How to choose the right psychologist

The path to successful therapy

Psychology Melbourne established its Centre for Excellence in Psychological Practice close to a decade ago, inspired by pioneering research that is of vital significance to anyone looking for a psychotherapist in Melbourne, or for that matter, anywhere.

That research revealed that the best psychologists achieved significantly better results in half the time taken by less able clinicians. The highest performers helped clients improve 10 times faster than the overall average. Clients treated by the least able counsellors were more likely to drop out, and in some cases, actually went backwards.

The research completely upset the profession’s emphasis on so-called “evidence-based” techniques, revealing that far more important than the treatment model or therapy program is the person who is delivering it. The treating psychologist has five to nine times more impact on the outcome than the type of treatment model being used.

At Psychology Melbourne, we encourage our psychologists to constantly develop their level of performance through a commitment to an emerging process called “deliberate practice”. We also support them with systems and training that focus on the most important elements of successful therapy and track client progress to identify any problems.

For clients, the benefits of our approach are obvious and continue to lie at the heart of our practice:

Psychology Melbourne has a large team of endorsed Clinical, Counselling, Health as well as highly experienced General Psychologists, who have a number of specific areas of expertise, including:

Our psychologists operate at our CBD headquarters in Queen Street, and 17 other locations across Melbourne and interstate. They may also operate on-site, generally when handling critical events and EAP-related assignments for our business and government customers.

Our founder and principal psychologist, Jill Wright, has been a tireless driver of continuing education within the profession’s peak body, the Australian Psychological Society. Twice elected to the national board of that body, she established the APS's Melbourne Branch Study Group Network in 2008, which for 10 years fostered the professional development of thousands of psychologists.

Hundreds of working psychologists have benefited from her work recruiting expert lecturers and supervising the network’s operation, keeping fellow psychologists up to date with advances in psychotherapy. Her ongoing involvement in her own practice issues gave her an extraordinary insight into what happens – or ought to happen – in the consulting room, and a determination to improve the experience of clients.

What to expect and how you can benefit

Psychology Melbourne has made a significant investment in identifying the key factors involved in successful therapeutic outcomes and helping our therapists develop the necessary attitudes and skills.

We have even created our own training course, with the help of skilled, doctoral-level practitioners, to increase the ability of our psychologists to strengthen the Therapeutic Relationship – the critical bond between therapist and client, which with other “client factors”, account for more than 70 percent of client improvement.

Research shows that these client factors receive too little attention in academic coursework and postgraduate training and as a result psychologists rarely emerge from university with the knowledge, experience and the sheer devotion required to reach the highest standards. In addition to additional training, we have developed internal systems to monitor performance of clinicians and progress of clients.

Matching client and therapist

The central importance of the client/clinician relationship should demand the utmost attention to matching a client with the most appropriate psychotherapist, rather than adopting a “next cab off the rank” approach.

In another innovation, Psychology Melbourne pioneered the use of a “matching session”, in which a client is interviewed by one of our specially trained psychologists, to evaluate key issues and characteristics and match them to our team members.

While clients are free to make their own choice from our team of psychotherapists, independent research on our results proved there was a significant increase in successful outcomes when a client was professionally assigned to a therapist using our matching criteria.

We employed an independent researcher to analyse the impact of matching sessions and Jill Wright delivered the resulting research paper, “Building the Therapeutic Relationship in Private Practice, at the 2014 APS Annual Conference in Hobart. That paper showed a significant link between matching and successful outcomes.

What to look for in psychotherapy

The most perfunctory search for counselling or psychotherapy in Melbourne throws up a smorgasbord of practices, some with dubious qualifications and so-called “independent” Google reviews that are fictitious and self-serving. But how do you get helpful advice on a topic that you’re probably not going to post on your Facebook timeline?

This article aims to help you navigate the jargon and understand the different approaches, costs and outcomes. It will show you how to take advantage of Medicare rebates and provide other ideas that reduce the cost and the time involved in counselling and improve outcomes.

The information here will help you avoid the risk of physical and mental side-effects and less-than-optimal results of some approaches to mental health.

It’s important before you begin counselling to understand the differences in therapies and practitioners; that you know exactly what to look for in a therapist and how to play your part in establishing and maintaining the bond that will largely determine just how beneficial your experience will be.

