Depression and recovery in Australia
Experiences with health professionals: Psychiatrists, psychologists and other counsellors
Most people we spoke to were seeing psychiatrists, psychologists or other counsellors for their depression, and had usually been referred by a GP. When discussing experiences of counselling, people often used the terms ‘psychologist’, ‘counsellor’ and ‘therapist’ interchangeably.
A few people had seen the same therapists for long periods of time, in some cases over twenty years. Other people had professional support over many years but would change individual therapists from time to time, if the relationship had become too familiar with a given therapist or treatment was no longer effective.
Reactions to experiences with psychiatrists, psychologists and other counsellors were varied. People who chose not to engage with psychiatrists or psychologists for their depression mentioned reasons such as not believing that ‘talking therapy’ could help, being intimidated by such encounters, or finding it too expensive. Most people had who received subsidised psychological counselling through the Australian government’s 'Better Outcomes in Mental Health Care' (Better Outcomes) and 'Better Access to Psychiatrists, Psychologists and General Practitioners' (Better Access) programs (designed to increase access to mental health professionals) were grateful for these initiatives.
Experiences with psychiatrists
Many people we talked with were seeing psychiatrists and a few had very long-term therapeutic relationships with their psychiatrists. The longest was 25 years with a few other people seeing the same psychiatrist for 10 to 15 years. Psychiatrists assisted mainly with mental health-related medication, with some providing talking therapies, including psychoanalysis. Experiences with psychiatrists were diverse. In many cases, the perceived quality of the relationship rested on whether people’s views about their diagnosis, the causes of depression, and views about treatment fitted with those of their psychiatrist. Nonetheless, if they felt the relationship was genuinely caring some people continued with the same psychiatrists even when they did not agree on diagnosis or treatment, or doubted that they could be ‘fixed’.
Ruth described her experience with a psychiatrist as very positive one.
Ruth described her experience with a psychiatrist as very positive one.
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Yeah I, look, I consider like a bit of a life coach. You know, like I said, I don’t have to see her once a month. I don’t have to see her twice a month. I can see her once every three months, four months, six months. It's all a matter of how I feel. So, for me, I like the opportunity to sit down and talk to her. I can talk to my sister, you know, and, and I sometimes will sit with my sister and tell her what my psychiatrist said to me. She goes, Ruth but I've told you that. I said yeah, but you telling me that is not the same as somebody, you know, somebody else telling me that; because a lot of times...
I've got a friend who also, you know, suffers a bit from depression, and she's very resistant to go and talk to someone. And she says to me well, I talk to my friends. That's not the same. It's not the same. Yeah, I've got heaps of friends I can talk to, and I do talk to my friends, but I just find it a lot more - I get a lot more out of going to talk to my psychiatrist and I get a lot more from the advice she gives me. And it might be exactly the same as my, you know, very - my - one of my closest friends says, but it doesn’t have the same impact, doesn’t have the same impact.
Long-term relationships with therapists were central to some people who didn’t have much social support.
Shaz kept seeing the same psychiatrist for a long time, despite pressure from friends to find...
Shaz kept seeing the same psychiatrist for a long time, despite pressure from friends to find...
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Disassociating, yeah. I’m disassociating from my body. And I’d mentioned that to my psychiatrist and he said, ‘Well that’s a little bit concerning,’ but… he is so cool. I’ve been seeing the same psychiatrist ever since I was 19. I’ll be 46 in August, go and see him every three weeks and I can talk to him about anything. I can fart in front of him if I have to. And a lot of people have said to me go and see another psychiatrist, he’s not fixed you, because I’ve been seeing him so long. And I say, ‘Why would I do that? Why would I - even after seeing him for five years, why would I just pick up, go to someone else and try to start all over again?’
But that’s the thing what people say, they say, ‘He hasn’t fixed you’. But I don’t think I’ll ever be fixed.
In contrast with the accounts above, some people were critical about their encounters with psychiatrists.
Emma was shocked by a psychiatrist's insensitivity in diagnosing her perinatal depression.
Emma was shocked by a psychiatrist's insensitivity in diagnosing her perinatal depression.
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I didn't, I think you just gel with some people too. Like in, to be honest the psychiatrist I never really got a connection with her. I felt like I was a number and she did keep telling me she's a resident here and she's on a contract and I, I was, as I said to you before, I wasn't in any state to listen and take on someone else's problems. But she did tell me sort of things about, I guess it was just light hearted conversation, you know, you make a nice small chat. But I, I wasn’t in any state to hear about how she's not happy that her job isn't permanent and all that sort of thing. I didn't think it was appropriate by any stretch.
