QUESTIONS

What happens in therapy?
Is therapy the same as advice?
How many sessions will I need?
Is it like I've seen on the movies?
Psychiatrist, Psychologist, Psychotherapist or Counsellor?

WHAT HAPPENS IN THERAPY?

You and I will sit in comfortable chairs facing each other, at a distance apart which feels right for you. To begin the first session I will ask you to complete a simple form that asks for contact details. I will outline legal issues around confidentiality and ask you to sign the form confirming this has happened.

I’ll ask about any previous or current experience with psychotherapy. Then you will be invited to tell me a little bit about your life, your family and relationships, your work, things that you love doing or are good at. Anything about yourself you would like to share with me.

All of this usually takes 10-15 minutes. I’ll now ask you to tell me about why you came to see me.

The process from now on will evolve gradually and the experience will be different from anyone else’s therapeutic relationship, for both you and me. Sometimes it will feel as though I am gently asking lots of questions, sometimes it will feel more like a conversation. Some clients just need to be able to talk for a while, to begin to make sense of their lives by unburdening to someone else. I’ll leave you lots of space for this. I may suggest tasks or experiments you can try between sessions.

I will be very curious about your strengths, your resources, relationships which are important to you and about times when things are better. I’ll be especially interested in learning how you will know when a problem has been solved. I see my task as facilitating a process where I help you come up with the best solution for your own, unique life. This solution will almost certainly be different from the way another person might have handled the same circumstances. Simply because circumstances are never the same.

WHAT’S THE DIFFERENCE BETWEEN THERAPY AND ADVICE?

A very good question indeed. If there are problems in your life, you will almost certainly have others giving you advice. Friends, parents, partners and fellow workers. Invariably the advice starts “You should ....”. And how often do you think, “they don’t really understand”?

A good therapist will rarely advise except perhaps if they feel your safety is an issue. The advice of others, even when given from a position of caring, often contains an element of self interest. And it is always based on the other person’s own life experience. Your life, beliefs, values, experiences, goals and needs are unique. Which is why in therapy we will work to construct a solution that fits your unique circumstances.

A little less seriously, the Irish novelist, dramatist and poet Oscar Wilde said: “I always pass on good advice. It is the only thing to do with it. It is never of any use to oneself.”

HOW MANY SESSIONS WILL I NEED?

That, unfortunately, is impossible to answer. Therapy will be finished when you know it is finished. In practical terms, some clients only come for one session. Some clients will come weekly or fortnightly for many months. This is particularly the case if someone needs support after having suffered deep trauma. Research shows clients attend for an average of three to four sessions – but no-one is average!

I’VE SEEN THERAPY IN THE MOVIES – IS IT ANYTHING LIKE THAT?

Probably only very approximately. Therapists work in many different ways (“modalities”), so a range of styles is seen in the media, usually exaggerated for dramatic effect! Therapists, psychologists and psychiatrists are often seen behind a desk – I don’t do that.

The most unfortunate misrepresentation in the media is that of ‘other’ relationships between client and therapist, often with some implied or explicit sexual element. In reality this is always a gross betrayal of trust by the therapist and can cause great damage to their client. Such behaviour will result in loss of membership of the relevant professional association. In New South Wales it is properly a matter to be taken to the Health Complaints Commission.

PSYCHIATRIST, PSYCHOLOGIST, PSYCHOTHERAPIST OR COUNSELLOR?

There is no research showing that for general mental health issues any category of mental health professional has better results (“outcomes”). This is because the most important predictors of a successful result (the “common factors”) are applicable to all categories of mental health professional. The relationship between you and your therapist is the key factor. Also very important is the kind of person the therapist is. Personality, life experience, clinical experience and empathy all contribute to this. 

Many of my clients have been to psychiatrists or psychologists before coming to work with me. On the other hand, I will sometimes suggest a client see a psychiatrist or GP if medication may be helpful. 

A psychiatrist is a medical doctor who has done several years further training and has been accepted by the Royal Australian and New Zealand College of Psychiatrists. Certain medications can only be prescribed by psychiatrists (e.g. medications for schizophrenia). Medical doctors who are not psychiatrists, such as GPs, can prescribe the common depression medications. 

A clinical psychologist is a psychologist who has done 2 years further university training. Only clinical psychologists and psychiatrists are able to provide a formal mental health diagnosis (e.g. “this person has schizophrenia”) in NSW. 

A psychologist has completed a 4 year psychology degree and 2 further years of internship to be registered with the Australian Psychological Society. The 4 year degree is a science degree – no working directly with clients is permitted. Client contact begins with internship. 

A registered counsellor or psychotherapist has generally done a 2 or 3 year degree/diploma and has been accepted by one of the two professional organisations (ACA or PACFA). Client contact / internship will generally be part of the degree studies. In 2009-2010 a new registration body is being set up in consultation with the Australian Government. This is ARCAP – the Australian Register of Counsellors and Psychotherapists. 

While definitions are fluid, counselling is often used to describe a set of skills for helping clients cope with a current crisis (loss of a job, being present at a disaster etc.) Psychotherapy covers a very large range of skills that can be used to work with deeper issues (childhood trauma, depression, unresolved grief, anxieties etc.)