When therapy goes wrong

Some of what goes wrong in therapy is ordinary and fixable, and worth raising before you decide to stop. A smaller set of things are wrong whatever else is happening, and they need something different. And a complaint about 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 goes somewhere different from a complaint about 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 .

The ordinary kind

You don’t click with them. 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 doesn’t suit what you came to work on. The rebated sessions run out before you’re ready. Things move for a while and then stop moving.

None of it has to end the therapy. Most of it changes once it’s said out loud. Telling your therapist something isn’t working has lines you could use, and why therapy stalls goes through the common reasons and what each one points to.

Feeling worse

Feeling worse can mean something is wrong. Tell your therapist you’re feeling worse, rather than waiting to see whether it settles. If the work is overwhelming you, they need to know while it’s happening rather than afterwards. The same goes if you’re leaving sessions in worse shape than you arrived and it isn’t easing.

Some approaches do involve a stretch where things get harder before they ease. Trauma work is the usual one. In that kind of work your therapist sets it up with you beforehand, checks how you’re going while you’re in it, and slows down when you ask.

Does therapy actually work? covers what the research says about people who get worse during treatment.

The things that aren’t about fit

Anything sexual or romantic.
Being pushed into something after you’ve said no.
Your private information being shared for reasons that have nothing to do with your care.
Money or favours — being sold something, lent to, borrowed from, or hired.
Being treated for something your therapist has no training in.

None of these depends on how the therapy is otherwise going, on whether you liked the person, or on whether some of it helped. If you’re dealing with sexual harm, 1800RESPECT is on 1800 737 732.

What you can do

Say it in the room. Tell your therapist what isn’t working, and give them the chance to change how they’re working with you.
Ask for 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 . Your therapist or 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 can point you to someone else.
Stop. You can stop going without notice, without a reason and without a final session.
Raise it formally. Where a complaint goes depends on whether your therapist is 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 .

Stopping at any one of these is a complete answer. You don’t owe anyone the steps after it.

Making a complaint, and where it goes

If you want to take something further, where it goes depends on whether your therapist is registered. Who does what sets out the roles.

Psychologists are registered, with Ahpra The national regulator for health practitioners, including psychologists and psychiatrists. Its public register shows whether someone is registered now, what kind of registration they hold, and whether any conditions have been put on their work. More in the jargon decoder , the national regulator. Ahpra can look into safety concerns raised about a registered health practitioner (Ahpra). It doesn’t handle fees and charges, or dissatisfaction with the service you got. It regulates individual practitioners rather than organisations.

You can ask to stay anonymous, or to have your name kept confidential. Ahpra says that may limit what it can then do about your concerns. Most notifications are closed within ninety days (Ahpra). That figure is about the whole system rather than a promise about any one case, and a notification being closed isn’t a finding either way.

Counsellors 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 aren’t registered, so there’s no registration to take away. That’s how the professions are set up in Australia rather than anything about the person you saw. 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 aren’t registered with Ahpra either, even though a treatment plan 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 their sessions.

Unregistered practitioners are covered instead by a code of conduct for health workers who don’t have to register, and counsellors are named in it. Every state and territory has a health complaints body that runs the code. The one where you live takes the complaint.

The health complaints body can look into a complaint about someone who isn’t registered. At the serious end it can order someone to stop providing a service, either while the investigation is running or at the end of it. Five states recognise each other’s orders: New South Wales, South Australia, Queensland, Victoria and Western Australia. An order made in one of them holds in the other four.

Professional associations. If your counsellor or psychotherapist belongs to one, you can complain to it about a member (PACFA). An association can look into a complaint about its own members. It can’t stop anyone practising; only a health complaints body can do that.

Checking someone before you start

Anyone can search both registers.

Psychologists are on the Ahpra register. It shows whether someone is allowed to practise, and any conditions on what they can do (Ahpra). What it doesn’t show is a complaint that didn’t lead to a condition.

Counsellors and psychotherapists can be listed on the ARCAP register The national register of counsellors and psychotherapists, run jointly by the Australian Counselling Association and the Psychotherapy and Counselling Federation of Australia. More in the jargon decoder , which the two main associations set up between them. You can search it by state. Everyone listed holds a counselling or psychotherapy qualification, keeps up professional development and has clinical supervision (the ARCAP register).

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.

Where next

Which approach you end up in matters less than whether you can work with the person delivering it. Why who you see matters more than what they do covers why the relationship does more of the work than the method.

If you’re starting again, finding a therapist covers where to look and what to ask.