And when I just cried, when I cried in her office she just sort of looked at me as if I was a freak. And when I cried when she said post, when she said you've got postnatal depression and I absolutely burst into these tears she sort of. I think she actually said something which I took to heart - and you do when you're in that state of mind. Said something like, well what did you think I was going to say? And I thought that wasn't particularly supportive, so it would have made it so.
Yep. Second sentence when I walked into the, door…
Absolutely, it was like being knocked in the face from Mohammed Ali. It was, I can remember just taking, stepping back and being short of breath. Even like I said, you know, classic sort of, oh panic. Yes, yeah. I'm almost, I'm not that kind of person but I almost wanted to write in to the [name] Hospital and complain about her. Just to have a bit of justice or just, it was actually more so she didn't do it to somebody else. So she didn't - you've got to, I think you've got to let people down kind of a bit more gently. Even if you've seen six people during the day and you've told them that they've got depression. Everyone's an individual and it can still shock them.
Chloe found psychiatrists too cold and clinical
Chloe found psychiatrists too cold and clinical
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Well I’ve been through a lot of [laughs], a lot of psychologists and a few psychiatrists. From my experience with psychiatrists, most of the ones I’ve seen are very cold and clinical and they kind of are - almost judgmental, is the vibe they gave me. So like I think I saw one psychiatrist actually who was just so like cold and she didn’t smile and she just, was very intrusive and treated me like not like an equal almost. I actual left feeling 100 times worse than when I walked in which was scary because I went in to talked about depression and I walked out being more depressed like, oh my God. She made me feel really horrible. And after that, I swore I’d never see another psychiatrist. But psychologists - a bit hit and miss. Like I’ve had a few where they’ve been a bit similar, like a bit intimidating and then but the other ones I’ve seen have been really good; like just really good to talk to, and yeah.
Ron discussed his preference for psychiatrists who are open-minded and treat their patients as...
Ron discussed his preference for psychiatrists who are open-minded and treat their patients as...
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And consequently over the years I’ve met doctors, some doctors who’ve uh told me a lot more and uh also had their own views about things, and different views, very different than conventional wisdom too. To the point that the person I see now is even questioning the word depression and working on mindfulness. And of course I’ve seen, you only have to Google that, mindfulness based can be something or other, that's become a, become a, a new sort of modality and a franchise almost. So again, it just reinforces to me that the jury is still out about this thing we call depression.
So some of those doctors and professionals and professors are in high places with high influence and they’re authorities. So I think it’s all part of the human condition. So the doctors - and they’re all male by the way, except there was one female doctor, in fact my doctors I have now, uh the three, there’s a psychiatrist who I’ll see as my mentor and my coach in mind, mindfulness and there’s two women doctors who look after my bodily and maybe also psychological needs too. but they’re all open people that I can challenge and I can say no to, that aren’t just, just swallow the pill. I, I actually ask, ‘Do I need this and why?’ And uh I have a relationship with them, so I’m grateful I have that. You know, we can choose our hairdresser, we can choose our doctor, we can choose the person who services our car, we don’t have to stay with one person, many people stay with the same doctor on the same medication for 30 years and never think they can actually change, well, you can.
Of course if we reduce the need then there will be a lot less jobs for doctors and psychiatrists and all those other healthcare people out there who make their whole living off the misery and struggle and suffering of people. But that’s okay, [smiles] maybe they can become balloonists and uh, you know, uh design uh saunas or something, I don’t know.
Experiences with psychologists and other counsellors
Most people had seen psychologists or other counsellors and these experiences varied. Some were very positive and people engaged in long term counselling relationships which they described as beneficial. Qualities and approaches that people appreciated included patience, listening and support, working with patients at their own pace, being encouraging, helping people to understand and accept their own experiences as part of the narrative of their lives, and not imposing solutions on them. Sara said her psychologist helped her understand herself better and gave her ‘permission to understand [her] own vulnerability’. A few people were very proactive and assertive in their communication with therapists.
Debra was positive about her psychologist's ability in and approach to helping her to better...
Debra was positive about her psychologist's ability in and approach to helping her to better...
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I've been seeing a wonderful psychologist it's very important to be able to get a really good therapist as well. Someone that can listen to you and can - my psychologist actually says to me, can, can articulate to me what's going on in my head. You know, which is absolutely fantastic. Once again the old pedestal comes into act with me, I set myself very high expectations being an overachiever. So if I am trying to come down off medication and it doesn't work the way I want it to then that also fuels the depression and the anxiety as well.
