De-Mystifying Therapy: Who does what?
You might hear in popular media people mentioned their “therapist”, or “being in therapy”. But what is "therapy", and who does it? This can be especially confusing when the professional landscape differs between the US and UK. Below we've outlined some key similarities and differences in the various 'helping professions' within an Australian context.
Psychotherapists and Counsellors Psychotherapists and counsellors are professionals trained at a Bachelor or Master’s level who (generally in Australia) are registered with Psychotherapy and Counselling Federation (PACFA) of Australia or the Australian Counselling Association (ACA). Psychotherapists and counsellors can work with many different communities and individuals amongst a range of modalities, specialities or focuses. For example, some counsellors might specialise in working with certain populations such as children or teenagers, in certain organisations such as domestic violence or homelessness services. Some specialise in certain practices such as Acceptance and Commitment Therapy (ACT), in trauma-informed practices such as Eye Movement Desensitisation and Reprocessing (EMDR), mindfulness, Cognitive Behvaioural Therapy and many many more. Psychotherapists and counsellors work with individual children or adults, families, couples or organisations, or a combination. Many psychotherapists and counsellors work in an integrative fashion: meaning that they integrate a number of theories and practices in their work. For example, Psychotherapists at AkindaCo combine Systemic Family Therapy, Expressive Therapy and child-centred Play Therapy in their work with children, families, individuals and couples. Some psychotherapists may have a Doctor of Philosophy (PhD) and might do academic research alongside their clinical work.
Unfortunately, Psychotherapists and Counsellors are not eligible to register with AHPRA and therefore cannot acquire a Medicare Provider Number. This can sometimes be confusing, as some Psychotherapists actually have early career degrees in Social Work or Psychology and then have gone on to study Psychotherapy. These people are eligible for a Medicare Provider Number, but they publicly decide to call themselves “Psychotherapists” rather than Psychologists or Social Workers. It is important to note that Psychotherapists undergo extensive training and ongoing professional development in their work in a similar fashion to Psychology. Their training involves extensive work on the skills needed to work with people, and students must pass rigorous practical assessment in their therapeutic work. Both PACFA and ACA have jointly suggested that Psychotherapists and Counsellors be included as Medicare Providers as they provide an equivalent, effective services to social workers and are “standing alongside psychologists”. Wait times for Psychology assessments and appointments are often months or years (especially for children), making these services vastly inaccessible for communities in need, versus 62% of psychotherapists and counsellors could see a new client within two weeks, and 23% could see a new client in 48 hours.
Social Workers
In Australia, Social Workers are trained at a Bachelors or Masters level and are registered with the Australian Association of Social Workers (AASW). Some Social Workers qualify as Mental Health Social Workers if they do post qualifying training after 2 years of work. Social Workers can work as case managers, in social policy and many other positions. Some Social Workers do direct clinical work with a similar diversity and variety mentioned above for psychotherapists and counsellors, but some might not do clinical work. Mental Health Social Workers can apply to be registered with the Australian Health Practitioner Regulation Agency, at which point they receive a Medicare Provider Number making them eligible for use of Mental Health Care Plans through the Better Access Scheme.
Psychologists
In Australia, psychologists are trained at a Masters or Honours level. There are varying types of Psychologists who have diverse specialities. Psychologists can specialise in the same types of therapy that Psychotherapists use, such as CBT, EMDR, trauma-informed practice, ACT and more. However, Psychologists must seek further training in modalities such as Expressive Therapy, Family Therapy or Play Therapy as these (and many other) specialities are not part of their core training program. Some Psychologists might have a research-based PhD and work in universities. Psychologists are registered with Australian Health Practitioner Regulation Agency (AHPRA), and, after registration, can acquire a Medicare Provider Number making them eligible for use of Mental Health Care Plans through the Better Access Scheme. Psychologists can work in a similarly integrative fashion to Psychotherapists and Counsellors if they have undertaken Psychotherapy or Counselling qualifications, as well as their psychology qualifications. Psychologists can perform certain assessments and diagnostic assessments for the purposes of, for example, NDIS funding.
Psychiatrists
Psychiatrists are medical doctors who have then done post-qualifying residencies in hospitals in psychiatry and are registered with the Royal Australian and New Zealand College of Psychiatrists. Psychiatrists can perform assessments and diagnostic assessments for NDIS or in a hospital setting. Psychiatrists can prescribe pharmaceutical drugs, including psychoactive drugs. Some Psychiatrists might call themselves Psychotherapists (including very prominent figures in the history of psychotherapy, including Irvan Yalom, R.D. Laing, Salvador Minuchin, Viktor Frankl, Loren Mosher and many more). Psychiatry services are available within the public health system (with extensive wait times) or privately (at a high cost).