapeutic hypnosis is very different from the ‘stage’ hypnotists that you see on TV.
The counsellor and client meet on a regular basis to allow the client to discuss their feelings and problems in a safe and non judgmental environment. The client is helped to work through their emotions and issues to find solutions that are right for them. Many counsellors work from a ‘person-centred’ perspective: that is they see the client as being their own expert on their problems and do not tell clients what to do. Some also use other techniques, such as CBT, solution focused therapy (SFT) or narrative therapy etc.
Medication can help to reduce mood fluctuations, psychosis, panic attacks and depression, and is often effective as a treatment for mental health problems. Not every medication is suitable for every person, and some people have to try several different types before they find the one that is right for them. It is very important to have your medication regularly monitored by a GP or psychiatrist to ensure its ongoing effectiveness. While medications on their own do not cure mental illness when used with other therapies they can regulate an illness and reduce the severity of symptoms.
Sometimes a short stay in hospital is recommended if a person is feeling suicidal or there are concerns that they may hurt someone else. It can also be helpful if medication needs to be stabilised or if the illness has severely affected the person’s ability to function day-to-day. Admission into hospital can be both voluntary (where the person consents to treatment) or involuntary (where the person can be given treatment against their wishes). Involuntary hospitalisation only occurs in certain circumstances when it is not possible to care for the person safely in the community. Hospitalisation can provide someone with a chance to adjust to medication and/or start talking about the symptoms they are experiencing.
Many professionals use an eclectic or mixed compilation of different therapies depending on the needs of their clients. For example, a psychotherapist may primarily use psychotherapy techniques but may draw on cognitive-behavioural therapy techniques, relaxation and hypnotherapy as part of therapy as well.
Support from family and friends is crucial as it reduces isolation and enables people to cope better with a mental illness. Community support and the reduction of the stigma surrounding mental illness is also greatly needed. Other forms of support which can be crucial to recovery include supported accommodation programs, support in gaining employment and income support from Centrelink or Disability Services.
Support groups exist for many types of mental illness. These can provide contact with others experiencing the same condition, education, coping tips and the reassurance that you are not alone. Groups exist for consumers of mental health services and their carers and family members. Details can be obtained from the Mental Health Information Service.
Choosing a psychologist, therapist or counsellor
Feeling comfortable and confident with a therapist is important. If you feel you can’t really talk to your counsellor, that they don’t really listen to you, or that you are experiencing no change or improvement, then it is worth talking to them about this. If you are still not satisfied try someone else. It is important to remember that counselling is not something that is done to or for you. Change can only occur with hard work from you. A good relationship with a Therapist or Counsellor is of utmost importance for positive results.
When you first go to a practitioner it is worth asking them questions about how they can help you. Think about what you want to get out of your therapy. Some helpful questions could be:
- Are you a member of a professional association? If the practitioner is a full member of their professional association, this should mean that their qualifications and experience meet certain standards. For this reason, it is better to obtain a referral to a counsellor or psychologist through their professional body than to choose one from the White Pages. Such membership also means that the practitioner abides by a Code of Conduct so you can make a complaint to the professional body about their conduct should you need to.
- Do you receive regular clinical supervision? Professional codes of ethics often dictate that counsellors and psychotherapists receive supervision to monitor and assist them in their work with clients.
- What days and times are you available? Unless sessions are reasonably easy to fit into your life it can be too easy to give up.
- How much do you charge? Private Counsellors can be expensive, charging anything from $80 per hour upwards. Some low-cost counselling services exist but may have long waiting lists. Medicare rebates are available for psychologists and mental health accredited social workers in certain circumstances.
- How can you assure me that what I say will be kept confidential? Most practitioners maintain case notes that must be stored in a secure place. Nobody other than your counsellor should read your case notes although they may discuss your case anonymously with their clinical supervisor. Unless you tell the practitioner that you intend to harm yourself or another person or have abused a child under the age of 18, what you say to the practitioner should not go any further.
What Can I Do to Help Myself?
- If you are diagnosed with a particular mental illness, learn as much as you can about it and ways to treat it. This helps to ‘de-mystify’ the illness, making it less scary or confusing as well as helping you to choose the best treatment. It is often helpful to read other people’s stories about how they coped with the same problem. Don’t be afraid to gain a second opinion of your diagnosis from another doctor or health practitioner.
- Don’t let misconceptions about mental illness stop you from seeking help. Asking for help is not a sign of weakness. It demonstrates self respect and caring for your health.
- Talk to Someone
Where do I go for help?
Mental Health Information Line
1300 794 991
Anxiety Disorders Information Line
1300 794 992
Your local doctor (GP)
Translating & Interpreting Service
(TIS) 131 450
Please call the Mental Health Information Line through the Telephone Interpreter Service (TIS). Free to Australian citizens or permanent residents.
This information is for educational purposes. As neither brochures nor websites can diagnose people it is always important to obtain professional advice and/or help when needed.
This information may be reproduced with an acknowledgement to WayAhead – Mental Health Association.
The Association encourages feedback and welcomes comments about the information provided.