Many people avoid therapy because they feel it will involve extensive sessions of looking into the past and not managing immediate issues. Therapy deals primarily with the issues the individual brings, and what they would like support with. It is a client-centred approach, and typically involves 6-8 sessions (shorter or longer depending on client needs).
The first session is an ‘initial assessment’ and during this session, individuals get a chance to tell their story. What brings them to therapy, what they would like support with, and what is their background (family, work, culture). This session is an opportunity for the psychologist to get an idea of the issues being faced within the context of your life.
During this session the client and psychologist will together set a therapeutic goal – what the individual would like to achieve/gain out of therapy. After this session, the psychologist is usually able to recommend what type of therapy would be suitable, and approximately how many sessions it will involve. All decisions are made collaboratively with the client.
Each session is typically 50-60 minutes long, beginning with a weekly check-in and ending with progress reviews.
Cognitive Behavioural Therapy (CBT)
CBT is based on the assumption that thoughts, feelings, and behaviours are interlinked, and by changing one’s thinking, an individual can effectively change what they do/feel. Therefore, psychological issues, according to the CBT approach, is believed to be caused by distorted thinking, and restructuring these cognitions in therapy to more realistic and balanced thoughts is believed to improve behaviour and mood.
Beginning in childhood, individuals develop views about themselves and the world, and these feed the automatic thoughts that arise in their mind when perceiving any given situation. Thus all psychiatric disorders that CBT treats can be traced back to a negative core belief. CBT focusses on balancing these negatively biased beliefs and learning to manage the negative automatic thoughts that arise.
The aim of CBT is to assist clients in identifying cognitive distortions, and developing more positive ways of thinking/behaving. Dysfunctional cognitions are corrected over a series of short, structured, CBT sessions.
The CBT approach assumes distorted or negative thoughts precede a negative affect and behaviour, and CBT focuses on correcting the false self-beliefs that cause the client’s mental distress. Although medication can successfully treat up to two thirds of clients with depression, it has its downfalls—many clients don’t respond to medication or experience side effects, and individuals may prefer a non-medicated approach to therapy. CBT is an effective non-pharmacological treatment of mental disorders.
CBT involves psychoeducation, reframing core beliefs, and behavioural therapy to overcome initial inertia. Treatment sessions begin with the psychologist helping the client identify false negative interpretations of reality. These are then related to early life experiences/events that may have led to this cognitive distortion. Psychologists then work with clients to uncover evidence to prove to themselves whether this perception is true or false. Once identified as distorted thinking by the client, it becomes easier to reframe this cognitive dysfunction to a more positive way thinking. This is the cognitive aspect of CBT, and the behavioural aspect involves mood diaries and task journals. The behavioural dimension is included for the client to overcome their initial inertia and create positive reinforcements to lift energy and increase activities they engage in.
The behavioural aspect is often used throughout CBT, and involves the client documenting their daily activities, and moods during each. In this way, they are able to identify when they are feeling most low, and decrease those activities while increasing others. Task journals are also used to create ‘action plans’ on dealing with challenging situations – this will include the negative automatic thought they expect to have in that situation, and an alternative way they can think, along with an action of self-care to cope in that situation.
Since the first study published in 1977, the efficacy of CBT has been tested frequently, and there is a strong research background supporting the use of it in therapy for a variety of psychological disorders (depression, anxiety)
Acceptance and Commitment Therapy (ACT)
“The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it.” – Dr Russ Harris
Fundamentally, the therapy encourages clients to accept what is out of their personal control, and commit to action that improves and enriches their lives. The purpose of ACT is to develop psychological flexibility in order to deal with external circumstances, find meaning and purpose in life based on values, and be open and mindful of the present moment. ACT aims to equip clients with skills to live a rich and meaningful life.
Mindfulness is a buzz word in Western psychology and is increasingly recognised as a powerful therapeutic intervention for everything from work stress to depression. ACT is essentially a mindfulness-based therapy, and facilitates the psychological processes of thought defusion, acceptance, and contact with the present. ACT works on the assumption that in a state of mindfulness, thoughts and feelings have less of an impact on an individual, and they are thus able to act in a way that is in line with their values and what is important to them. The all-encompassing approach makes ACT suitable for a range of disorders, and is a long-term approach to psychological wellbeing.
ACT uses six core principles to help clients develop psychological flexibility:
Contact with the present moment
Each principle has its own specific methodology, exercises, homework and metaphors.
ACT teaches clients how to alter the way difficult mental experiences impact an individual, rather than having to eliminate them from occurring at all. ACT is not about getting rid of bad feelings or getting over old trauma.
