Why therapists work in different ways

Two therapists with the same title can work in quite different ways. What a therapist offers comes from their training, their profession, where they work, who they mostly see, and what Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder . Knowing that helps you ask the right questions when choosing someone to see.

Where they trained

Where a therapist trained shapes where they start. A 2023 study of clinical psychology training in Australia found that Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT), and the ideas behind it, were the main focus of most programs (Impala and colleagues, 2023).

Training isn’t the whole story, though. An older Australian study, of 103 Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder in Melbourne, found that the Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder each one leaned towards went along with differences in their personal characteristics. University training mattered most for those who leaned towards CBT (Poznanski and McLennan, 2003). So the way a therapist works often reflects who they are, as well as where they trained.

Why there are so many types of therapy explains the approaches themselves.

Most therapists mix approaches

In a survey of more than 2,000 therapists in North America, most said they drew on more than one approach, or described their approach as eclectic (Cook and colleagues, 2010). Eclectic means they combine methods from different therapies. The things they said they did most often were about the relationship: showing warmth, acceptance, understanding and empathy.

Therapist profiles often call this integrative or eclectic. Both words mean the therapist draws on more than one approach. So the approach named on a therapist’s profile won’t tell you everything they do. Many therapists add training, skills and areas of focus over time.

Their profession

A therapist’s title gives clues about their background, but it doesn’t describe everything they do.

Psychologist. Trained to assess mental health problems and to treat them with therapy. That takes six years of study and supervised practice at minimum, and they’re Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder with the national regulator.
Clinical psychologist A psychologist with an extra endorsement, which usually means two more years of training aimed at more complex problems. More in the jargon decoder . A psychologist with an extra endorsement, which usually means two more years of training aimed at more complex problems. Clinical psychology is one of nine areas a psychologist can be endorsed in, after further study and supervised practice (Psychology Board of Australia). Of the nine endorsement areas, only clinical psychology attracts the higher Medicare rebate (MBS note MN.6.2).
Counselling psychologist. Counselling psychology is another of the nine areas. A counselling psychologist is a psychologist with additional recognised training and supervised experience in providing counselling. That’s different from being a Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder .
Counsellor and Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder . The minimum training to join a professional association as a counsellor or psychotherapist is lower than what is required to become a psychologist. Neither title is protected in Australia. Plenty of practitioners go well beyond that minimum. Person-centred and Narrative therapy A therapy built on one principle: you are not the problem, the problem is the problem. It works on the story you tell about your life, including what that story leaves out. More in the jargon decoder are mostly practised by counsellors and psychotherapists rather than by psychologists.
Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder . Trained in therapy, and in practical help with things like housing, money and family services.
Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder . Focuses on function and daily life alongside the therapy itself.

Who does what has more detail on each profession. Once you’ve checked someone is properly qualified, their title tells you less than you’d expect about how they’ll work with you.

Where they work and who they see

Where someone works affects how they practise. Workplace programs, community health services and headspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder each shape the work in their own way. They often offer a set number of sessions, you’re generally allocated someone rather than choosing, and the focus is on what the service is built to do. Free and low-cost options covers how these services run.

A therapist who mostly sees young people, or works in a trauma service, will have built their skills around that work. Research comparing therapists’ results across different kinds of problem found that most did better with some than with others (Kraus and colleagues, 2011). So it’s worth asking how much of someone’s work is with people facing difficulties like yours.

What Medicare rebates

A Mental Health Treatment Plan from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gives you a Medicare rebate on up to ten sessions a calendar year. They’re arranged as six, then a review with the GP before the remaining four. Counsellors and psychotherapists aren’t part of the scheme.

Medicare keeps a list of approaches that can be used with a rebate under the plan. It applies to general psychologists (Medicare calls them registered psychologists), mental health social workers and mental health occupational therapists (MBS note MN.7.4). The list includes CBT, interpersonal therapy, EMDR (eye movement desensitisation and reprocessing) A structured therapy for memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist's hand as it moves from side to side. The aim is for the memory to become less upsetting. More in the jargon decoder (EMDR), skills training and relaxation strategies. The list also includes narrative therapy, but only for Aboriginal and Torres Strait Islander people. Some therapies that aren’t named on the list may still attract the rebate, because they sit under one of the broader headings that is, such as CBT.

Clinical psychologists work under a different rule. Medicare recommends CBT, but allows other approaches with good evidence behind them where the clinical psychologist judges they fit (MBS note MN.6.2).

If the approach you want isn’t on the list, or you’d need more than ten sessions, ask the practice how they’d handle it before you book.

Asking how they work

Because training, workplaces and personal styles vary so much, it helps to ask each therapist how they work, and how much of their work is with people dealing with something similar. You can ask before you book or in the first session.

Questions to ask a therapist has questions you can pick and take with you, and how to find a therapist covers where to look.

Whatever their training, the relationship with your therapist matters a great deal. Why who you see matters more than what they do explains why.

Where next

If you’re not sure therapy is what you want, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.