How to shop for a psych

0:02 A listener production, Welcome to another solo episode of Crapy or Happy. Today, I'm answering a question that was put to me recently, which is, how do you shop for a psychologist? And I thought, well, that's an interesting question, and I know many people probably wonder the same thing, and I thought this would be really easy. I'll be able to answer this really quickly, and then I realized it maybe there's kind of layers to the question. So what I want to share today is, I guess, first of all, if you're shopping for somebody to help you with a mental health condition, if you're struggling, the difference between a psychologist and a counselor or a social worker.

0:47 So just briefly, I will cover off that, and then how do you go about finding somebody who is a good fit for you? And what might be some of the things to look for when you're looking for a psychologist. I also will just run through quickly what the current process is for making an appointment and what is available in terms of Medicare rebates at the time of recording, this is May twenty twenty three. So first of all, a lot of people will ask what's the difference between a counselor or a psychologist, or even a psychiatrist or a social worker. Psychologists have a minimum of a four year degree. They're trained in all aspects of mental health disorders, how the brain works, the biological basis, the history of psychology as a profession, some counseling skills, neuroscience, that kind of thing. Not all psychologists choose to do therapy. Some psychologists contribute to research, like they choose to do research work or stay in academic work, or they might do organizational work. They don't necessarily go down that path of doing therapeutic work. Often they will also have an additional two year master's degree. Some now who have maybe been registered for a while don't have a two year masters but they may have done a two year period of supervision, so they've all had some kind of training for at least six years if they're working with clients. Generally, psychologists

2:18 are not medical doctors. They can't prescribe medication, so that is the key difference between a psychologist and a psychiatrist. A psychiatrist is a medical doctor who has chosen to specialize in mental health. So a psychiatrist will also a sense and diagnose and treat mental health conditions, but they also can dispense medication, and as I mentioned in a previous episode, oftentimes if you're working with a therapist, for example, if you're working with a psychologist, they may refer you onto a psychiatrist for something that's a little more complex, or if you need to have your medication reviewed. Over the years, I've referred many of my clients in private psychology practice to a psychiatrist because they've had a hard time adjusting to different types of medication, and sometimes a psychiatrist is best placed to really look into what's going on there. So the difference between a psychologist who offers counseling services and somebody who is just called a counselor, is that a counselor can have, Like there can be loads of different pathways to becoming a counselor different types of courses they could have studied. I mean, I know people who've done twelve week kind of certificate course and are calling themselves some form of counselor. Other people have got really extensive training and qualifications. It's not as clear like you would have to look into what a particular counselor's qualifications are. I mean, even somebody in a church

3:49 doing voluntary sort of pastoral care work can call themselves a counselor. I mean usually these days, I think you'd probably have a minimum of some kind of basic training and a certificate level qualification. But it varies, is all I'm saying. It's not as cut and dried psychotherapy is. You know, there are psychologists who are trained in psychotherapy, or there are people who simply study kind of psychotherapy, and that's kind of a different approach to therapy, which is often very long, very intensive, often one or two sessions a week over several years. It's really like digging into your childhood and uncovering stuff from your subconscious, very kind of Freudian. Some people get a lot of value out of that if they can afford to do that, because that's a long, expensive process, whereas seeing a psychologist tends to be more of a relatively intended to be short sharp address a problem. Experiencing depression, you're experiencing anxiety, you're struggling with something. Maybe you have a diagnosis of something more complex, of bipolar disorder or some sort of personality issue or substance use, or even just relationship issues workplace stress, and you kind of referred for that particular problem, and there's a course of treatment over a number of sessions to specifically address that problem. Having said that, I have had clients of mine who I have continued to see for many, many years. There are limits to what

5:20 medicare will pay for or what it will rebate, but once there is a relationship established, often that relationship can be quite long lasting if there is a good relationship formed. So a psychologist aims to assess, diagnose, provisionally, diagnose, and treat mental health disorders as listed in the DSM five, which is the Diagnostic and Statistical Manual of Mental Health Disorders. Even under the umbrella of psychologists, there is a distinction between clinical psychologists and psychologists who have endorsements in other areas of psychology. Now this gets a little controversial because often the training is very similar, if not the same.

