- Sonia Neale
What exactly is therapy and what is a counselling therapist?
A Psychiatrist is a doctor who specialised in psychiatry. Psychiatrists are allowed to prescribe medication and can diagnose a mental health disorder/illness. Psychiatrists can give talk therapy but generally do not. Fifteen minutes sessions are not uncommon.
A Clinical Psychologist cannot prescribe medication but can diagnose mental health issues as well as give therapy. Sessions usually last from 45-60 minutes. The Medicare rebate for Clinical Psychologists is $124.50 which only covers ten sessions annually. Clinical Psychologists can charge up to $240 for a one-hour session, so there will be a gap fee unless bulk-billing occurs. After ten Medicare rebated sessions the client will pay the full amount.
A Counsellor, Counselling Therapist or Psychotherapist can give talk therapy. No Mental Health Care Plan or referral is needed. There is, at present time, no public or private healthcare rebate a client I see can claim. My fee is $50.00 for 55 minutes. This is why I keep my fee as affordable as possible. There is no limit on the number of sessions and all sessions will be a $50.00 flat fee for as many sessions as required. For the best results therapy is usually twice weekly, weekly or fortnightly. People find that 10-20 sessions is a good length of time to see some change in their lives. Other people can require a longer time-frame.
To be a good effective counsellor, it is always insightful to experience what your clients are going through. During my university years studying psychology and counselling, and subsequent professional and personal development, we were advised to get our own therapists. I saw a therapist who I “clicked” with immediately. She was warm, kind, empathic and trustworthy. Bit by bit I told her my story and eventually we undid some of the repeat patterns of behaviour I was largely unaware of. This enhanced my life to a greater degree. We were the right “fit” for each other.
There is a general consensus within the industry that therapy and the therapeutic relationship is what heals the client. It is more about the right “fit” of the client and therapist rather than the prescribed treatment modality or qualification. I believe that trust and rapport, safety and security are crucial elements within the therapeutic relationship.
For the first session, amongst other information, I like to get the client’s contact details, nuclear and extended family structure and location, sleep/appetite/energy and motivation history as well as what the presenting problem is and what is happening in their life at the present time for this to occur. Any unhelpful thinking patterns and coping skills and strategies (healthy or unhealthy) they have in their lives are noted. Included are any protective factors, services, support systems or supportive people they can rely on.
Actively listening to people’s story and their individual “voice” enables me to start to recognise themes, links and patterns of past-to-present behaviour. We tend to unconsciously (out of awareness) repeat the patterns we are familiar with, patterns we sometimes but not always learned in childhood, and unless we recognise these enduring patterns, we can go on wondering forever why we are still making bad choices in different areas of our lives. Setting homework helps discover these patterns.
Developed collaboratively during therapy sessions, homework assignments may be used by clients to rehearse new skills, practice coping strategies, and restructure destructive beliefs. Homework also helps reinforce and embed these new learning strategies until they become habitual and automatic. Therapy is much more than just one hour per week. Diary sheets on thoughts, feelings, behaviours and consequences helps people recognise their own patterns. This way clients can own and take ownership of their issues and make sense out of them. This is empowering and more enduring than if the therapist points this out. If you only binge-eat on the way home from work every day, what is it about that time of day that compels you to want to overeat?
Homework depends on the client. If I have a full time working mother of three, I will try not to set too much homework. She has enough to do without adding to her workload. If I have a young man who complains of boredom, ennui and lack of motivation to do anything, a greater amount of homework would be most appropriate.
I like to work with what my client brings to therapy and work empathically, eclectically and with the focus on the individual client’s needs, rather than any prescribed or manualised treatment guaranteed to work if you follow it with blind faith. I believe that a therapist’s openness, flexibility and curiosity are vital tools that enable clients to explore their own inner world creating and maintaining the change they want to see in themselves.
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