Who should I see about my anxiety?
Understandably, there is often confusion as to what particular professionals do and how they differ from each other. Here's a brief explanation of each of the professions involved in the mental health field.
GPs are often the first point of contact and can have a key role in managing mental illnesses. They can recognise mental disorders, conduct tests to eliminate physical causes for the symptoms, and provide referrals to other services including psychologists or psychiatrists. GPs can provide medical treatment for conditions affecting mental health and can prescribe medication (such as antidepressants) for symptoms associated with the problem, for example sleeplessness or loss of appetite. GPs can also provide support. Their professional association is the Royal Australian College of General Practitioners.
Psychiatrists are specialist medical doctors who diagnose and treat mental disorders. They offer a comprehensive assessment of psychological functioning and focus on interactions between medical conditions and psychosocial disorders. Like GPs, psychiatrists can prescribe, administer and monitor medication. They may also offer psychotherapy. A referral letter from a GP is necessary to claim the Medicare rebate. Clients do not pay out-of-pocket to access psychiatrists through Community Health Centres although they may be required to pay psychiatrists in the private sector who do not bulk bill. Psychiatrists do not advertise their services so it is up to your GP to refer you to someone appropriate. The professional association for psychiatrists is the Royal Australian & New Zealand College of Psychiatrists.
Psychologists often have a wide range of expertise and work with psychological functioning in individuals and organisations. Clinical psychologists have undergone additional, specialist training to help people with a mental health problem find ways of functioning better. They specialise in the assessment and treatment of psychological disorders, generally using various forms of psychological therapies. Although psychologists cannot prescribe medication, they can suggest that a client sees a GP for a referral to a psychiatrist if they believe they could benefit from medication. You can claim a Medicare rebate for up to 10 sessions with a psychologist if your GP develops a management plan for your condition and refers you. A higher rebate is given when you see a clinical psychologist, although their fees are usually higher. To find a psychologist in your area either speak to your GP or contact the Australian Psychological Society on 1800 333 497.
Social workers specialise in working with individuals and families where mental health problems exist in connection with social problems such as family distress, unemployment, disability, poverty and trauma. They consider the client’s total situation, including their relationships, financial resources, employment, housing and health. A social worker can offer case management to people with a mental illness to coordinate the services they need. They often work for community services and organisations. There are also a number of accredited mental health social workers who work in private practice. They are qualified to work with individuals who are experiencing a range of mental health disorders, including depression, mood and personality disorders, trauma and family conflict. You can claim a Medicare rebate for up to 10 sessions with a mental health social worker if your GP develops a management plan for your condition and refers you. To find a social worker in private practice you can search the website of the Australian Association of Social Workers.
Counsellors are professionals who build a therapeutic relationship with clients to assist them to develop understanding about themselves and to make changes in their lives. Counsellors do not give advice but help their clients to find their own solutions using existing personal strengths and resources, as well as helping the client develop new ones. Currently the counselling profession is unregulated, meaning that anyone may advertise themselves as a counsellor, even if they do not have appropriate qualifications. To ensure that you access a qualified counsellor, you should obtain a referral to a registered counsellor through the Australian Counselling Association or the Psychotherapy and Counselling Federation of Australia.
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What is the difference between psychiatrists and psychologists?
Hear Professor Rocco Crino answer this frequently asked question in the video below.
Psychiatrists are medically trained doctors who specialise in the treatment of mental illness. Like GPs, they can prescribe, administer and monitor medication. Psychiatrists do not advertise so it is up to your GP to refer you to someone appropriate.
Psychologists are trained in human behaviour and use a range of therapies to treat patients. They provide services including assessment, psychological testing, and various types of psychotherapy and counselling. Clinical psychologists have additional qualifications and specialise in the assessment and treatment of mental health problems.
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How to choose a psychologist, therapist or counsellor
Feeling comfortable and confident with a therapist is important. When first searching for a therapist, don’t be afraid to ask questions and feel free to try some alternatives. If you feel you can’t really talk to your therapist, that they don’t really listen to you, or that you are experiencing no change or improvement, then it is worth talking to them about this. If you are still not satisfied try someone else. It is important to remember that therapy is not something that is done to or for you. Change can only occur with hard work from you.
When you first go to a practitioner it is worth asking them questions about how they can help you. Think about what you want to get out of your therapy. Some helpful questions could be...
Are you a member of a professional association?
If the practitioner is a full member of their professional association, this should mean that their qualifications and experience meet certain standards. For this reason, it is better to obtain a referral to a counsellor or psychologist through their professional body than to choose one from the White Pages. Such membership also means that the practitioner abides by a Code of Conduct so you can make a complaint to the professional body about their conduct should you need to.
Are you professionally accredited?
