When it isn’t therapy you need
A handful of ordinary things produce something that feels exactly like a mental health problem. Bad sleep, drinking, money trouble, a job that’s grinding you down, grief, a physical cause nobody has checked. Each of them has its own answer, and therapy on its own is a slow way to get at any of them.
Most of what follows runs alongside therapy rather than instead of it, and a good therapist asks about all of it in the first session anyway. These are simply the things most easily missed, and missing them costs months.
A physical cause nobody has checked
Thyroid trouble, low iron and low vitamin B12 can all produce low mood, exhaustion or trouble concentrating. So can sleep apnoea, perimenopause, and the side effects of a medication you’ve just started. There’s a longer list of less common causes behind those. The feeling is the same from the inside. The treatment is not.
A 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 is the right first stop when something came on quickly and nothing in your life accounts for it. Also when what you notice most is physical — exhaustion that sleep doesn’t fix, a racing heart, a body that won’t settle. And when it started after a change of medication.
Getting a physical cause ruled out doesn’t close off therapy, and it usually takes one appointment and a blood test.
Sleep
Insomnia that has gone on for months is a condition in its own right, and it has its own treatment.
The Royal Australian College of General Practitioners recommends cognitive behavioural therapy for insomnia (CBT-I) as the first thing to try, ahead of sleeping tablets. It runs to about four to eight sessions. Sleep improves for up to 80% of the people who do it, and most of those who were on sleeping tablets reduce or stop them. The benefits keep going after the sessions end (Sleep Health Foundation).
CBT-I is a therapy, delivered by 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 among others, so it isn’t an alternative to seeing someone. People often bring the sleep problem to general therapy and spend a year on the anxiety around it, when the sleep itself has a short and specific treatment. Ask for CBT-I by name.
Sleep apnoea is the other sleep problem worth raising with a GP. Ask about it if you snore heavily, wake unrefreshed however long you were in bed, or someone has noticed you stop breathing. Untreated, it produces exhaustion, irritability and trouble concentrating that look a lot like depression.
Alcohol and other drugs
Alcohol lifts mood for an evening and lowers it for a day or two afterwards. Drinking regularly keeps anxiety topped up, and that’s hard to see from inside the pattern.
Low mood improves markedly for many people after three to four weeks without alcohol. That’s why clinicians usually wait about four weeks before deciding whether a depression is running on its own or being driven by the drinking (McHugh and Weiss, 2019).
One safety point. If you drink heavily every day, stopping suddenly can be dangerous. Speak to a GP before you stop, rather than deciding on your own on a Sunday night. A GP can arrange for you to stop safely.
The National Alcohol and Other Drug Hotline is free and confidential on 1800 250 015. It connects you to the alcohol and drug service in your state or territory, and it’s answered around the clock everywhere except South Australia, where it runs 8.30am to 10pm.
Money
Money trouble produces sleeplessness, trouble concentrating, dread about the post, and a constant background shame. None of that is a misreading of the situation.
Financial 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 are free, independent and government-funded. They’re a different thing from financial advisers, who sell products. A financial counsellor can:
- work out what you actually owe
- negotiate with the people you owe it to
- arrange hardship terms with banks and utility companies
- deal with debt collectors for you
The National Debt Helpline is on 1800 007 007, 9.30am to 4.30pm on weekdays, with web chat until 8pm. It costs nothing. Never pay anyone for financial counselling, debt advice or credit repair: the free service is the one with the training and the obligations behind it (National Debt Helpline).
If money is also what’s standing between you and a therapist, free and low-cost options has what’s available without paying.
A job that’s making you ill
Work health and safety law in Australia treats these as hazards an employer has a legal duty to manage, in the same way as a physical one:
- unmanageable workloads
- bullying and harassment
- little control over your own work
- 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 distressing material
- poor support from managers
The model code of practice sets out the detail, and each state and territory has adopted its own version (Safe Work Australia).
Therapy can help you carry a job that’s harming you, and it can help you work out what to do about it. It can’t change the workload. Your union, the health and safety regulator in your state, and sometimes a frank conversation with a manager are the tools built for that part.
Doing both at once is usually right. Neither the therapy nor the workplace side has to wait for the other.
Grief
Grief hurts for a long time, and that isn’t a disorder. It comes in waves, it lands on anniversaries and in supermarkets, and it takes far longer than most workplaces and most friends expect. Most people get through it with the people around them and without a therapist.
Grief works the same way when what you’ve lost isn’t a person. A marriage, a career, a body that used to work differently, a future you’d assumed you’d have.
What’s worth raising with a GP is grief that hasn’t moved at all after a long time. That means still not being able to work or look after yourself, or feeling nothing at all since and having that not shift. Specific approaches exist for grief that’s got stuck, and they’re different from general counselling.
When home isn’t safe
If someone you live with frightens you, controls your money, checks where you go and who you see, or hurts you, safety comes before anything else on this page.
1800RESPECT is on 1800 737 732, around the clock, for domestic, family and sexual violence. It’s free and confidential, and it has web chat as well as a phone line.
Couples counselling is not the answer where there’s violence or coercive control. Joint sessions can make things more dangerous, because one person then has to go home with the other. Individual support, from someone who works in this area, is what’s needed first.
In an emergency, call 000.
Where therapy still fits
Therapy and nearly everything on this page belong together rather than in place of each other.
Sleep, drinking, money, work and safety are the first things a decent therapist asks about. They change what the rest of the work can achieve. Sorting out a sleep problem or getting a hardship arrangement in place often makes therapy possible rather than unnecessary.
And what sits underneath some of these situations is exactly what therapy is for — why the job was impossible to leave, or what the grief has opened up.
If nothing on this page fits your situation, that’s useful too. Ruling these out is part of working out what will help.
Where next
Would I benefit from therapy? takes the personal version of the question seriously, and starts from what you’d want to be different rather than from whether things are bad enough.
Who does what explains which professional handles which part of all this, including what a GP appointment can cover.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.