Why at least 18 sessions is vital – a client’s perspective

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I am calling on the Labor government to agree to a 12 month moratorium on the cutting of Medicare Better Access Initiative to Psychologists from 18 sessions to ten sessions.

I have accessed the Medicare Better Access Initiative since 2006 utilising all 18 sessions per year for the past five years.  I am now mentally well and working (which means I am now a tax payer).  There are many and varied reasons why at least 18 sessions of therapy is vital for therapy to be successful.


1. Establishing Trust and Rapport.

You are meeting a stranger for the first time and trust needs to be established before you can tell them your life story of trauma, relationship breakdowns and job losses etc.  This happens gradually over a period of time as the relationship gains trust and rapport.  This is a process that requires tact, diplomacy, grace and dignity.  This is not like cancer treatment, setting a broken bone or repairing a split spleen or liver.  Therapy can involve dealing with much ingrained shame, guilt, judgement and self-criticism.  Having a mental illness can make some people feel so ashamed they are suicidal.

2. The presenting issue is rarely the problem.

When you present to a psychologist because you are having work/relationship/family issues or eating disorders, alcohol and drug dependency and start to delve into why they are not working, you can uncover some debilitating long kept hidden trauma, such as sexual abuse, bullying at school, physical abuse that you have not previously made connections with between your current events and your past history.  Dealing with them takes more than ten sessions when you take into account history taking, house-keeping and trust and rapport.

3. Client/Therapist fit.

You need to “click” with your therapist.  The relationship (fit) is more important than the technique used.  This is a well known fact within psychology circles and evidence-based-research shows this.

4. Six plus four sessions is not based on evidence-based research.

Before the Budget cuts were announced, the Medicare Better Access Initiative was reviewed very favourably because it was successful.  Evidence-based research has found that 15-20 sessions is about the minimum amount for a mild mental health issue to be resolved.

5. Not everyone needs or wants 50 sessions with a psychiatrist because they perform a different role from a psychologist

If you are not on medication, it does not mean you don’t have a severe mental illness. Psychiatrists do not practice talk therapy, they tend to have 3-4 short sessions per hour specifically to deal with medication issues, ie trying new medication, changing any ineffective medication and getting that medication in harmony with your mental health condition.  There is not “one size fits all” cure.  Talk therapy is left to psychologists and neuroplasticity evidence-based research shows that the right psychotherapeutic talk relationship can change the shape, structure and chemistry of the brain in a positive manner alleviating the symptoms of depression and anxiety.  It is also showing great positive steps in alleviating the hearing of voices as well.  Medication does not suit everyone, is very potent and the side effects can be worse than the “cure”.

6. Not everyone can access ATAPS, nor do they need a team-based-approach.

I do not qualify for ATAPS because I am not considered to be of low socio-economic status, indigenous or living in a rural area.  We are not battlers, neither are we rich or middle-class.  We are caught in-between.  Although I had severe mental illness, I did not need a team based approach.  One-on-one psychology sessions worked for me.

7. Better Access 12 – 18 Sessions is better than emergency department visits or psychiatric hospital stays.

Better Access 12 – 18 sessions has enabled me to live my life in mental harmony.  People with severe mental illness need more sessions and these extra sessions develop more mind skills.  Six sessions plus four barely covers housekeeping rules, mental health history and a chance to establish trust and rapport.  If 18 sessions is working and it did for me, keeping me out of hospital on several occasions, then surely that is more cost effective for the Labor government than me visiting emergency departments or having lengthy psychiatric hospital stays.  It makes financial sense to keep Better Access 12 – 18 sessions as they are for the 13% who have used them.  If it is not broken, don’t fix it.

8. Only 5% accessed all 18 sessions.

If this is the case then the financial cost of keeping Better Access as it stands will not cost much more than changing it to 6 + 4.  But if those 5% who accessed all 18 sessions can only have 6 + 4 sessions, then those 5% of people will not get the additional support they require and emergency departments and psychiatric hospitals will be obliged to take up the slack.