6:06 There are people who have loads of experience and who are highly qualified, but who haven't necessarily studied gone down that path of doing a master's in clinical psychology, or who have chosen not to get an endorsement in that area, and there is a differential in the amount of Medicare rebate available between a clinical psychologist and other kinds of psychologists. Now, many would argue that there should not be a differential because the service being offered most of the time is the same. You can be a very effective practicing psychologist, and you might have an endorsement as a clinical psychologist, you might have a health psychologist some other educational psychologist, and your service that you offer and the treatment that you offer can be just as good as anybody with a clinical psychology master's degree, which is what I have.

6:56 And to be completely transparent, the reason that I got a clinical master's degree when I actually originally enrolled in a health psychology masters and then I transferred at the first available opportunity into clinical because I knew that the Medicare rebate was much higher and that that would be an incentive for people to choose me over potentially another psychologist. And I'm lucky that I had that option available to me. And I'm not saying it's fair or it's right, but when lots of other psychologists have got the same level of training and experience and qualification, but that is the way it is currently under the Medicare system in Australia. So as my background is psychology, then I am going to talk to well, how do you find a psychologist?

7:38 If you're shopping around for a psychologist, how do you go about that? It's a tricky one because what have you got? You've got Google, It's really hard to know what it is you're looking for. I mean, obviously the first issues that people look for are accessibility, like who's close by to me? And what do people charge and what do they specialize in. Generally speaking, any privately practicing psychologists will usually be able to deal with like the broad spectrum of the typical things that present in a private practice. So you know, it's often said anxiety and depression are the bread and butter of privately practicing psychologists.

8:18 Workplace stress, relationship issues, addiction issues when I say addiction in a substance misuse kind of issues, parenting struggles, all of the general sort of psychological and emotional issues that we frequently deal with that we all experience from time to time. Most psychologists will be trained to help you with those things, and their approach might be a little different. So I'm going to talk about that just in a second. Oftentimes your GP will have a list or will have somebody that they refer to. But having said that, oftentimes a GP won't have a list. They will say to you, you find somebody and you bring me name, and I'll write the referral. What I found in my experience is that when a GP referred to me, even if they'd never heard of me, say a patient specifically asked to see me, or because they had a recommendation by a friend, Like as soon as I was able to establish a relationship with that GP and provide them with reports and feedback and the patient was able to go back and offer some good, positive feedback about what we were working on and how it was going for them, then often that GP would then continue to refer to me. So it just says to me that when they find somebody, when they develop that relationship and they know that they can reliably refer to somebody who's going to provide a good service, and they will often just continue to refer to that person. So your GP may well have relationships with psychologists. Some GP practices also have a psychologist in

9:50 the practice, so it makes it very easy and very accessible. The reason I'm talking about getting a referral from a GP is that is currently the only way that you can gain a Medicare rebate for your sessions with a psychologist and social workers. You can submit claims to Medicare and get a rebate on some of your fee, reducing your out of pocket expenses. I think it's really important to make the point here because this is something that is so often misunderstood. If you have a referral from a GP to see a psychologist, if you have a mental health care plan from your GP, it doesn't mean the psychology is free. It is a rebate. So some psychologists, just like some gps, may give you the opportunity to bulk bill, particularly if you're having a hard time financially.

10:44 They might have certain criteria where they will simply accept the Medicare component so the Medicare rebate and you don't have to pay any gap. Most psychologists can't afford to do that. Most psychologists will normally need to charge something on top of the Medicare component, and that is your out of pocket expense. For example, currently the Medicare rebate for a clinical psychologist it's just been recently increased to one hundred and thirty one dollars and sixty five cents, so that psychologist may be charging you one eighty two hundred to twenty to fifty. They'll set their own fee. You pay them the fee you submit the claim to Medicare, and Medicare will rebate you will reimburse you one hundred and thirty one dollars and sixty five cents. If the psychologist that you're seeing is a generally registered psychologist, so then not clinical, they don't have a clinical endorsement, then the Medicare rebate currently available is eighty nine dollars and sixty five cents, So again their fee might be one fifty, one, eighty two hundred, whatever. The amount that you can climb back from Medicare is eighty nine dollars and sixty five cents, and you can claim back seventy nine dollars and five cents for a session with a social worker. I'm not a social worker, so I can't speak to that profession, but I can tell you that you can claim a Medicare depending on their endorsements and their qualifications. There is also a limit to how many sessions you can claim the Medicare rebate for, so currently it's ten sessions per calendar year. Now, most people would argue that that's not really enough. Unfortunately, when psychology services were first included in

