The World Health Organisation defines mental health as:
“… a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
In other words, mental health, just like physical health, isn’t just the absence of disease, but a state of well-being that we constantly strive for. And mental health practitioners can help us improve our mental health skills.
A lot of these skills you’ve acquired growing up. There are skills about social interactions like turn-taking, sharing, reciprocity and empathy. There are also skills about self-regulation and ‘coping’, like eating chocolate, talking to friends, journaling, exercise and using positive affirmation.
Most of the time, the skills we have work well, when we remember to use them. But sometimes we begin to rely on a few too heavily, like emotional eating or regularly shouting to be heard by our partner. Sometimes we encounter a new situation, where our old skills don’t see to be enough, like police officers working in hostage negotiation.
This is where psychologists can help. They’re experts in mental health skills. They spend 4 years studying all the major theories on human psychology, before spending at least another 2 years studying and practicing how to apply these to help other people in therapy. They’re not experts in your life, or even experts in how to live their life perfectly – they’re just people who can teach you some coping skills you may not have encountered.
What is a therapist?
What’s in a name? I say ‘psych’ and some people think ‘psychiatrist’, some people think ‘psycho’, and I think ‘psychologists’. And what’s the difference between a shrink and a therapist?!
Well, generally, the term ‘therapist’ is used to describe any health professional who offers ‘psychotherapy’, or ‘talk therapy’ for mental health problems. They may be counsellors, psychologists, psychiatrists, clinical social workers or mental health nurses. Each profession focuses on different professional skills and different client issues, but they all work together (ideally) to provide clients with support to life a full and rewarding life. For the differences between these professions, check out the table below.
Different therapists offer different therapies. These range from the familiar psychoanalysis (think every TV show and movie on therapy) to the more commonly-practiced cognitive-behavioural therapy. The main point is that different therapies work better for different people, but that all therapies can and do work well. But to get a sense of what might work for you, have a look at the list of common therapies below.
Types of Psychotherapy
Acceptance and Commitment Therapy (ACT) gets its’ name from one of its core messages: accept what is out of your personal control, and commit to action that improves and enriches your life. The aim of ACT is to maximise human potential for a rich, full and meaningful life. ACT does this by: teaching you skills to deal with your painful thoughts and feelings effectively – using mindfulness activities; and helping you to clarify what is truly important and meaningful to you – allowing you to use that knowledge to guide, inspire and motivate you to change your life for the better. ACT may require a radical re-thinking of the way you think about your thoughts and feelings, with these ideas often taught through activities in session and at home.
Cognitive-behavioural therapy (CBT) helps people to identify and change inaccurate perceptions that they may have of themselves and the world around them. It assumes a circular relationship between thoughts, feelings and behaviour, where change in one causes change in the other two. The therapist helps the patient establish new ways of thinking by directing attention to both the “wrong” and “right” assumptions they make about themselves and others. It is a problem-focused and directive approach where the therapist teaches new skills to the patient.
Dialectical behaviour therapy (DBT) is a form of CBT. The term “dialectical” refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes—the middle way—is found. In keeping with that philosophy, the therapist assures the patient that the patient’s behaviour and feelings are valid and understandable. At the same time, the therapist coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behaviour.
Family Therapy involves engaging with the whole family system as a functioning unit. While the individuals in the family are as important in family therapy as in individual therapy, family therapists also deal with the personal relations and interactions of the family members, both inside the family and in the therapeutic system which comprises the family, the therapist or therapists, and their broader community.
Gestalt therapists and their clients use creative and experiential techniques to enhance awareness, freedom, and self-direction. The word gestalt comes from the German word meaning shape or form, and it references the character or essence of something. At the core of gestalt therapy is the holistic view that people are intricately linked to and influenced by their environments and that all people strive toward growth and balance. Gestalt therapy emphasises the therapist’s use of empathy, understanding, and unconditional acceptance of the client to enhance therapeutic outcomes. Gestalt therapy places emphasis on gaining awareness of the present moment and the present context.
Humanistic therapy is founded on the belief that moral and ethical values and intentions are the driving forces of our psychological construct and directly determine our human behaviour. This value-oriented approach views humans as inherently driven to maximize their creative choices and interactions in order to gain a heightened sense of liberty, awareness, and life-affirming emotions. Psychologists who practice this method of therapy take a nonpathological approach and target the productive, adaptive, and beneficial traits and behaviours of a person. Self-actualization is at the heart of humanistic psychology.
Interpersonal therapy (IPT) focuses on the behaviours and interactions a patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behaviour. Doing so can help the patient learn to be more objective about current relationships.
Mindfulness-based cognitive therapy (MBCT) integrates aspects of cognitive therapy with components of a mindfulness-based stress reduction program. It teaches clients to become more aware of, and to relate differently to, thoughts, feelings and bodily sensations; in particular, to view thoughts and feelings as passing events in the mind rather than as necessarily reflecting reality. The program teaches skills in disengagement from habitual (automatic) dysfunctional cognitive routines, especially depression-related ruminative thought patterns as a way to reduce risk of relapse and recurrence of depression. Clinical course participants develop personal documentation detailing warning signs and related action plans, as well as considering how to maintain practices and habits they have found helpful.
Narrative therapy is a method of therapy that separates the person from the problem and encourages people to rely on their own skill sets to minimize the problems that exist in their everyday lives. Rather than transforming the person, narrative therapy aims to transform the effects of the problem. Practitioners of narrative therapy believe that simply telling one’s story of a problem is a form of action toward change. Narrative therapists help to objectify problems, frame them within a larger sociocultural context, and make room for other stories. Together, therapist and client identify and build upon “alternative” or “preferred” storylines that exist beyond the problem story; these provide contrast to the problem, reflect a person’s true nature, and offer opportunities to rewrite one’s story. In this way, people move from what is known (the problem story) to what is as of yet unknown.
