Finding the right psychotherapist ― and what to expect from them
Finding the right psychotherapist ― and what to expect from them
John Cuturilo, B.Psych.Sc., G.Dip.Couns., M.A.C.A.
Finding a therapist to help with personal challenges can be daunting. Trying to learn what all the different job titles and therapeutic methods mean is itself enough of a challenge, and then there is the issue of finding one who is both available and feels right for you. In my experience as both a counsellor and a client of therapy, too many people are not given the proper information to make the initial decision as simple as possible, and once they reach therapy, they face a mess of variance in how well the therapy is actually delivered. But I am equally willing to admit that we need to address these problems as I am determined to provide you with quality guidance on how to navigate them. In this article, I will clarify some of the confusion surrounding choosing a therapist. It can not, of course, replace the actual therapist's advice, but hopefully will make your initial search easier.
What do all the titles mean?
First, let us address what each of the common mental health professions do and what separates them. I will eliminate some confusion by stating that we will use the term "psychotherapy" to refer to helping people learn to address personal problems using non-medical methods ― most commonly talking therapy, but also referring to some other methods. Some argue that, for example, "psychotherapy" means something different to "counselling", but these arguments are an over-complication of what can be a simple matter. "Psychotherapy" is the practice, and different professionals with different titles use it.
• Psychiatrists are the most qualified mental health professionals, trained in both general medicine and psychology. They can diagnose mental illnesses, provide psychotherapy, advise other practitioners on treatment, provide testimony in legal settings, and unlike the other practitioners, administer medicine and other physiological treatments. "Psychiatrist" is a protected title; one must have completed minimum qualifications and hold a licence. They are usually engaged to help when a person's problems are so severe that they stop them from living life normally and caring for themselves (which usually means they have a mental illness), and medical treatment is necessary. Examples might be severe depression and anxiety, schizophrenia, personality disorders, and phobias.
• Psychologists can not administer medical treatments, but provide psychotherapy, advise on treatment, and may provide testimony and diagnose mental illnesses depending on their specialisation. They also must have completed minimum qualifications and hold a licence. Psychologists help with a broad variety of personal problems, often working with severe cases of mental illnesses alongside psychiatrists, but also often working with challenges that are not illnesses.
• Counsellors and psychotherapists provide therapy without diagnosing or using medical treatments. At the time of writing, these titles are not protected, meaning that while they are liable for their services, there are no minimum qualifications that they must hold to practice and they do not require a licence. There are private organisations that accredit members, and currently we are working to develop standards which may involve licensing. Counsellors and psychotherapists are quite diverse, and they help with the most common problems for which people seek therapy. There are some myths about them that I also debunk later.
• Social workers help clients to work with themselves and other systems and seek opportunities in the community to better their wellbeing. Some provide psychotherapy.
• A number of newer and less recognised roles exist, usually in public practice and not-for-profit organisations, but some are entirely privately funded. These include psychosocial recovery coaches and behaviour support practitioners operating under the National Disability Insurance Scheme (N.D.I.S.), psychosocial support workers, lived experience workers, and various coaches such as life coaches. The definitions of what some of these personnel do can be quite vague, their scope is often limited, and the qualifications required to practice are not always to the same standards as in other professions, but they can nonetheless be pivotal in helping you when they practice diligently.
Your choice of practitioner depends on the severity of your problems, your needs and preferences, and the practitioner's competence, therapeutic style, and personal qualities — which have a major influence on how well they work with you. For example, I as a counsellor regularly help clients experiencing problems such as depression, anxiety, and trauma, with which a psychologist or psychiatrist may also help. However, if a client were suffering trauma so severe that they experienced loss of memory or consciousness, I would refer them to a psychiatrist as this would be in need of medical attention.