People taking their first steps into counselling are often understandably unsure about what they might be getting in to. The following outlines what to expect in a session with your psychologist and how to interact with him or her in a productive partnership and how to judge their performance.

If you’re not making progress in psychotherapy, moving on could be the best thing for you, and we can show you how to make that an easier process.

Varieties of therapeutic approaches

Too many people enter therapy with little understanding of the most essential information … what anthropologist Gregory Bateson called “the differences that make a difference”.

No one should enter counselling without knowing why the counselling you receive from a psychologist is different from the approach of most psychiatrists, the counselling offered by someone calling themselves a “counsellor” or for that matter, someone advertising their services as a “psychotherapist”.

Unlike psychologists and psychiatrists, neither of those generic “counsellors” and “psychotherapists” may have university qualifications, be registered with the Australian Health Professionals Regulation Agency or be covered under Medicare. They may not be bound by the strict code of ethics and scientific disciplines that apply to psychologists.

Psychologists vs. psychiatrists

There is a crucial difference between a psychiatrist and a psychologist which really ought to be better known, given that people constantly approach one while seeking the other.

Where psychologists help people change without using drugs, most psychiatrists prescribe medication. Psychologists do, however, work collaboratively with psychiatrists and GPs in cases where clients are taking psychiatric medication.

Both psychiatrists and psychologists have years of university training and both are proud to declare that they employ “evidence-based” techniques. Both are eligible for Medicare rebates.

Psychiatrists receive their initial training in medicine, and subsequently in medico-psychiatric solutions. For most psychiatrists, training in psychotherapy comes a distant third. A small minority of psychiatrists work with psychotherapy.

You should think about consulting a psychiatrist if you or a family member have ever suffered severe mental health conditions, such as severe bipolar disorder, psychosis or schizophrenia. If you see or hear things that aren’t there, if you suffer from severe mood swings, severe depression or are engaging in destructive behaviour, you might talk to your GP about a referral to a psychiatrist.

Psychologists, on the other hand, undergo 6 – 8 years of academic study and training in the application of the science of mental functioning and human behaviour. They employ a variety of psychotherapeutic techniques which have been thoroughly researched and proven to be more effective as drugs in treating mild to moderate mental health conditions and less costly financially and in terms of side-effects.

Psychologists are required to undertake extensive, continuing professional supervised training every year. They are subject to a professional code of ethics and must maintain high standards of practice. They have clinical skills that allow them to help people deal more effectively with life problems and address mental health issues of varying degrees of severity. And like doctors, their services are eligible for benefits under the Mental Health Care Plan Medicare Rebate. Link to gov page

Different types of psychologists

There are several varieties of psychologists, with different academic and practice backgrounds, levels of experience and preferred approaches. Some have been endorsed in different areas, such as health, organisational, education and sports psychology, which qualifies them as experts in those areas.

While all psychologists must be registered with the regulating body, the Psychology Board of Australia (PsyBA), those who have not been recognised as “endorsed” are commonly referred to as General Psychologists. While they might be regarded as the mental health equivalent of medical General Practitioners, and endorsed psychologists as medical specialists, they frequently do the same work. There is considerable overlap in the work of all psychologists.

Endorsed psychologists generally have Masters degrees or PhDs, but many have the same academic qualifications (four-year degree and two years supervised practice) as registered psychologists as they were “grandfathered” into the endorsed categories when the endorsement system was established.

Registered psychologists may have many more years of clinical experience than “clinical” or “endorsed” psychologists and research has shown that they achieve identical outcomes to specialist psychologists. (Pirkis, J. et al. (2011). Australian and New Zealand Journal of Psychiatry, 45, 726-739).

Here is a brief description of some of the nine endorsed categories:

Clinical psychologists

These psychologists have received additional training that allows them to focus on individuals with more severe mental health issues, such as psychosis or schizophrenia and work in health settings such as hospitals.

In Australia they are generally more comfortable with the medical model of psychology, which sees mental health conditions as illnesses with biological causes. This is distinctly different to the approach of clinical psychologists in the UK, for instance, who have publicly criticised the medical model and instead asserted “overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse”. Most non-clinical psychologists in Australia would support the UK view.

