Submission to a Member of Parliament

Submission to Minister of Health
  Elaine Hosie on Medicare

   This is a letter I sent to my local Member of Parliament (who happens to be Liberal, although there has been a change of government to Labor). I emailed it to her before she had an hour-long meeting with me and Michael Costa, who had seen her on a previous occasion. She gave us very valuable advice on how to lobby, but was not able to do much more.

   However, we did arouse her interest and sympathy. If enough Counselling Psychologists do the same, our cause can be advanced.

 

20/2/08

The Hon. Fran Bailey, MHR.

Dear Ms Bailey,

   Thank you for agreeing to talk with Mr Michael Costa and me regarding the situation of Counselling Psychologists.

   The Howard government did a wonderful thing for the Australian community when it made it possible for people to claim a Medicare rebate for psychological therapy. This has been long overdue, and research shows that the benefits will be clear to see in many ways, although there is an inevitable time delay. The evidence is available, and I can supply a long list of references if you wish.

   However, the people who advised the then Minister for Health were ignorant about the work psychologists do, and the various specialties within the profession. I have spoken to Professor Lyn Littlefield, who has been the Australian Psychological Society´s main negotiator. According to her, initially the Government wanted to limit the rebate to Clinical Psychologists, and it was only through considerable lobbying, supported by the Australian and New Zealand College of Psychiatrists, that a rebate was allowed for work by other psychologists.

   All psychologists registered with the State Psychologists´ Registration Boards have essentially the same training. The differences are more in terms of the special needs of particular target populations than in terms of skills, knowledge or expertise. Perhaps the best way to state this is to reproduce an article I wrote for the newsletter of the APS College of Counselling Psychologists:

What is Counselling Psychology?

   Some time ago, a student asked me to define counselling psychology in 6 sentences. I didn´t think that would do justice to the topic, so I sent him the following email:

Dear Daniel,

   I tend to call what I do 'therapy' simply to distinguish it from what spiritual counsellors and crystal gazers and Tarot card readers do. In Australia, anyone can adopt the name of Counsellor and request payment for services.

   However, I don't consider myself to be an expert on what Counselling Psychology is. I am attaching a lovely paper from Dr Elizabeth Tindle. It is FAR more than 6 sentences though, and you'll need to ask her permission if you want to quote from it. It may be best just to read it and use it to inform your understanding.

   I think that all specialisations in psychology are a matter of the target clientele, and of certain problems and resources that characterise this population. So, Clinical Neuropsychologists work with people who may have some form of brain damage. Educational and Developmental Psychologists work with youngsters. Clinical Psychologists would probably be better called Psychiatric Psychologists, because they tend to work with severe psychiatric disorders. Health Psychologists work with people suffering physical somatic problems. And so on.

   Counselling Psychologists often work with just about any person, in just about any situation, with almost any problem. In medicine, one of the specialisations, and perhaps the most challenging one, is General Practice. I think I am the psychologist equivalent of this.

   However, I think that both by training and by practice, we psychologists are much more like lawyers than like physicians. A dermatologist and a heart surgeon have very different training and expertise. In contrast, all lawyers -- and all psychologists -- share very similar training, use very similar techniques and strategies in their work, and are distinguished more by interest and experience than by qualification. A solicitor practicing family law can be admitted to the bar, but won't thereafter do criminal practice. The distinction is between lower and higher levels, not qualification for specialisations. Really, although we pretend otherwise, the same is true for psychologists.

   OK. A definition?

   All applied psychologists use the one set of techniques, and hopefully all have similar attitudes. In other words, counselling skills are at the base of all the specialisations. However, Counselling Psychologists focus on using the therapist-client bond to bring out the strengths and resources of the client in order to have the client break out of the shackles imposed by one or more problems. This is done using a wide range of powerful, research-based techniques -- most Counselling Psychologists will use any method that works. They do not go down the medical path of diagnosis - treatment, but assessment through reflective listening, advanced empathy to bring out the client's strengths and resources, and an intuitive bonding with the client.

:)
Bob

   Insofar as Clinical Psychologists differ from other specialist-level psychologists, it is expertise in working in psychiatric wards, with people so ill that they are unable to function within the community. The Medicare rebate is explicitly for a very different population: people who go to their GP, paediatrician or psychiatrist because they are suffering. If the person is sufficiently affected that inpatient treatment is necessary, they will be hospitalised, rather than be referred for weekly meetings with a psychologist.

   The implication is that if anyone has unique specialist skills to deal with this population, then it is Counselling Psychologists, not Clinical Psychologists.

   The APS recognises nine specialities, as indicated by the fact that there are nine Colleges. Not all of them focus on working with people suffering from psychological disorders. For example, Sports Psychologists use essentially the same skills for enhancing performance (in many fields, not only in sport), while Organisational Psychologists consult businesses and organisations on issues such as resolving workplace conflict, getting the best from their employees, minimising absenteeism, etc.

   However, any person with a College membership should be competent at therapeutic counselling. The learning of relevant skills and knowledge is at the core of all Masters´ courses in psychology. Therefore, any psychologist who qualifies for membership of any of these Colleges should be considered to have specialist level skills. Specifically, Counselling Psychologists have had their training focus on precisely those skills and information that Medicare requires.

   My personal preference is that there should be only one level of rebate for the clients of psychologists. This should NOT be available to just any person registered as a psychologist, but only to those who can demonstrate specialist-level capability by qualifying to become a member of a specialist College.

   Currently, those who qualify for membership of the College of Clinical Psychologists get a high rebate. And yet, anecdotal evidence is accumulating that many Clinical Psychologists have no experience in this type of work. Also, psychologists who are currently allowed to register for Medicare do not necessarily have the experience to do a proper job. I am appending a paper by Carmel O´Brien to illustrate these points. It appeared in the same newsletter as mine above. [This is a PDF file.]

   Perhaps it is appropriate for me to say a few words about my background and experience. I gained a Ph.D. in psychology (thesis in cognitive psychology) in 1972. I have taught at Monash University and RMIT, where I was responsible for setting up two of the first Australian courses in counselling. Then I was a Research Scientist at the CSIRO.

   I left psychology to follow other fields including writing, and then returned to start a private counselling practice in 1991. I have run this practice since, with part time work as a family therapist with Anglicare, a telephone counsellor, and as a therapist at an Aboriginal Health Centre.

   My case load has included people suffering from the following:

   You may agree that this is as severe as it gets. I feel I deserve to be considered as a specialist provider of psychological services.

Sincerely,
Bob Rich
Counselling Psychologist

 

Home  Submission to Minister of Health  Elaine Hosie on Medicare