I can tend to look at my mental illness as sometimes very black and white. There's a wrong way or a right way or a yes or a no way. I'm working at the moment with therapy to tackle that a different way using mindfulness as well as a way to treat it. But yes I'm hope, I've requested to go and have a psychiatric evaluation after I found out about the leukaemia. And then see whether I get re, whether it's a re-diagnosis of whether it's just anxiety and whether it is anxiety and depression. This will actually probably be my first psychiatric evaluation since the last breakdown nine years ago.
Some people said counselling helped them to understand the nature of their distress and prompted them to take an active role in helping themselves to feel better.
Louise described how her counsellor motivated her to take a more active role in getting better...
Louise described how her counsellor motivated her to take a more active role in getting better...
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It’s a – I think it’s a bit like when you take your car to a mechanic. I mean, I can change my tyres. I can – I really can do that. But, it’s easier if I go to a professional and get them to do it, because they can do it faster and quicker and they’re aware of things that I might not be aware of and I sort of see it along those type of lines and it wasn’t as though when I have depression that I don’t – I don’t think to myself I’m just going to give up on it all and – every day, you know, I think it’s a new day and start again, start afresh.
But it gets to a point where it’s just not working anymore. So you go to a specialist in an area and if it’s – I know that my keeping physically active is good and I actually really don’t like physical activity, like exercise. But it’s good for you, so I do it. so yeah I go to a gym and, and, and I’m with people and, and I’m going to the doctor that, that’s the medication part of it and going to see a professional person. They know how to ask questions that can delve deeper into things of why you might have a certain line of thinking and how you can change that, ‘cause it really all has to do with your thinking.
Some people preferred counselling over antidepressants. They appreciated the confidentiality and professionalism of the relationship and the space it provided for them to talk openly about their feelings. A few people commented on the benefits of counselling accessed through the Better Outcomes or Better Access programs.
Kim Hai enjoyed the confidentiality and space to talk freely that her psychologist provided.
Kim Hai enjoyed the confidentiality and space to talk freely that her psychologist provided.
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In counselling, I found - the first thing I found is like I don't put too much burden on the counsellor, because it's her job. She get paid for it, so I feel a bit less than you know feel obliged and talking to a friend. If I talk to a friend I feel like they have to listen to all my suffering, and ah it's not fair on them. With the counsellor, I know they debriefing sessions and they get paid for it. It's their professions, so I feel more freely to talk to them about traumatic events.
With the counsellor, I feel like it's totally confidential and I like the fact that they don't give too much advice. They will just listen to you but I also like the fact that sometime they challenge my thinking. I think it wouldn't be so useful if they don’t challenge my thinking. So I think all those combined make me feel like I can talk to them more freely and maybe, just for me, by talking it out, I brainstorm myself to find a solution for myself. I brainstorm myself to find a way to heal myself through just like talking, and the other side just listening to it. Sometime asking questions like you're asking me, probing, sometimes just asking me so that I understand my situation more.
I understand like I have choices and responsibilities going with those choices and I feel like I can help myself. I have more belief in myself through brainstorming it out with the counsellor. That, that's how I view my counselling sessions, and I think in my life I will go to counselling again, if I need to.
Yeah, the last bout of counselling, that last 12 months, was all on Medicare and I think that was a great help that the Government gave some funding. If not, I wouldn't have been able to afford the whole 12 sessions without the help of Medicare.
A few people described significantly different experiences with other counsellors as compared with psychiatrists. In contrast to her negative experience with a psychiatrist, Emma, who experienced perinatal depression, found her psychologist very helpful.
Emma talked about the reasons she found her counsellor especially helpful.
Emma talked about the reasons she found her counsellor especially helpful.
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The other treatment I had was counselling. I saw this divine lady who, specialises in postpartum relationships and, I can't remember. That, that's her speciality and she's written various books on it
I thought I could, I mean she actually, she's open about having PND herself. She's got four children, she had it with her third, which is random and I've heard various stories like that. But she, so between her, so sorry she was fabulous support. I found her amazing, even if I was just calling up for a, to book an appointment. She actually took the time to ask how you are. It wasn't just like you were making, a money maker for her or, she even - even her little answering machine messages on the phone. Isn't it funny how you really latch onto things but just to hear her voice on the phone really calmed me down because I knew that, alright in two days I'll be able to see [counsellor]. And I'll, I'll discuss this with her or I'll just sit in her office and cry and she'll get it, she understands it. So she was like a rock for me, her and my GP and my mum and my sister were my support crew.