It is often advised to consult with your general practitioner when you have concerns about mental health. This is a sound idea as if there are any risks to you, they can help you manage them. However, they generally refer to psychologists for therapy, which has been deemed the default option. A good psychologist will help you, but usually they are not the only type of professional who can. It helps to approach potential therapists directly. Search the Internet for therapists in your locality, or search a directory such as Psychology Today, Good Therapy Australia, and the Australian Counselling Directory. Examine their websites and profiles, read about their experience, credentials, and how they present themselves, and ask them questions about how they may help. You can also check their credentials publicly:
• Psychiatrists must be registered with the Medical Board of Australia: https://www.medicalboard.gov.au/
• Psychologists must be registered with the Psychology Board of Australia: https://www.psychologyboard.gov.au/
• Counsellors or psychotherapists are usually registered with:
◦ The Australian Counselling Association: https://theaca.net.au/home
◦ The Psychotherapy and Counselling Federation of Australia: https://www.pacfa.org.au/
• Social workers are registered with the Australian Association of Social Workers: https://www.aasw.asn.au/
Some myths about "safe" professionals debunked
There presumably is a narrative that the quality control of professions such as counselling can not be trusted as they do not require a licence and are largely unregulated ― at least judging by the fact that our services are not eligible for Medicare rebates (see later). Let us be reminded of some facts. First, any person professing to provide mental health services, regardless of what they call themselves, is still legally liable for them ― and any harm they may cause while practising. Second, even if the requirements to maintain a psychologist's licence are more rigorous than those for a counsellor's accreditation, both professionals work alone with clients. The harm that is the subject of those fears of "unregulated" mental health professions is often only addressed when a client who has experienced it makes a report to the relevant authority ― if this is even feasible given the bureaucracy of our regulatory systems. Second, both a psychologist and registered counsellor must undertake regular professional development and supervision regardless of seniority, but supervision is consultation that happens separately from client work; it does not involve a scrutineer regularly observing their appointments with clients. Third, there are plenty of instances of so-called "licensed professionals" causing harm by incompetence ― in the treatment histories of myself, friends, relatives, clients, and other people I have known, notwithstanding other people in the world who often write of their experiences.
There is also the myth that counsellors just empathise with you for emotional support, but do not conduct therapy that could help a person with "real" problems. The fact is that competent mental health counsellors are trained in many of the same types of therapeutic methods as psychologists. We can work with many of the same problems including depression, anxiety, complex trauma, addiction, fears, and relationship problems. We are also trained to manage risk and prevent suicide and self-harm. The diagnosis and treatment of more severe mental illnesses such as schizophrenia, related psychotic disorders, and personality disorders requires more qualified professionals, but these are not the most common mental health problems, and treating every issue as a serious mental illness is actually harmful because it interrupts the mind's natural exploratory and management tendencies. Although I am not professing our perfection or guaranteeing the results of any therapy, I and other counsellors whom I have known have helped people to prevent self-harm and eliminate destructive behaviours.
Unfortunately, a person's title or licence is not a proxy for their actual competence. Psychotherapy varies wildly in terms of its quality. If you are uncomfortable with the interactions you are having with a therapist, address them directly, seek the advice of another professional, or speak to their regulatory body for advice on what standards you can expect. Keeping your wits about you is the most clear guidance I can provide here.
What type of therapy is right for me?
It is easy to be confused by the lists of the different therapies that practitioners provide. A competent therapist should be able to listen to your needs and explain what intervention may be appropriate, in language that you understand. They must be able to help you make sense of how the therapy explains and treats your problems. Different approaches may overall be better for certain problems and people, but usually, a number of different therapeutic techniques may be suitable when they are delivered effectively. You should be able to focus on using the tools to heal yourself ― not having to learn the theory of how the method works. Below is an outline of some of the most common types of therapy, however it is not exhaustive, and the methods are often combined with each other.
• Cognitive and behavioural therapies: these include a range of specific methods such as cognitive therapy, cognitive-behavioural therapy (C.B.T.), rational emotive behaviour therapy (R.E.B.T.), and dialectical behaviour therapy (D.B.T.). They all essentially work by helping you to understand how your thoughts, emotions, and actions contribute to your problems, and help you to change them accordingly. These are some of the most common therapies and are well-supported by evidence. Behaviour therapies include methods such as exposure, behavioural activation, and applied behavioural analysis. They all involve understanding the reasons why we act as we do, and teaching new actions via the consequences of our choices. Like many types, these therapies carry a high risk of harm if practised incorrectly and therefore must be done with caution.
• Psychodynamic therapies/psychoanalysis: these approaches help you to understand how your past and your unconscious thoughts and emotions contribute to your present. This is an older form of therapy that is less used now as it tends to take longer and is surrounded by more scepticism, yet it is still preferred by some therapists and clients.
• Acceptance and commitment therapy (A.C.T.): this type of therapy works on the basis that we often make unhealthy choices in response to distress, which stops us from being who we wish to be. It involves accepting that life can involve challenges, and committing to making better choices that are aligned with our values and goals.
