So, you’ve decided to seek help for an issue that is invading your life and causing disruption and distress. You’re feeling more confused than ever. You may also be seeking the answer to the following question I get asked a lot:
What is the difference between a counsellor and a psychologist?
The simplest way to distinguish the difference between a Counsellor and a Psychologist is by definition. These are provided by the ACU, a university that runs courses in both:
Psychology studies the human mind and behaviour. Studying psychology provides students with a comprehensive understanding of behavioural and mental processes.
Counselling focuses on client’s concerns and difficulties and includes understanding people’s patterns of thoughts, behaviours, feelings and the ways in which these may be problematic in their lives. Studying counselling involves learning how to assist people to develop understanding about themselves and to make changes in their lives.
What does this mean in real terms?
To expand, I would say that Psychology training focuses on understanding, analyzing and diagnosing mental health issues. Counselling training focuses on skilfully listening to people and then using those skills to explore possibilities in helpful ways via reflections and questions.
Do these already seem quite different to you?
The language is vastly different and describes two entirely different ways to approach problems. However definitions may not mean much in terms of actual practice.
A Psychologist may decide to enhance their counselling skills with studies in psychotherapy. A Counsellor or psychotherapist may decide to complete studies in Psychology in Australia so their clients are eligible for the Medicare Mental Health Plan rebate (see more below).
Therein lies the crux of the issue around this confusing use of words and how they relate to our mental health system. By attempting to medicalise mental health (for which we have little evidence of success. Consider how many folks rate themselves as unhappy and/or discontented, and how many mental health issues we do not have permanent working solutions for), we have made a lot of people feel powerless and that they need someone to ‘diagnose’ them to manage problems of the mind, heart and with the society we live in.
The truth is you might be a lot more powerful than you have given yourself credit for.
Well that’s great, but I’m in distress and looking for help…?
- When you start Googling, or you see ads regarding mental health on TV, the first point of call recommended is usually your GP. In our culture, Doctors are generally given the authority to know everything about health regardless of actual expertise in different areas. I question the wisdom of this pathway.
Some food for thought… If you think about how long the average Doctors appointment is, and how little mental health training is included in a medical degree… surely that’s not comparable to a longer conversation with a good Counsellor or a Psychologist who has 3+ years of specific training minimum?
Also, a mental health professional will suggest you see a Doctor or refer you to one if you need it. So it can work the other way and you have the added comfort of knowing you’re likely to see a GP who understands mental health.
2. When you go to the GP for a mental health concern, to get a mental health plan you will be asked 10 questions from a very simple assessment form, to gauge your ‘level’ of mental illness and distress. The GP may or may not take into account much of your personal circumstance.
- If your mental distress is assessed as very high or crisis level, you may need immediate support. You may also be linked in with a Psychiatrist who can manage mental health medication.
- If it’s assessed as somewhat moderate-high (this is most people) you may be given a Mental Health Plan (now called the Better Access Initiative) and perhaps a referral to a Psychologist or a Social Worker (or maybe an OT or Nurse with extra training in mental health). Sometimes this occurs on top of prescribing medication such as anti-depressants, even if there was no in-depth discussion about your circumstances. Sometimes you may be talked into taking medication even if you say you don’t want any.
3. Job done! You can begin your ‘treatment’. After some happy pills and 6-10 sessions you’ll be well on your way to happiness and normality.
I know for a lot of people this process takes a weight off their shoulders, and I completely understand that: “What a huge relief. I want the pain to end and someone is going to take care of it”.
For some folks it really works and that’s brilliant.
It’s also brilliant that people with more ongoing severe mental health concerns can get the help they need from medical professionals.
However, if it did work that easily for everyone, then I would throw my hat up in relief and find another profession.
The reality can be not-so-great for many people…
It is incredibly sad and, yes, angry-making to continually meet people who are bewildered and devastated by the fact that this process didn’t solve the issues they were being paralysed by, didn’t lead to the relief and long-term benefit they were hoping for, and ultimately just didn’t help.
For starters, anti-depressants aren’t magic happy pills.
For many people it’s not really the right pathway. That might be largely because they weren’t really consulted. It might also be because the intervention was not culturally appropriate for them, or not suited to them or their situation as an individual.
What’s a Mental Health Plan and why is there a problem with it?
- A Mental Health Treatment Plan allows you to receive a number of subsidised therapeutic sessions with a Psychologist or a Social Worker. So you might be able to have some sessions with a professional who- for example- normally charges $180/hour for only $100/hour, because Medicare will rebate you the remainder amount. Which is awesome, and a very positive thing about the Australian system.
Limitations with this system:
- You may not be referred to someone who really suits you and the problems in your life.