Counselling psychologists

Counselling psychologists have similar qualifications as their clinical cousins, but generally work with mild to moderate, less pathological problems. In practice, the boundaries are blurred. Counselling psychologists will work with one, or possibly a mix, of the recognised psychotherapeutic approaches (see below).

Health Psychologists

Health psychologists have a particular focus on the link between biological, social, and psychological factors and health and illness. They can help people deal with the emotional consequences of medical conditions such as cancer or diabetes and management of health issues, including unhealthy behaviours, such as smoking or eating disorders.

Education and Development Psychologists

These specialists work with children of all ages and their parents on early and late childhood issues, including anxiety and depression, autism spectrum disorders, Attention Deficit Hyperactivity Disorder (ADHD) and developmental and educational problems.

Psychotherapeutic approaches

Psychologists tend to fall into one of five particular ways to explain how people think and what helps them make positive changes. These are:

A wide variety of evidence-based techniques are associated with these approaches, including:

Your psychologist may use one or a combination of the above.

But research shows that no one therapy is more effective than another, and the type of therapy used is much less important than the psychologist who delivers it.

Medicare and the cost of therapy

All psychologists at Psychology Melbourne are registered with the Australian Health Practitioner Regulation Agency (AHPRA) and have Medicare provider numbers, enabling you to claim a Medicare rebate for your counselling and group sessions.

To claim these rebates, you must have a referral, in the form of a Mental Health Care Plan, from your GP, psychiatrist or paediatrician. Eligible people can receive:

Psychology Melbourne is also registered with the ATAPS (Access to Allied Health Psychological Services) scheme, under which patients are eligible for a maximum of 12 sessions per calendar year.

Psychology Melbourne is also registered with many other private health and government insurance agencies, too numerous to mention. You can ask our reception for more information

What to look for in a therapist

While some Melbourne practices suggest grilling a prospective counsellor with a lengthy list of questions, most of the important answers can almost certainly be gleaned from a Google search or through social media.

What you are looking for is not so much a factual summary as an emotional impression. Do you feel comfortable with this person? Does he or she engender trust? Do you feel they are open and encouraging. Would you describe them as warm and compassionate, but willing to challenge you when necessary?

Psychology Melbourne’s Personal Matching service takes the angst out of finding the right psychologist for you. You will be asked about the sort of psychologist you would feel comfortable with, such as someone more forthright or someone more warm and supportive.

Remember that you are not looking for a friend. The social rules that you might have come to expect in other situations do not apply in a psychotherapy consulting room.

You are going to be paying for a professional to fulfil a unique role in your life: one centred entirely on you and your issues not the needs and feelings of anyone else, including the therapist.

Your role in therapy

At all times during therapy, it pays to remember that while you are participating in a collaboration with your therapist, you are in the driver’s seat. You should not simply be a quiet passenger, and a good psychologist will work hard to engage you in the process.

You are the best judge of whether you’re progressing … whether you’re feeling less anxious or depressed; feeling more confident or in control; better at problem-solving and decision-making; embracing life-enhancing choices rather than avoiding them.

Although sometimes during the therapy process, you may experience setbacks, these should not be too prolonged. Learning to change your behaviour is a bit like learning a new golf swing. It may feel awkward at first but if it improves your game, you should stick with it.

What you do between sessions – your “homework” – will also contribute immensely to how things turn out for you.

Agree on your goals

The therapeutic process works best when you set goals, work towards achieving them and with your psychologist, monitor your progress.

This is also discussed in our matching process or in your first session with a psychologist, so think about what you want to achieve before you attend. While you might find your goals change during counselling – in which case it will be interesting for you to compare them with your later goals – knowing where you want to go generally helps you to get there.

You and your psychologist should work together to identify and define these goals. You both need to agree that those goals make sense and that you are both willing to work on them.

Your psychologist might believe that some of your goals are impractical or unachievable and therefore less than helpful. They might, for instance, be dependent on somebody else changing their behavior, rather than you changing yours, and therefore beyond your power to achieve.

Remember you can only change your own behaviour, not someone else’s. But if you change your behaviour, others may change in response. For example, a client may learn a different way to approach their partner and find this reduces their conflict. If you have any questions about this, raise them with your psychologist

Having reviewed your goals, your psychologist will work with you to develop a well-defined plan of action. Within that structure, both client and psychologist collaborate to produce health-promoting behavior change.