12:19 the Medicare scheme under the Better Access Program, there were twelve sessions available per calendar year, with the option to then put in a request for an additional six under exceptional circumstances. So there were eighteen sessions available. Long story short, over time, it's been cut, and it's been cut, and it's back to ten and there are no exceptional circumstances. During COVID, they temporarily increased it to twenty sessions, so you could claim a Medicare rebate for twenty sessions per calendar year. In twenty twenty three, that has been scaled back again to ten, so that is per calendar year. This means that if you get a referral from your GP to see a psychologist and it's February, you've got ten sessions that you can claim a rebate for through until the end of December that year. If you get your and then your ten starts again from January the following year, that referral stays valid and you can start again with another ten sessions the next calendar year. If you get your referral in October, then lucky you, you only have to use up those ten sessions by December and again. Then in the new calendar year, your ten available sessions starts again. In order to claim a Medicare rebate, you must have a referral from your GP and a mental health care plan. It's simply a treatment plan put together between you and your GP where you agree that you're going to see a psychologist and the psychologist is going to report back to the GP about your progress.

13:45 If you have a mental health care plan from a GP, you are eligible for a Medicare rebate. There is nothing to stop you from calling up any psychologist in private practice and making an appointment directly if you choose not to see your GP, and if you're happy to pay the full fe and not claim a Medicare rebate, and some people, for privacy reasons, will choose to do that, and you are within your right to just call up and make an appointment. In many cases, private health funds will also cover some of your fees. You cannot claim a private health fund rebate and a Medicare rebate for the same session. But what has happened with some of my patients in the past, my clients is that after they've exhausted their ten Medicare rebateable sessions, then they will say, well, I've also got private health insurance and can I use those?

14:36 And certainly you can. And every private health fund, and depending on your level of cover, will have a different cap will have a different amount that it reimburses you for those sessions. So you can kind of extend a little bit if you've got Medicare first of all, and then you're able to use whatever you've got available to you with your private health fund. Again, if you choose to pay out of pocket and you don't want to rebate, you can just go and pay of pocket and that is completely fine. When you see your GP and you ask for a mental health care plan, you ask for a referral to a psychologist, then you will initially be allocated six sessions, and after six sessions, then the psychologist's job is to report back to the GP on your progress.

15:21 You need to go back to the GP, and the GP provides a top up basically of the additional four sessions. Now, look, I don't know why you've got to go back to the GP. I didn't make the rule. I would have thought you could just get a referral for ten sessions, then report how you're going, report back to the GP the six sessions, and then the extension is a hangover from the early days when it was six plus six and then an additional six and exceptional circumstances. Now that at six plus four this process is still in place that after six you have to go back and get your GP to endorse an additional four sessions. I feel like, and you probably recognize that this just puts a lot of barriers in the way to people accessing treatment. First of all, you've got to wait for an appointment with your GP. You've got to make a long appointment. You've got to take time out of your day to go and see the GP. Then when you've got that, you've got to shop around for a psychologist or you take your referral, and then you've got to wait to see the psychologist. Usually I've had to tell your whole story to the GP in order to get the referral in the first place. Then you have to go to the psychologist tell them your whole story. And then after six sessions, when you just feel like you're getting some momentum, you've got to go back to the GP, make another appointment, probably pay out of pocket for that as well, before you can come back and see the psychologist. Like I said, I don't make the rules. I can completely see though, why many people would avoid this whole process, like having to tell your story over and over and make all of this time out of your busy schedule to have

16:52 all of these additional appointments. This is where, thankfully, one positive benefit that came out of COVID is the of telehealth. So you now can claim a Medicare rebate for telehealth appointments with a psychologist, so you can have an appointment over the over a video call, and it's the same number of sessions. It's ten sessions per calendar year. So again the history of that is that prior to COVID, they introduced telehealth for psychology in around twenty seventeen, but there were really strict rules about who could access that. You had to prove that you were a certain number of kilometers away from the closest available psychologist. It was really for people in remote areas. There was no consideration of other factors that might impact a person's ability to get into physically attend an office. But with COVID, they recognized that we needed to make mental health services available and accessible when people were in lockdown, and so they extended Medicare to cover telehealth for psychology. Lo and behold, it works a treat. People really love it. It's very effective.

