What therapy actually is
Therapy is a private conversation with someone trained to have it. Sessions usually run about 50 minutes, weekly or fortnightly, in a consulting room or over phone or video.
People come for all kinds of reasons:
- Something specific. Panic attacks, trouble sleeping, a temper you’re struggling to control.
- A pattern that keeps repeating. The same difficulty turning up across different jobs or different relationships.
- A particular event. A death, a diagnosis in the family, a separation.
- A decision. Wanting to think something through properly before you commit to it.
Most people arrive with a mix of those, and part of the early work is sorting out which one is actually driving the rest.
What a therapist brings is training in how these conversations work. How to ask a question that opens a subject up rather than closing it down. How to notice what you’re already doing that helps, including the parts you’d never think to mention. When to stay with something long enough for it to come clear. They also bring knowledge of which strategies and techniques tend to work for what.
What actually happens
The first session is mostly getting to know each other. Your therapist will ask what brought you there, then a lot of practical questions. They’re building a picture of how you’re managing day to day, not only how you feel about it. Expect questions about sleep, appetite and eating, alcohol and other drugs, and exercise. Also whether you’re still seeing friends and family or have dropped out of contact, how work or study is going, money worries, and your living situation. They’ll ask how long all this has been going on, whether anything like it has happened before, what you’ve already tried, and who you’ve got around you for support.
They’ll usually also ask whether you’ve been having thoughts of hurting yourself. It’s asked of everyone, as a matter of routine, and not because of anything in particular you’ve said. They ask so they know you’re safe. Answering honestly does not mean losing control of what happens next. Crisis support sets out what’s available if things are urgent right now.
Therapists take notes. Some write them during the session, some afterwards. The notes are part of your health record, and you can ask what’s being written and ask to see them.
After that it depends on the approach, and there are many. Some give you things to practise between sessions: tracking when a mood shifts, trying a different response to a situation, gradual Exposure (facing things in steps) Facing what you've been avoiding, a bit at a time, and staying long enough for the alarm to settle. For fear and anxiety, it's often the part of therapy that does most of the work. More in the jargon decoder to something you’ve been avoiding. You go through how that went at the next session. Cognitive behavioural therapy (CBT) is the most common of these in Australia. It works on the links between what you think, how you feel and what you do. You identify the patterns and habits that keep a problem going, then test them against what actually happens.
Plenty of other approaches work differently. Some stay with what’s happening in the room as it happens. Somatic therapies work with what you notice in your body. Narrative therapy works on the story you tell about your life. Person-centred counselling has no exercises at all and consists of talking and being listened to closely. 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 just happens to be the most common of them. Which one suits you is worth thinking about rather than leaving to whoever you happen to reach first.
What doesn’t happen. There’s no physical examination and no medical procedure. Some body-based approaches ask you to notice physical sensations while you talk, and a small number involve touch, which is always explained and agreed with you first. You aren’t tested, scored or graded, and nothing is diagnosed without it being discussed with you. You can ask what your therapist is doing and why at any point, and you can stop at any point without giving a reason.
Counselling, psychotherapy, therapy: does the word matter?
Not much, and not in the way people expect.
In Australia all three words get used for the same work, and practitioners choose between them by habit, by training tradition, and by what their clients understand. A 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 , 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 and a 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 might all be doing person-centred work with someone who is grieving, and describe it differently on their websites.
Where a distinction is drawn, it’s usually this: counselling for a difficulty you have now, psychotherapy for longer-standing patterns, over more sessions. It’s a soft distinction, and plenty of practitioners use both words about the same client.
What actually matters is the training and registration behind the person, and that’s not soft at all.
- Protected titles. “Psychologist” and “Psychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder ” are protected under national law. Nobody can use them without the qualifications and registration to match, and there’s a national register you can check them against.
- Titles anyone can use. “Counsellor”, “psychotherapist” and “therapist” are not protected. Most people using them are qualified and belong to a professional body like the Australian Counselling Association (ACA) One of the two national associations for counsellors and psychotherapists. It sets training and supervision standards, and takes complaints. More in the jargon decoder or Psychotherapy and Counselling Federation of Australia (PACFA) One of the two national associations for counsellors and psychotherapists. It sets training and supervision standards, and takes complaints. More in the jargon decoder , which set standards for qualifications, supervision and ongoing training. Someone who has joined nothing can use the same word, so it’s worth asking what a practitioner’s training is and which body they belong to.
Training and registration decide what a practitioner can treat, what they charge, whether 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 pays anything towards it, and who you can complain to if something goes wrong. Who does what explains each profession, the training behind it and what it costs.
How it differs from talking to a friend
A friend who listens well is worth a great deal, and therapy isn’t a substitute for having people in your life. It’s a different kind of conversation, and the differences are practical.
Your friend has a stake in the outcome. They have their own opinions, wants and needs, and they may play a part in the situation you’re describing. If you’re having trouble with your partner, your friend has met your partner, has a view about them, and has to keep seeing them at dinners. If you’re thinking about leaving your job, your friend may rely on you being at that job, or may envy you for considering it. A therapist has opinions too, and isn’t a blank wall. But they have no stake in which way you go, and part of their training is noticing when their own reaction is getting in the way and keeping it out of the room.
