Mental health professionals

We explain the difference between psychiatrists, psychologists and counsellors.
 
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01 .Introduction

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It’s estimated one in five Australians has suffered from a mental health problem in the past 12 months, and almost one in two will experience a mental health disorder in their lifetime. 

Whether you’re floundering for purpose and direction, having relationship problems or suffering serious health issues based on drug and alcohol abuse, there are many professionals who can help.

We explain the differences between:

This article also explains How to choose a mental health therapist, and other options available.

For more information about Health practitioners, see General health.

For problems such as anxiety, stress, depression, grief or difficulties with coping, your first port of call could be your GP, who in turn may choose to refer you to a psychiatrist, psychologist or another mental health practitioner. This referral may be part of a GP Mental Health Treatment Plan – see Better Access scheme.

The alternative is to seek the help of a psychologist or counsellor yourself, which in fact is what many people do. So when you’re feeling under siege and overwhelmed, who can you turn to for help and what should you look for?

Psychiatrists

A psychiatrist is a qualified medical doctor with additional training and qualifications to become a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems. 

In addition to talking therapies, psychiatrists are able to prescribe medication to treat people and have specialised knowledge of mental health disorders caused by biological changes in the brain, such as schizophrenia, Alzheimer’s dementia and delirium.

To see a psychiatrist you’ll need a referral from your GP. Ask your doctor if they think talking to a psychiatrist would be appropriate and useful – they might suggest a psychologist or counsellor is a better option. If your doctor feels you could benefit from talking to a psychiatrist, they may well bring it up with you first.

Training

Becoming a doctor requires five or six years of university study followed by 12 months as an intern in a general hospital. This is followed by at least another year in a hospital as a Resident Medical Officer. 

Postgraduate training in psychiatry, conducted by the Royal Australian and New Zealand College of Psychiatrists, takes at least five years, during which time doctors work under supervision in hospitals and community clinics with children, families, adults and the elderly on a full range of psychiatric problems. 

Experience and competence are tested throughout the training process.

Costs

Costs vary greatly depending upon whether you see a psychiatrist through a public health service, such as a community health centre, or privately. 

Medicare rebates are available, though out-of-pocket expenses may apply if the doctor doesn’t bulk-bill. Make sure you ask about costs and billing when you make your first appointment.

Psychologists

Psychologists deal with everything from depression, stress, anxiety, eating disorders and suicidal thoughts, to improving relationships and personal growth. 

The professional title is restricted to psychologists who are registered with the Australian Health Practitioner Regulation Agency via the Psychology Board of Australia (PsyBA).

Psychologists aim to change the behaviour and thought processes of their patients, teaching them skills to function better and improve their quality of life without the use of medication. A typical patient undergoes short-term treatment in a series of four to 10 sessions.

Sometimes a single session will suffice, while other patients will need long-term treatment and support. The psychologist should give you an indication of how many sessions will be required at your first meeting.

Training

Psychologists undergo an accredited four-year university degree, and after two years of postgraduate supervised practice can be registered with the PsyBA. 

Clinical psychologists have an additional two-year postgraduate Masters degree (which also entails supervision), and while they may charge more, they can offer a higher Medicare rebate (where applicable).

Costs

The Australian Psychological Society recommends fees of $119 for up to half an hour or $218 for one hour, however it’s up to the individual practitioner. 

Current Medicare rebates under the Better Access initiative are $83.25 per session for a psychologist and $122.15 per session for a clinical psychologist, and while some may bulk-bill, others may charge a gap fee, so check what the out-of-pocket costs will be.

There’s no Medicare rebate if you see a psychologist without a referral, though your private health insurance extras cover may offer a rebate – check with your fund, as benefits are sometimes very limited. 

Your private health insurance may also cover any extra sessions you require above and beyond those allowed under Better Access.

 
 

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Counsellors

Unlike psychiatrists and psychologists, counsellors have a wide and varied level of training. Unfortunately anyone can call themselves a counsellor, whether they’ve done a correspondence course that teaches the basics, a two-year diploma or the six years of training and supervision required for the Masters of Counselling Psychology – or no training whatsoever.

Training

Membership of one of the professional associations for counsellors means the counsellor has undergone an accredited training program of at least two years, undergoes continuing professional development and meets agreed ethical and professional practice standards. 

The Australian Counselling Association (ACA) is a national peak association for counsellors and psychotherapists with more than 3000 members. 

The Psychotherapists and Counsellors Federation of Australia (PACFA) is an umbrella organisation for 37 member organisations, and individual counsellors and psychotherapists join one of these organisations – they may advertise membership of either PACFA, the member organisation or both. Counselling psychologists may or may not be members of the Australian Psychological Society, PACFA or ACA, but they are registered with PsyBA.

If you’d like to see a counsellor who’s not a registered psychologist, look for a member of either ACA or a PACFA member organisation so you can be confident they have adequate training and ethical standards. 

Both peak bodies have searchable lists of members on their websites so you can find one that suits your specific needs and location. They’re also collaborating to provide a single master list of all counsellors and therapists in Australia.

Costs

As a ball park, counsellors charge between $60-$150 per session. Some charge more or less than this, or may charge according to a client’s financial circumstances. At present there are limited benefits for members insured with Medibank Private (extras cover), providing the counsellor is accredited with ACA or PACFA. 