18:01 Thankfully they have continued telehealth to now they have anyway, I'm actually I'm not too sure if that the plan is just to continue that indefinitely, but my understanding is that that has remained so at least now you can avoid a trip into somebody's offers. You can actually have these appointments remotely, no matter where you live, and you can submit your Medicare claim and have it rebated. So this brings me to the whole shopping for a psychologist and how do you pick a good one or how do you find someone one? Now, there are websites that are completely set up to provide telehealth, to provide virtual therapy, I mean actual therapists. We're not talking about AI, actual therapists.

18:55 One that I came across, and I don't want to promote any particular organization, but just when I was looking online, there was a there's an organization called Talked t a l k ed talked dot com dot au, which is a hub for psychologists and for people looking for psychology where people can, you know, scroll through, look for who they like, look at what people's rates are, look at people's ratings and reviews. This is very interesting because as psychologists, our ethical standards always said that we could not accept testimonials. We can't post testimonials on your website or anything like that. But this website has got all of these patient reviews and ratings, so that's kind of interesting. Even scroll through and see if you can find somebody in there, and it will tell you if they're medicare rebatable or if they're not, if they're a psychologists, some other kind of counselor or therapists, and their what their fees are, and what their specialty is. So that's lovely. If you are looking for somebody to see in person, then often EAT is about looking for somebody who you think is going to be able to address the issues that are pertinent to you. And oftentimes psychologists will put on their website what their particular focus is, the kinds of issues that they tend to specialize in. Even when we're practicing in private practice, and we can deal with a lot of issues.

20:21 Most of us will have particular interest and particular experience in certain types of issues. So, for example, I've often spoken about the fact that seventy percent or more of my private practice for years was women going through pregnancy or post natally. I did a master's degree where I focused on mindfulness for the perinatal period and how that helped to reduce women's post natal anxiety and depression. It was what I was really interested in, and I really focused on that, and therefore I got a lot of experience working with that particular group of people. So gps learned that that was what I specialized in, and they referred many women to me. Another GP that I worked closely with had a case load with a lot of young women, so women in their late teens, early twenties, in that sort of university age group, and she was a young GP, and so they really resonated with her.

21:14 She had a great relationship with her patients, and so when she started referring to me and I was able to develop rapport with those young women, then again she started to refer more and more of those patients to me. So this is what happens over time when we build these professional relationships with other practitioners. So it will be ideally the case that your GP should go down that path, will have a network, We'll be able to recommend somebody for you. Oftentimes a friend might have a recommendation. If you know somebody has seen a psychologist, then you can ask them whether they would recommend that person. I have certainly had referrals come to me based on existing clients referring other people that they know. And the other thing that you might do is if you know a psychologist, you can ask them who they'd recommend. Now caveat on that.

22:08 I get asked all the time. People ask me because I have a bit of a public profile, and because I have a Facebook and an Instagram page and a podcast, people will often say to me, I know you're not seeing clients, but can you recommend somebody? It is really hard. Psychologists are changing jobs, going out of private practice, going into public health, going into coaching. It is really hard. So I will where I can refer to somebody that I know who might have a similar approach to me, But often it's really I'm just going by somebody else's recommendation as well. So personal recommendations, your GP is a good place to start. Otherwise, it's really just a case of getting online and looking at different practices, prices, approaches, whether you particularly prefer a male or a female. If you're dealing with something that is very pcific, like for example, an ADHD diagnosis, or you've got a teenage child that's causing issues or a relationship issue, then you look for somebody who specializes in that area, because oftentimes psychologists will very much have an area of specialization. Otherwise, it's a case of just going along and finding out what they can do to help. When psychologists start talking about the kind of therapy that they do, like they do CBT, or they do this, or they do that. Now I'm going to do another episode, So my next solo episode, I'm going to break down the difference between all of these kinds of therapy. I think the important thing to say now if you are shopping for a therapist is

23:39 if you know nothing about different kinds of therapy and you're just looking at somebody's website, then you may choose to engage, for example, a Christian therapist or somebody who has a kind of a yoga background or interest, somebody who's into more boudiest kind of ideas, something that resonates with you that you kind of get intuitively, that's how you're going to find someone that is going to be helpful to you. And the reason that I say that is because it has been proven that the single most important ingredient in a successful therapeutic relationship is the relationship.