The conversation runs one way. You don’t have to ask how their week was, manage their reaction to what you’ve told them, or worry about being too much three conversations in a row. You aren’t expected to give anything back.
It’s confidential, within limits. A therapist should explain those limits in the first session. Broadly they are a serious risk to your life or someone else’s, and a court order or subpoena for your records. Depending on the state and the profession, there may also be a legal duty to report concerns about a child’s safety. Outside those, what you say stays private, including from your family and your employer. What happens in a first session covers what to expect.
They’re trained for the things that are hard to hear. Friends flinch, change the subject, or rush to fix it, mostly because they care and it’s frightening to hear. Staying in the conversation is part of what a therapist is trained to do.
How it differs from talking to an app or an AI
A lot of people try something digital first. That’s a reasonable place to start, and for some people it’s the only door open at the time. Two quite different things get lumped together, though, and they’re worth separating.
Structured programs are courses rather than conversations. They’re written by clinicians, usually built on CBT, and worked through module by module. In Australia that means This Way Up, MindSpot and MoodGym, among others. They’ve been tested in trials, and MindSpot comes with optional phone support from a real clinician. If you want something to work on while you’re waiting for an appointment, this is the strongest form digital help takes. Free and low-cost options covers what each one costs and how to get started.
Chatbots and AI assistants are conversations. Some are purpose-built for mental health; others are general assistants that people have started using this way.
What they’re good at is real. Available at three in the morning, no waitlist, no appointment, little or no cost, and nobody to face afterwards. For some people the anonymity is what makes a first attempt possible at all.
Research suggests they can be helpful. One review pooled 39 trials covering around 7,400 people and found a small improvement in depression and anxiety (Kim and colleagues, 2026). Small is not nothing.
The finding comes with fine print, and it’s worth knowing before you make a chatbot your main support. Nearly all of those trials had weaknesses that tend to make a treatment look better than it is. Mostly people knew which group they’d been put in, which is hard to avoid when what’s being tested is an app. More than half of the trials never checked whether anyone came to harm. There are also signs that trials with disappointing results were never published. And people were mostly asked how they felt at the end of the study rather than months later, so nobody can say yet whether the improvement lasts.
One more thing about those 39 trials: they tested apps built for the job. The general AI assistants most people actually use have barely been studied for this at all.
Then there’s what a conversation with software can’t do. Much of what makes therapy work is another person understanding you accurately and accepting you anyway. For a lot of people, not having had that is a good part of what’s wrong in the first place. Software can produce the shape of it. What it can’t be is someone who has actually understood and accepted you.
An AI will also tend to agree with you. That’s pleasant, and sometimes the opposite of useful: it can settle you further into a way of thinking that’s part of what’s hurting.
One practical thing worth knowing: what you type into a general AI assistant is usually stored, and may be used to improve the product. A therapist’s notes are a health record, with rules attached.
And if things are urgent, this is the wrong tool. Crisis support has the numbers, and they’re answered by people.
What a therapist will and won’t do
They’ll ask more than they tell. Most of a session is questions, and in some approaches advice barely features at all. If you want a therapist who gives concrete suggestions, ask before you book — it varies far more by practitioner and approach than most people realise.
They’ll keep the time. Same slot, same length, and knowing there’s a limit helps focus the session. If you need longer or more frequent sessions, ask your therapist.
They’ll stay a professional. No friendship outside the room, no socialising, no appointments as a favour, no treating people they’re close to. Sexual contact with a current client is prohibited under every professional code in Australia, and the Psychology Board’s code treats relationships with former clients as inappropriate in most cases as well.
Some overlap can’t be avoided, and that’s allowed. In a small town, or inside a particular cultural or community group, your therapist may be someone you also see at school pick-up, at the footy club or at a community event. The rule isn’t that it can never happen. It’s that they should raise it with you, agree how it will be handled, and keep what belongs to the therapy out of the rest of it.
They’ll say when something isn’t working, and can take it if you say so first. Raising it is normal and useful, and asking to be referred to someone else is a request they’re used to receiving.
How long it goes on
Six to twenty sessions covers a great deal of what therapy is used for. Some approaches are deliberately brief and built around a set number of sessions. Eye movement desensitisation and reprocessing (EMDR) for a single traumatic event, or a structured CBT course, can be six to twelve. Others run open-ended for a year or more, which is more common where the difficulty is long-standing rather than recent.
How many sessions Medicare pays for is a separate question from how many you might need. Medicare gives a 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 on up to ten individual sessions a calendar year under a Mental Health Treatment Plan, plus ten group sessions on top. That’s a funding limit, not a judgement about how much therapy anyone needs.
Ending is meant to be planned: a few sessions where you go over what’s changed, what you’d do if it comes back, and what would make it worth returning. Plenty of people stop by simply not booking again, which is allowed and common, but means missing the planned ending.
Where next
Would I benefit from therapy? takes that question seriously rather than answering it for you.
If cost is the thing standing in the way, free and low-cost options sets out what’s available without a Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder and without paying, including services you can use now.
Who you see matters more than what they do. The fit between you and the therapist does more to predict how therapy goes than the type of therapy does. Worth knowing before you spend a long time choosing between approaches.