Psychodynamic therapy is based on the assumption that a person is having emotional problems because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychoanalytically oriented therapies are characterized by a close working partnership between therapist and patient. Patients learn about themselves by exploring their interactions in the therapeutic relationship. Psychodynamic therapy is administered over a period of at least several months, although it can last longer, even years.
Solution Focused/Brief Therapy (SFBT) is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy. The SFBT approach assumes that all clients have some knowledge of what would make their life better, even though they may need some help describing the details of their better life and that everyone who seeks help already possesses at least the minimal skills necessary to create solutions. A hallmark of SFBT is its emphasis on clear, concise, realistic goal negotiations.
How to Navigate the Mental Health System
Congratulations, you’ve decided to seek professional help! That’s a big first step.
The next is to get the help you need, from a person you can trust, at an affordable cost.
Step 1: What’s my issue?
If your main issue isn’t about kink or poly, then any therapist should be fine, but if you’re concerned, you can always ask them about their personal opinions. Or if you’re in Melbourne, Australia there’s a list of kink-aware therapists at: https://fetlife.com/groups/1213/group_posts/906692
Step 2: Who should I see?
Choosing a therapist is a bit like going on a blind date. Just as we judge people on appearance and ‘vibe’, it’s ok to pick a therapist based on these principles. So first decide if you have any preference for age, gender, race or religion in your therapist.
Use the ‘Find A…’ functions on the websites of the peak bodies to find a list of local therapists. Then, also like online dating, read their online profiles. Check their websites and do a general Google search, focussing on memberships to registration bodies and medical societies.
Next you need to initiate contact. Organise a quick email exchange or phone call with a few different therapists. Ask all the questions you need to before agreeing to a session. Some clinics also offer a matching service where they conduct a general intake interview and then match you to the best therapist for your needs. Ask if this is offered.
Other questions might include:
Therapists are used to this, so don’t feel bad if you decide not to go with them – they understand.
If there isn’t a kink-aware therapist in your area, then there are lots of education sources for therapists willing to learn. (https://ncsfreedom.org/images/stories/pdfs/Activist/What_Professionals_Need_to_Know_About_BDSM_1.pdf; https://ncsfreedom.org/images/stories/PolyPaper/72548_NCSF_2012poly7.pdf And when in doubt, look for a therapist with GLBTQI training – they’re often more open and understanding.
Step 3: Funding
Therapists generally offer full fee and Medicare-subsidised appointments and may also offer rebates for private health funds, but this does vary.
To get access to the Medicare subsidy, you first need to get a Mental Health Plan from your GP. This will involve some general questions about why you want to see a psychologist, and some form of measurement of your current levels of depression and anxiety. Make sure you have a therapist in mind before seeing your GP, as the referral is person-specific and GPs sometimes just look up the closest therapist.
Once you have your referral, you need to ask your therapist if they offer bulk-billed places. Like doctors, some therapists charge a fee minus the subsidy, others just charge the subsidy for certain clients (e.g. students, pensioners). Medicare rebates vary from $60 to $125 based on the psychologist’s level of qualification and session length, so make sure you know all the details. The recommended rate for psychologists at full fee is $240/hr, with the expectation that they’ll do another 30min of work in terms of notes and administration.
GPs act as ‘gate-keepers’ to the public subsidy for psychologists, so some may be quite strict on whether they will ‘let’ you see a psychologist. If they say no, don’t despair. Either try another GP, or look at some other options, like your workplace Employee Assistance Program (EAP) or the great range of online self-help programs. These programs are great, and have all been researched and accredited, but they work better with face-to-face sessions too, or as maintenance once you’ve stopped seeing a therapist.
Check out https://fetlife.com/groups/72925/group_posts/7653318 for a list of good online programs.
Step 4: First appointment
Appointments usually last between 45 minutes and 1 hour.
Therapists will generally first give you a run down on the limits of confidentiality, their background, and will give you the option to ask questions. Now is also a great time to explain your expectations for the process and ask any further questions you might have. They will then generally do a structured intake interview about your history and relationships, or they might just ask you “what brings you here today”. This is your time, so use it however you want. Psychotherapy is a joint activity between the psychologist and you, so don’t expect them to tell you what to do.
At the end of the first session, they will probably briefly summarise your discussion and give you some idea about future sessions and their plan for your continued therapy (usually 1 session/month or so).
It may take a few sessions to feel completely comfortable and to feel you’re making progress. This is normal. But it’s always a good idea to talk to your therapist about what’s making you uncomfortable and try another session.
Don’t forget, they’re providing you with a service, so you’re completely entitled to point out any problems.
If it still doesn’t feel right after a second session, then ask for a referral. It’s ok to say ‘this isn’t working for me’, for whatever reason. But don’t give up on treatment because this relationship doesn’t work. Take the time to discuss why it might not be working and then try again with a different person or therapy type.
If you think something inappropriate has occurred, you can contact the peak body (https://www.ahpra.gov.au/) or your GP to discuss your concerns confidentially.
Step 5: Go back!
Over 50% of clients don’t return to therapy after a first session. While this might be that they’d got the help they need, for many it’s because of self-stigma, feelings of discomfort or a range of other life issues. To get a lasting benefit, it’s best to stick to your plan. Just like with exercise, the first session can feel strange, but try to stick with it.
It’s also always ok to re-engage with professional help whenever you need it. That can be with your original therapist or an entirely different person or service.
Just remember, therapy is to help you improve your mental health, not just to treat mental illness. Psychologists offer a great service, but it’s your choice how, when and if you use it.