Personal values and your psychologist

Psychologists constantly work with people who have different political, cultural, religious and personal values. They are trained to keep their personal views outside the consulting room. Neutrality is an important value in the training of psychologists.

If you have a guiding philosophy, religious belief or cultural background it is important to let your psychologist know. If you feel that your psychologist’s attitudes clash with your values, you can raise the problem with them and if necessary, ask our reception for a free rematch.

Treatment plans

At some point early in the process, probably after a couple of sessions, your psychologist should create and share with you what’s known in the profession as a treatment plan. It should include your expressed reasons for coming to therapy; your psychologist’s assessment of your issues and your situation; your goals and the proposed approach to meeting them. That will allow you to evaluate how well your psychologist has understood you and your issues and give you an opportunity to clarify any areas of doubt or misunderstanding. You should ask your psychologist to explain anything you don’t understand and if you don’t agree on any point, revise the plan together.

How will you know you’re making progress?

While working on issues in therapy may at times be emotionally painful, your therapy should not be a prolonged process of misery. You should have regular positive experiences: new insights; compassion for yourself or others; the gift and relief of understanding; a sense of new alternatives and unexpected abilities and powers; of unexpressed needs and desires and a determination to explore and fulfil them. You might become aware of subtle changes in your attitudes or your behavior and your goals might shift. Therapy is different for everyone, but the path should be firmly set towards progress.

Moving on

Psychotherapy isn’t cheap, and you don’t want to waste money and time if it isn’t working for you. Believe it or not, the average psychologist has an overly optimistic view of their own proficiency. They can miss or simply fail to look for signs that therapy isn’t working for the client. Ask your psychologist if he or she uses Feedback Informed Therapy, which accurately measures the success or otherwise of each session. If you feel you’re going nowhere, or perhaps even going backwards, speak up. Either put your psychologist on notice or end your sessions. A good psychologist will be ahead of you and will suggest referring you to someone else if they think your therapy isn’t working. Psychology Melbourne supports routine outcome monitoring to evaluate client progress.

Psychology changes lives

Modern psychology changes lives. Research shows that people who receive therapy from a psychologist are better off than 80 per cent of those who have not had therapy.

What they do, essentially, falls within the category of what has been known since the days of Sigmund Freud as “the talking cure” – an ongoing “conversation” between therapist and client.

Talking about stuff might not seem particularly radical, but recent developments in neuroscience and brain imaging confirm that the talking cure produces positive physiological changes in the brain.

Psychoanalysts also practise the talking cure, but psychologists generally deal in less expensive, shorter-term conversations than psychoanalysts, who can spend half a lifetime engaging in two- or three-weekly sessions with the client on the couch.

While many people have clearly benefitted from long-term psychoanalysis, it’s generally not what psychologists do, although psychologists, like psychoanalysts, do work with the subconscious.

There’s a pill for that, isn’t there?

If psychiatric or psychological practices claim — as some in Melbourne do — that your mental health issues could be related to “underlying brain chemistry issues”, be on your guard. Unlike diseases such as diabetes, for which lab tests can be used to check sugar levels, there is no test that can determine a living person’s brain chemistry, and no conception of what a correct chemical balance should be.

Despite that, the drug industry has convinced most people that low serotonin levels are responsible for depression.

Over the past decade or so, the public voice of psychiatry overseas has disowned the “chemical imbalance” theory, describing it as “a kind of urban legend never seriously propounded by well-informed psychiatrists” and alternatively as “a simplistic misinterpretation by anti-psychiatry groups and bloggers”.

In Australian medical circles, however, that “urban legend” is still being used to promote pharmacological solutions for mental health problems.

While drugs may play a role in treating the most serious cases of mental illness, drug-free therapeutic techniques practiced by psychologists have been demonstrated to be more effective and longer-lasting, without the serious side-effects of psychiatric medicines. These may include significant weight gain leading in some cases to type two diabetes; sexual difficulties and suicidal thoughts and actions.

The techniques used by psychologists can in some cases work well when used in conjunction with medically-prescribed drugs and in those cases your psychologist can work co-operatively with your GP or psychiatrist.