24:22 It's the therapeutic alliance. So regardless of the type of therapy that the person does, the therapeutic alliance how much you and the therapist have rapport, how much you trust that the therapist has your best interests at heart, how much you feel that they understand you, that they're empathetic towards you, and how much you agree on their approach, that is going to be the secret source that means therapy is successful process for you. If you are really anti CBT, you think that that's not helpful for you, and you go in to a therapist and they're very traditional CBT, We're challenging your thoughts and they're not able to convince you of the effectiveness of that approach, well, then that's probably not a healthy therapeutic alliance. You're going to feel like you're not on the same page right from the outset. If you don't really know much about CBT, or you don't know much about act or mindfulness, or you don't know much about any different kind of approach to therapy, and you walk in and you share with the psychologist what's going on for you, and they explain to you what their approach is and why they feel it's effective, and you're open enough to try it, and you take their you know, you trust their professional judgment, then that's the start of a healthy therapeutic alliance. You just need to be trusting enough to accept that the therapist has your best interests at heart. That's the foundation of a healthy therapeutic relationship. And the relationship is everything.

25:54 You have to feel like you can trust them. You have to feel like there is empathy and understanding and that it's going in the right direction for you. If at any point you feel like this is not working for me, I don't think you've got my best interest at how or your approach is just not working for me, then that's when things will start to break down. It's not to say that the relationship is over, because if you can bring that to a session and talk about it and talk through it, and they can explain to you why they're doing the thing that they're doing. Then that can get back on track, and that can be fine. Drilling into needing to understand every kind of approach that a psychologist might use in order to know if that's going to work for you is not really the issue.

26:36 It's the relationship that's the issue. It's the trust and the alliance that is going to be the key to your success. So you should never feel bad about shopping around for a therapist if you go and see one. Now, of course, the limitation of this is that you do want to get those ten sessions under Medicare per year. So if you waste three or four of them burning through psychologists until you find one that you like, it's going to be a slower process. You're not going to have as many sessions available to you under medicare. But if you meet with somebody and you feel like you just don't vibe with them, then you can go and find somebody else. Your referral is valid, not for a specific psychologist. If your GP has written you a referral to me, for example, which you can't because I'm overseas at the moment. But if you had a referral to come and see me, what goes on your Medicare record is that you have a referral, that you have a mental health care plan. You are entitled to use that mental health care plan with any psychologist you choose. If you call me up and I can't see you for six months, you don't need to go back and have a new referral written for a different psychologist. You just need to find somebody who is available. Or if you come and see me and say I don't really get her, she's a bit not really my cup of tea, and I think I'd like to see somebody else, then you can go see somebody else, and you can take that referral to wherever you want to go. And then you just need to tell your GP or tell your new therapist who your GP is, because they need to communicate

28:08 with each other in order to extend you beyond those six sessions. I have noticed that there's some psychologists who will maybe offer like a fifteen minute call. I personally have never done that, but you know, if a psychologist offers that, and they offer you the opportunity of a fifteen minute call, you might take them up on that, just to see if you kind of get them to see what the rapport is like. Having said that, pretty hard to establish a rapport in a fifteen minute phone call, so you know, normally I would suggest that you go along and you spend the hour with a person, share with them what's happening for you, get their import into what they think that they can offer to help you, what their approach might be, and give it a few sessions and see how it's going before you kind of jump ship and decide to go and see somebody else.

28:59 I hope that it's been helpful. I know that people have lots of questions about the process, which is why I rather than just talk about how do you find a good psychologist? So I thought it was really important to just cover off what the actual process is, what's available in terms of Medicare rebates, you know how that referral works, how that referral can follow you to different therapists and ultimately therapeutic alliance. That is the most important thing. So just find somebody that you gel with, find somebody that you kind of get the sense that they kind of get you. They understand you that maybe you have similar interests or backgrounds or even stage of life that they're going to get you. They're a professional, but they're also a human and then take it from there. It is not the style of therapy they use, it is the relationship that is going to make the biggest difference.

29:43 If you have any other questions, but all means hit me up, send me an email hello atkast done dot com, come into my DMS cast on Underscore XO I am on Instagram, and next time I will talk you through some of those different styles of approaches to therapy so that you have a better understanding and that might also help. I can't wait to catch you on the next episode of Crappy to have you listener