- You only get 6-10 sessions per calendar year. 10 maximum hours of therapy. So you might want to ask yourself ‘Can I afford the full price of this professional once my sessions are used? I may not need more than 10, but if I do is it in my budget?’ or ‘What if the Government reduces the amount of sessions per year for a Mental Health Plan in the middle of my work with someone [this might happen, it already has]? Will that be a problem for me?’ Maybe finding someone affordable no matter what your circumstances is a better place to start.
- Counsellors are not providers under the Mental Health Plan which means a GP will usually not refer you to one, no matter how amazing they are unless they are also a registered Psychologist or a Social Worker. You can now receive counselling rebates with some private health insurers though, so do check with yours.
That is because counselling in Australia is unregulated. This means any old joe can say they are a counsellor and it is legal to do so, whereas it would be illegal to say you’re a Psychologist, Social Worker or Doctor if you are not qualified and registered to practice.
I really hope this changes in the near future, as many of us Counsellors have chosen our pathways for a reason and we are highly qualified, experienced and committed to helping people.
The art of listening is incredibly undervalued. When people experience true transformation through therapeutic support, it’s usually related to being listened to, understood and then assisted to explore their own unique skills and pathways.
On the plus side:
It could also be argued that some countries over-regulate counselling, and that the testing required for registration might leave out a wonderful mixed-bag of practitioners from diverse backgrounds and cultures.
Our qualifications here, including at a University level, can be colourful, creative, culturally diverse, and unique with years of evidence behind them (think of Art Therapy, Gestalt Therapy, Hakomi, and varying other psychotherapies including my own Narrative Therapy Masters Degree through Melbourne University) and therefore allow for a broader choice in finding someone who will understand you.
As it stands at the moment, it is up to us individually to show you that we are qualified, insured, and dedicated to professional improvement, like I do on the Australian Counselling Association register (and on our websites or on the phone).
The issue with the Mental Health Plan pathway is that you may then not be inclined to look beyond the referral from a GP when a qualified Counsellor who specialises in your area of need might actually be what you are looking for and desperately need.
An extra word on fees…
- There is an enormous range in the fees charged by private Counsellors and Psychologists. Generally, fees could be anywhere from $70 – $250/hr. Most professionals set their own fees. What you choose to pay is really about how much you can genuinely afford, and how much seeing THIS person means to you and is helpful to you (which is priceless in many ways).
- Some parameters around what therapists’ base their fees on are: how experienced and qualified they are, what they need to live on, how much it costs them to provide the service in a particular location, time for research and admin, and keeping up with professional development and supervision requirements. There’s a lot going on outside of just you and them sitting in a room together.
- Do not assume because it’s free that it’s not good. There are free or heavily subsidised services out there. Quite a lot of private practitioners also work part-time in free services. If you think about why we might go into this kind of work, that won’t surprise you. Also, when we are applying for a job in a service we have to be qualified and clients should be notified if a counsellor is ‘new’ or an intern. Newbies ought to be receiving extra supervision from an experienced practitioner. The organisation did the job interview for you!
However, you also may have to go on a wait list, you may have to prove you have a low income, you may only be allowed a few sessions, you may have to travel and fit into limited time slots in business hours, and you might not get much choice in who you work with. Them’s the breaks with stuff that’s free.
You are entitled to ask questions about therapists located at any service though: even if it is free you deserve quality.
- If you can afford it, isn’t it worth budgeting and paying for the RIGHT person for YOU? We think nothing of spending $160 on an extra pair of shoes, a 5th electronic device, a new doona cover, a night in a hotel, or other ‘needs’ that provide a temporary good feeling. Imagine the real permanent difference a commitment to some time in counselling can make to your entire life.
Ultimately though, the most important piece of information is this:
You are the expert of You…
If the Mental Health Plan/medical approach outlined above doesn’t actually sound like it would suit you, or you’ve been down that road before and it hasn’t helped, or you’ve used up all your subsidised sessions and feel at a loss as to where to turn next, then the alternative process for finding a professional outlined in Part 1 of this blog post might help you.
We are invited to hand over our power to so many people every single day in many different ways. Counselling is a space in which you should be invited to recognise your own power. It needs to makes sense to you and you need to feel genuinely heard, have some hope your counsellor can help you, respects you and the effort you’ve put into living your life and managing the problems that have arisen.
That’s the place I look at things from and many people I have worked with- people whose voices have regularly been silenced in particular- have said how wonderful that was. I hope I can do the same for you.
Have you had an experience of help-seeking you’d like to share, or would like to set up a consultation for counselling with me? Please leave a comment or email me directly, I’d love to hear from you.
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