• Motivational interviewing: this is a versatile form of therapy that emphasises asking you the right questions and giving the right prompts to help you develop the desire for change and the choices to make it happen.
• Schema therapy: this works by helping you to identify what sets of ideas developed from a young age ("schemas") are influencing your problems, and address each of those sets of ideas.
• Gestalt therapy: this helps you to understand the unique meaning of your entire human experience in the present, in turn helping you to understand yourself and develop the confidence to live with more wellbeing. It often involves creative tools such as art, drama, and imagination.
• Existential therapy: this works on the basis that we create our own meaning in life and have infinite choices and responsibility for the consequences. It helps you to decide what meaning you assign to life and what choices you will make to enact it.
• Solutions-focussed therapy: this is a briefer type of therapy, and involves helping you to decide what immediate actions will help.
• Creative therapies: these may use art, music, writing, performing arts, and similar to help you understand yourself and the means of change.
• Strengths-based therapy: this uses your existing successes and virtues to solve new problems.
What should therapy involve ― and not involve?
There are infinite subtle ways to practice good therapy, but there are a number of qualities that all therapy should demonstrate, as well as warning signs of bad therapy.
• The therapist must first and foremost be sincere and relatable. While they must be calm and objective, it is too common for them to not demonstrate appropriate emotional responses to clients' experiences, challenges, or sensitive issues, appearing indifferent or disconnected and ignoring the opportunity to empathise with their emotional experiences. As obvious as it is that this should not be so, too many personal experiences and accounts relayed to me have involved therapists being unaware (or aware, even more frighteningly) that they present to their clients as dismissive, patronising, or accusatory.
• The therapist must be patient, working at a pace appropriate for you. Discussing personal problems often is confronting and distressing; the therapist must help you to feel as safe as possible and settle any distress so that you can engage. This involves demonstrating intense empathy. They also must be willing to stay present and let you speak freely, regardless of how uncomfortable your story may be.
• The therapist must be thorough. They ask questions, establish your history, context, and goals for therapy. History is important, as many problems are most credibly attributed to past experiences. They do not take what you tell them on face value without asking questions about what is unsaid; there may be valuable information and ideas which you have not yet thought to explore or realised was important.
• The therapist must balance being client-centred and directive. By being client-centred, they listen to your needs, refrain from judging, help you make decisions rather than dictating, and choose the therapeutic methods that are most suitable based on you rather than trying to force you to work with their preferred method. By being directive, they are not passively "smiling and nodding"; they provide structure so that appointments are productive, recognise when you need insight which you may not yet have, educate, and also are able to safely tell you what is necessary to help you grow ― even when it may not be easy to hear. When you are in distress, it is easy to feel aimless or take tangents in discussion; a good therapist will gently keep you focussed.
• Therapy must be action- and goal-focussed. The therapist must help you to specify what you want to achieve, in your terms, and help you take specific actions to achieve it. The process may evolve if your needs change, but at all times both of you should have a sense of approximately what you are doing and why. While flexibility is necessary, it should not be an infinitely fluid process; most people do not need to stay in therapy infinitely, and the therapist should help you to actually work with your original problems rather than working to profit from them by prolonging the process.
• Therapy must be educative. It should not only teach you the skills to solve your immediate problems, but teach you how your mind works so that you can solve other problems in future. The therapist must be able to explain information in a way that makes sense, and clearly relate this to your experiences.
Can they actually do that?
Helping professionals are almost always bound by codes of ethics. These codes guide how they must work to provide maximum benefit to their clients and avoid harm. Within certain limits, this often requires them to act in ways that may seem restrictive, demanding, or otherwise undesirable to you, but which are done to protect you ― sometimes from your own decisions. Let us examine some examples, and the caveats of this ethos.