The peak bodies are looking to extend private health coverage of counselling. Counsellors who are registered psychologists may charge more, but you may be eligible for Medicare or private health rebates.

Psychotherapists

Psychotherapy is any kind of psychological talking therapy that aims to restructure the personality or self. 

Many trained mental health professionals practice psychotherapy, including psychiatrists, psychologists, general practitioners, counsellors, art/music/drama therapists and social workers.

It’s also possible to train as a psychotherapist at postgraduate level without having a therapeutic background.

As with the term “counsellor”, anyone from a correspondence course enthusiast to a psychiatrist can call themselves a psychotherapist, so if they’re not a registered psychiatrist or psychologist, look for qualifications (such as a Master of Medicine in Psychotherapy for medical doctors) and/or membership of an appropriate professional association (ACA or PACFA-member organisation) to ensure they’ve undergone accredited training and meet ethical and work practice standards.

What to look for in a therapist

  • Qualifications There are many different diplomas and degrees on offer. Be warned, though, that some impressive-sounding qualifications may not have accreditation with relevant peak bodies, and may not be government-accredited either. Your best bet is to look for membership of an industry association.
  • Strengths and interests of person Some therapists specialise in particular areas such as drug and alcohol management, family therapy, eating disorders, sports psychology or relationships. Keep this in mind when searching or seeking referral for a therapist or counsellor.
  • Approach Therapists and counsellors use different approaches, from cognitive-behavioural therapy, expressive arts and psychoanalytic therapy to somatic psychotherapy, hypnotherapy and transactional analysis and many more in between. You may find a particular approach more appealing to you – see More Information (below) for useful resources.
  • Interpersonal compatibility The relationship between you and your therapist is an extremely important aspect of therapy. If you don’t click with them, move on as quickly as you can.

Better Access scheme

While some people may prefer to find a therapist on their own, others may choose to go through their GP. Doing so may give you access to subsidised care with a psychiatrist or psychologist.

The so-called Better Access initiative resulted from recognition that many people were not seeking or able to get the help they needed for many common mental health issues. The federal government's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medical Benefits Schedule (Better Access) initiative commenced in 2006.

Under the scheme, which was revised in 2011, patients can receive Medicare rebates for 10 individual and/or 10 group sessions per calendar year with a psychologist or occupational therapist or social worker who’s had appropriate training in mental health services. 

The treatment is an integral part of the General Practitioner Mental Health Treatment Plan and encourages a team-based, multidisciplinary approach to mental health care in the community.

The type of treatment offered is a two-tier system, with clinical psychologists offering what’s called “psychological therapy” and psychologists, social workers and occupational therapists offering “focused psychological strategies services” such as cognitive behavioural therapy, stress management or interpersonal therapy. 

Some argue the difference between the two treatment types is ill-defined and notional at best, and that psychologists with skills, experience and training equal to or greater than those of clinical psychologists are being unfairly penalised with a lower Medicare benefit.

The Better Access initiative was designed to provide treatment for common mental disorders such as depression and anxiety, where short-term interventions are likely to be useful in cases of mild to moderate severity. 

It wasn’t designed to provide intensive, ongoing therapy for people with severe, ongoing illness or with more complex or intensive care needs. In such cases, referral to Medicare-subsidised consultant psychiatrist services or state/territory specialised mental health services may be more appropriate, especially if affordability is an issue.

Other options

Telephone and web-based counselling

There are several free counselling telephone and online services on offer, the main ones being Lifeline, Crisis Support Services and Kids Helpline. A 2002 comprehensive review of such services for the federal government determined that the quality of service was of a high professional standard and that customers were very satisfied with the help they received.

These services are often staffed by volunteers who are professional counsellors, psychologists and social workers, and training at Certificate IV level may be offered to people who aren’t otherwise qualified. While best known for crisis support (the big ones are open 24 hours a day, 7 days a week), they also offer assistance with relationship issues, loss and grief, drug, alcohol and gambling problems and mental health and wellbeing.

Online therapy

MoodGym (Depression) and eCouch (depression, generalised anxiety and worry, social anxiety, relationship breakdown, and loss and grief) are free online programs designed and developed by staff at the Centre for Mental Health Research at the Australian National University, in collaboration with other experts. They provide evidence-based information and teach strategies drawn from cognitive, behavioural and interpersonal therapies as well as relaxation and physical activity.

Bibliotherapy

There are many self-help therapy books offering information, insight and therapeutic strategies (usually based on cognitive-behavioural therapy). Though some are undoubtedly better than others, studies on the effectiveness of bibliotherapy for depression have found that it’s almost always better than no treatment, and sometimes as good as professional therapy. The Black Dog Institute website has a list of books that can help with depression.

More information

• Australian Psychological Society (psychology.org.au)
• Australian Counselling Association (theaca.net.au)
• Psychotherapy and Counselling Federation of Australia (pacfa.org.au)
• Royal Australian and New Zealand College of Psychiatrists (ranzcp.org)
• Reach Out (information and resources for young people) (au.reachout.com)
• Black Dog Institute (blackdoginstitute.org.au)
• Mood gym (moodgym.anu.edu.au)
• E-Couch (ecouch.anu.edu.au)

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