Essentially, ACT is summarised by Dr Russ Harris with
“Embrace your demons, and follow your heart.”
Dialectical Behaviour Therapy (DBT)
Founded by Marsha Linehan, DBT was initially developed for the treatment of patients with borderline personality disorder. Since then, the modality has evolved to treat a range of psychological issues. In DBT the psychologist assures the person that their behaviour and feelings are valid and understandable. Treatment then moves into recognising the personal responsibility of the individual, and the power they have in taking control of their behaviour.
The essential principles of DBT are that it is:
Support-oriented: Strengths-based, working on what the client is good at and improving their life through those channels
Cognitive-based: DBT identifies the internal processes that make external situations a problem, and helps to change thinking so that it is not so rigid and a more balanced view of reality is created.
Collaborative: Relationship based. DBT often involves exercises to develop new ways of interacting with others, and to manage difficult emotions independently. A large part of DBT is emotional regulation.
DBT is comprised of:
2. Interpersonal Effectiveness – Focus is on response patterns. What are the individual’s patterns of responding to themselves and others? DBT skills training involve assertiveness and problem-solving – effective strategies for asking for what one needs, how to assertively say ‘no,’ and learning to cope with inevitable interpersonal conflict.
3. Distress Tolerance – Accepting, finding meaning for, and tolerating distress. Essentially, it teaches clients to bear pain in a helpful and psychologically healthy manner. The main survival strategies taught are distracting, self-soothing, improving the moment, and thinking of pros and cons.
4. Emotion Regulation – People with frequent experiences of mental distress typically have high levels of emotional intensity. Therefore, treatment involves learning how to manage the fluctuating emotions of the mind.
Psychology is the scientific study of the mind and human behaviour. A psychologist has undergone 5-6 years of University study and clinical training before becoming a fully registered practitioner. Psychologists use their knowledge to understand your specific needs and troubles and help you gain insight to your life. Through this understanding of unhelpful patterns of behaviour, change is planned in collaboration with the client, and the psychologist supports individuals during the process of implementing changes.
Any individual experiencing a level of mental distress can benefit from talk therapy. Common issues that therapy can address are:
Clinically diagnosed mental disorders (depression, anxiety, bipolar)
Coping with grief
Understanding and reaching life goals
Making sense of past traumatic experiences
Difficulties with managing mood/emotion
Suicidal ideation and self-harm
Managing/ending addictions such as alcohol, drugs, impulsive spending, sex…
Body image issues and eating disorders
Managing physical illness (e.g. terminal diagnoses)
Despite the scientific study of psychology, therapy is essentially a humanistic approach to coping with mental distress. Each person experiences life differently, and as a result, coping with each experience needs to be catered to your individual needs. Therapy will shift and mould to fit your requirements.
The aim of therapy is to create a safe environment for you to reflect on your internal processes, develop insight, and grow from that awareness into action.
At Dandenong Neurology, we strive to provide a holistic approach to addressing issues and creating a meaningful life. Therapy can draw on both Western psychology and Eastern philosophies, and will equip you with skills to manage life situations. We are interested in a long-term approach to care, and the later therapy sessions will include resilience building and awareness exercises to allow clients to manage future situations independently.
The approach to therapy is open and holistic, and as a result we draw on a range of practices:
Use of mobile apps
Introspective exercises – discovering values, developing awareness/insight, recognising purpose
(source: Australian Psychological Society)
To access mental health treatment under Medicare you must be referred by your GP, a psychiatrist or a paediatrician. If a GP is the referring practitioner, he or she will need to prepare a Mental Health Treatment Plan before referring you to a psychologist. You should book a longer session with your GP to enable time for this.
Medicare rebates are available for psychological treatment by registered psychologists under the Australian Government’s Better Access to Mental Health Care initiative. This scheme provides considerable assistance to people living with mental health problems, allowing them greater access to psychologists and providing more affordable mental healthcare.
Under this scheme, individuals diagnosed with a mental health disorder can access up to 10 individual and 10 group treatment sessions per year.
Referrals cannot be provided for the full 10 sessions. A referral is for a maximum of six sessions. Your referring doctor will assess your progress after the first six sessions and determine whether further sessions are needed.
After you have reached the maximum number of allowable sessions for the calendar year you will not be eligible for any further Medicare rebates for treatment you receive from a psychologist until the new calendar year.
Private Health Insurance
You cannot use your private health insurance ancillary cover to top up the Medicare rebates.
You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for any psychological services you receive. That is, you can either access rebates from Medicare by following the claiming process or claim where available on your insurer’s ancillary benefits.