Therapists can not have any relationship with a client other than to be their therapist. This means, for example, that I could not socialise with a client or be a customer of their business, I could not counsel one of my colleagues, and I could not seek therapy from my supervisor. This is because having any interaction outside of therapy could interfere with how we understand and work with the client, and the risk of this is too great to justify any possible benefit. I must keep the details of my clients and their therapy confidential, but the law requires me to report to the authorities if any information they relay to me suggests that a child may be in danger or may have been harmed. Having to forego confidentiality may well cause further problems in the client's life, but the law is inflexible in imposing those obligations on me. If I counsel an individual, I can not then counsel them with their spouse in combination, as my existing knowledge of them may interfere with my ability to remain objective. Occasionally, a client may clearly have a problem that is impacting their life and needs addressing, but their appointments pass with them simply making the same reflections repeatedly and avoiding the problem. Some clients do engage a counsellor simply for emotional support, and this is okay as long as they are safe and there are no serious problems affecting them. But if a client is paying me just to talk and I can clearly notice a problem they are refusing to address, it is my duty to gently explain that therapy can only continue if we address that problem. It would be unethical for me to take a client's money (especially if they are vulnerable) and allow them to repeat the cycles that are harming them in the first place. These may all make sense to you, but other examples may not.
An illustrative incident to which I refer often involved a therapist terminating services to me because I could only attend appointments via video conference due to work commitments; I had previously been visiting their office. They insisted that me suggesting that I could not visit them was self-sabotage (effectively, an excuse for me not to help myself) and did not trust that I would be as honest with them as I would be in person (both untrue). I was at risk (being suicidal) and willing to take responsibility for my change, but ethically they had the right to make that decision. Depending on the situation, you may also become aware of instances in which a client of therapy attempts suicide, and the therapist terminates their services. The justification used is that the needs of such a client are greater than those for which the therapist can provide. They would normally refer the client to services such as a psychiatric inpatient clinic. Regardless of the fact that the client has the choice about what they do, and even that they may be at an increased risk of another suicide attempt without their regular therapy, the therapist is considered to be enabling the risk if they continue working with them.
Admittedly, some of these examples of what are considered the therapist's ethical judgement are illogical. I can not fathom a similar situation in which I would have to insist that a client only consults with me in-person. But be aware that, while ethics will not always make apparent sense, we as professionals are bound to take specific actions to protect our clients, whether we agree with them or not.
"Free" therapy?
Medicare subsidises therapy from psychologists and some types of social worker. However, there is a myth that services from a counsellor are more expensive than psychology as there is no Medicare rebate for them. Let us establish the facts. A mental health care plan from a general practitioner entitles a patient to claim up to a maximum rebate from Medicare for up to 10 appointments with a psychologist (Services Australia, 2025). At the time of writing, the maximum rebate per appointment is $145.25 for a clinical psychologist (Australian Government Department of Health, Disability and Ageing, n.d.a) and $98.95 for a general psychologist (Australian Government Department of Health, Disability and Ageing, n.d.b). Unless the psychologist accepts this rebate as their total fee for the appointment, called "bulk-billing", the client will have to pay a "gap fee" to cover the rest of the cost. It is difficult to find psychologists who bulk-bill, and most charge a total fee of more than $200 per appointment. This means that a client could easily be paying more than $100 in gap fees for each of the first 10 appointments, and more than $200 for each of the rest of their appointments until eligible for a new plan. By comparison, plenty of counsellors charge fees approximately equivalent to the gap fee, and they remain so without eligibility criteria. I charge on a sliding scale and most of my fees are also in this range. Make the calculations yourself. If you are receiving benefits from public insurance such as the N.D.I.S., or your state's work or transport accident scheme, then they may fully subsidise your therapy, but these are limited cases. And while there are "free" therapeutic services available to the public, I earnestly encourage you to speak to as many people as possible who have used them — and that is all I will opine here.
References
Australian Government Department of Health, Disability and Ageing (n.d.a). "Medicare Benefits Schedule - Item 80010". https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80010&qt=item
Australian Government Department of Health, Disability and Ageing (n.d.b). "Medicare Benefits Schedule - Item 80110". https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110&qt=ItemID
Services Australia (2025). "Mental health care and Medicare". https://www.servicesaustralia.gov.au/mental-health-care-and-medicare?context=60092
About John
John Cuturilo is a counsellor and citizen journalist in Melbourne, Australia. He conducts therapy with a diverse range of clients and specialises in working with complex trauma and relationship problems. He seeks to address shortcomings in common practice by being versatile, educative, empowering, and relatable, integrating humanity and lived experience with evidence-based methods. As a writer and podcast host, he educates his audience about how psychology applies to their lives, encouraging them to be more critical, constructive thinkers. He eschews politics and popular rhetoric for a pursuit of objective reality and nuanced analysis.
Find him at: www.yourlistener.com.au
Are you seeking couple therapy with your partner? Find John at: www.alysplace.com.au
