Making Medicare Work

   Counselling Psychology has 42 percent of its members in private practice who are wedded to the discipline of counselling psychology, who treat clients suffering from a diagnosable disorder from a client-centred perspective by diagnosing the problem in collaboration with the client and working with the client to find solutions to that problem. Counselling psychologists engage with the subjective experience of the client. They use evidence-based techniques to provide symptom relief as well as dealing with long term structural gains. The counselling psychologist will use a range of techniques including CBT amongst others, to empower the client to regain control of their own life and to help the person find her or his own direction and then to achieve the goals associated with that direction.

   At the same time the discipline of Counselling Psychology in Australia is currently under threat from Medicare because of the focus on the practice of psychology from the scientific technical medical model of intervention.

   Counselling Psychology on the world scale is a discipline of psychology in its own right, which is recognised as different but equal to clinical psychology in both USA and Great Britain.

   Medicare is polarising the different philosophical positions about the practice of psychology in the Society. It is highlighting the differences between the objective rational scientific medical model represented by clinical psychology and the phenomenological client centred reflective model represented by counselling psychology. Each have a body of evidence-based literature to support the respective positions.

   So, how has Medicare worked for counselling psychology? Counselling psychology in Australia now needs to define itself based on the available evidence-based practice and practice-based evidence. Those of us practising psychotherapy from a counselling psychology perspective know that many interventions other than CBT work equally well at the right time and that nothing works unless the therapeutic alliance is firmly in place.

Issues for Counselling Psychology

1. Counselling psychologists are trained to work with the mentally unwell from a counselling psychology paradigm and continue to do so in private practice and other settings
2. Counselling psychologists do practise CBT but not as a single intervention for all purposes but as part of an armoury of intervention techniques
3. Counselling psychologists are particularly trained and skilled at working with the therapeutic alliance
4. In both the USA and UK, both disciplines of counselling and clinical psychology are treated as different but equal.
5. A body of evidence-based research exists rejecting CBT as the only preferred intervention and supports the importance of a number of variables that contribute to outcomes.

Eight Problems with Medicare from the experiences of Counselling Psychologists

1. In WA, for registration purposes, counselling and clinical psychologists are treated equally.
2. Clinical courses orient the clinical student to work with mental health issues sufficiently disabling to require inpatient treatment. In contrast, counselling psychology training focuses on serious mental health issues that still enable the sufferer to live within the community. This is the population who will be referred by a GP for psychological therapy. Therefore, if anyone is rightly to be considered a specialist for providing therapy for Medicare's target population, it is Counselling Psychologists, not Clinical Psychologists.
3. A significant number of older, very experienced members who have not had the opportunity to do clinical masters training but who have worked in the mental health field for many years are not being acknowledged for clinical membership.
4. Where clinical and counselling psychologists work side by side, with similar clients and do the same work, the clients of the clinical psychologist get a higher rebate. In these cases, both counselling psychologists and the public are being discriminated against.
5. Similarly, when a counselling psychologist is a Head of Department that includes clinical psychologists, those junior psychologists are eligible to "supervise" the work of the senior, more experienced psychologist for Medicare Category 1 purposes.
6. The assumption that all those "trained" in clinical psychology are entitled to a Category 1 rebate whether they are experienced or not in clinical practice.
7. Newly graduated clinical psychologists with little experience can set up in private practice and receive Category 1 rebates when very experienced and senior psychologists and therapists do not receive the same rebate.
8. The increasing and discriminatory statements from senior members of the APS, from the medical profession and other associated professionals, that only clinical psychologists are trained to work with depressive and anxiety disorders and to do CBT.

   Psychology in Australia is facing a huge challenge at present. That challenge is to get together on the same page and acknowledge the different perspectives of psychological practice as different and where the knowledge, skills and experience are equal, to acknowledge that equality. All have a place in psychology and all give the profession diversity, interest and excitement.

What has come out of this for Counselling Psychology? An urgency to identify Counselling Psychology in Australia and to advocate for its rightful place in maintaining and developing the health and wellbeing of the Australian public.

Elaine Hosie
National Chair
College of Counselling Psychologists

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