Aside from counsellors, most practitioners are now required by law to be accredited with a professional body. Unless you choose to see a counsellor, it’s important to make sure that any therapist you see has appropriate accreditation.
What days and times are you available?
Unless sessions are reasonably easy to fit into your life it can be easy to give up so it’s important to find a time that works for you. Many therapists will work primarily during regular work hours, but most will have some availability outside these hours, such as on weekends or evenings. There are also some good online treatments for common mental health problems and these might fit more flexibly into your life.
How much do you charge?
Some low-cost therapy services exist, for example through community health or public hospitals, but may have long waiting lists. Private therapists will charge a fee and these fees will often vary considerably. Medicare rebates are available for psychologists, psychiatrists, and mental health accredited social workers in certain circumstances, but they will often not cover the full fee. Therefore, you should have an idea of your out-of-pocket costs before you begin so that there are no nasty surprises.
How long will I need to see you?
There is no definite answer to this question and you should not expect your therapist to give you an exact answer. However, a good therapist should have a reasonable idea of when you should start to see some benefits and how long the “typical” treatment for your issues should last.
Are the treatments you will use scientifically tested and included in clinical guidelines?
There is now extensive research into the best treatments for all mental disorders. A good therapist should use a treatment that has been shown to work in multiple studies, unless these treatments have previously not worked for you. For most mental disorders, there are accepted clinical practice guidelines. These guidelines are usually produced by professional organisations, such as the Royal Australian and New Zealand College of Psychiatrists, and inform therapists and the public about the best treatments to use.
How can you assure me that what I say will be kept confidential?
Most practitioners maintain case notes that must be stored in a secure place. Nobody other than your therapist should read your case notes although they may discuss your case anonymously with their clinical supervisor. Unless you tell the practitioner that you intend to harm yourself or another person or have abused a child under the age of 18, what you say to the practitioner should not go any further, except as required by law.
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What are the different types of treatment?
Just as there are a number of mental health professionals, there are also a wide range of therapies. Some of the most commonly used approaches are outlined below.
Cognitive Behavioural Therapy (CBT)
Cognitive behaviour therapy (CBT) refers to a group of treatment procedures aimed at targeting unhelpful thinking patters and problem behaviours. CBT has a strong evidence base and is the non-pharmacological treatment of choice for many psychological problems and disorders.
Some of the techniques used include...
- Helping the person to identify their healthy and unhealthy emotional habits
- Assisting the person to keep their thoughts realistic and helpful
- Helping people learn to manage physical symptoms of panic and anxiety
- Helping people gain confidence that they can do things and go to places that they have been avoiding because of their anxiety
CBT is commonly used for anxiety disorders. Many research studies have shown CBT to be one of the most effective psychological treatments for anxiety disorders, sometimes in combination with medication.
Professor Rocco Crino discusses Cognitive Behavioural Therapy.
The counsellor and client meet on a regular basis to allow the client to discuss their feelings and problems in a safe and non judgmental environment. Through talking in depth, the client is helped to work through their emotions and issues to find solutions that are right for them. Many counsellors work from a 'person-centred' perspective: that is they see the client as being their own expert on their problems and do not tell clients what to do. Some also use other techniques, such as CBT, solution focused therapy (SFT) or narrative therapy.
Medication can help to reduce mood fluctuations, psychosis, panic attacks and depression, and is often effective as a treatment for mental health problems. Not every medication is suitable for every person, and some people have to try several different types before they find the one that is right for them. It is very important to have your medication regularly monitored by a GP or psychiatrist to ensure its ongoing effectiveness. While medications on their own do not cure mental illness when used with other therapies they can regulate an illness and reduce the severity of symptoms.
Sometimes a short stay in hospital is recommended if a person is feeling suicidal or there are concerns that they may hurt someone else. It can also be helpful if medication needs to be stabilised or if the illness has severely affected the person's ability to function day-to-day. Admission into hospital can be both voluntary (where the person consents to treatment) or involuntary (where the person can be given treatment against their wishes). Involuntary hospitalisation only occurs in certain circumstances when it is not possible to care for the person safely in the community. Hospitalisation can provide someone with a chance to adjust to medication and/or start talking about the symptoms they are experiencing.
Many professionals use an eclectic or mixed compilation of different therapies depending on the needs of their clients. For example, a psychotherapist may primarily use psychotherapy techniques but may draw on cognitive-behavioural therapy techniques, relaxation and hypnotherapy as part of therapy as well.
Support from family and friends is invaluable as it reduces isolation and enables people to cope better with a mental illness.
Support groups can provide contact with other people who are experiencing the same condition, coping tips and the reassurance that you are not alone. WayAhead runs over thirty support groups throughout NSW for people experiencing anxiety and their family and friends.
Professor Rocco Crino discusses alternative treatments for anxiety in the video below.