I just always felt like she was there. She was very flexible with her times and she'd always make a time for you during the day or - she worked up until six o'clock and I remember one time I was really bad and she said, oh just come now. I've closed but just come now. So she, she sort of, I felt like she understood that, when you're in a really bad state. I don't know, it's probably not nice for her from a completely work/rest, uh, relationship for me but, she understood that you needed, you need, when you need the support you kind of need it. And so that was quite selfless of her and also she, I felt that she'd, she'd been there herself, I could just, talk to her quite openly and even, uh, openly about how bad I was feeling.
Some people thought counselling was too costly, or would not help. Others found their initial encounters with their counsellors unsatisfactory, but kept searching for the ‘right one’. A few people were critical about specific counselling methods, including nondirective approaches. As John said, ‘I do understand the ideas of client-led recovery, but when you're really sick - or for me, I just needed someone to be a little bit directive’. Rosie was told by her counsellor she did not in fact have depression, which made her feel worse.
Akello was critical about her first psychologist, whom she found more 'businesslike' than caring....
Akello was critical about her first psychologist, whom she found more 'businesslike' than caring....
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And my - the first psychologist I saw - didn’t click – ah, she was - I felt like she was more about her time than helping me, so…
...we finished a session which - they had - the only session I had with her and she said, oh it’s time up and let’s see, you have to see me - when should we book another session? Yet I had seen a counsellor before her and after each session she would ask me what I had got from the session, you know, to know exactly where I’m standing. She said what, if you had to go with something today, what would you tell me that you’ve learnt today? But she didn’t tell me. I felt like she was - it’s about her earning her money and coming in and going out sort of thing.
So I thought I haven’t come this far to work with someone who I’m not comfortable with so I asked, I changed, and I was also able to get vouchers from my GP and, yeah, so I had six sessions with another psychologist who was really, really nice and at the end of each session she would say to me, what have you, what are you going to take home?
Rosie went to a couple of counsellors but found the experience so unsatisfying that she lodged a...
Rosie went to a couple of counsellors but found the experience so unsatisfying that she lodged a...
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So when [older son] died, I think that was one thing I was determined to do, was feel the pain, to, to live the grief so that I came out healthier out the other end. But again, I went to a couple of different counsellors. The (organisation name) have counselling. I went there for a number of sessions but I found all I wanted to do at the time was talk about me and what I was feeling and what I was experiencing and how do I deal with this, which is a natural thing I think when you’re in a counselling situation. And all she wanted to talk about was her daughter playing softball. So I was a little bit...
I was very annoyed at that [laughs]. I wrote her a letter and said, and she did write back and apologise. The first counsellor I saw has a very unusual style and I’d walk into the counselling session. So this was within weeks of [older son] dying. And I was just, oh my God. He would sit there and go well, and I’d say, well. And he’d go, well. So he’d wait for me to initiate the conversation. And I didn’t, I wasn’t ready for that, I was in shock, I wanted someone to lead me and to tell me it’s going to be okay even though it probably, or possibly it wasn’t going to be.
And so I gave up. I only went to four or five sessions or something. I couldn’t handle that person. So I left, I didn’t feel it constructive.
Troy was satisfied with the initial treatment he received for his depression from a much older psychologist, but as the relationship went on he began to feel patronised. He reflected that a significant age difference could be a barrier to the ability of older therapists to relate to the experiences of younger patients. Millaa was referred to a school counsellor by an attentive teacher who became aware he was being bullied. At first he gained some useful insights and skills from the experience but soon became bored, finding the counsellor quite superficial.
Millaa talked about how he felt scrutinised by a number of psychologists and psychiatrist during...
Millaa talked about how he felt scrutinised by a number of psychologists and psychiatrist during...
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And the counsellor came and saw me and started talking to me about all these different things. So counselling sessions upon counselling sessions. And eventually I was sent to [mental health service name] which is this – oh, what do you call it - I guess a psychologist's wet dream.
It's sort of like a clinic, in a sense. And I think it's also an asylum, but I'm not sure. Went there, they diagnosed me with - they did all these tests on me, you know, ah cogni- I can’t pronounce it – cog-
Cognitive
Cognitive, thank you, tests and you know, colour scheme tests, where you choose what colour you're feeling that day or all these other you know, tests. And then they came out with the diagnosis that I had depression and depression through Asperger's syndrome.
And they told my parents and my parents researched it and you know they said, ‘OK, so you've got this, and that and the other and it's okay, we'll have to deal with it’. And that was one of the first times I remember that my parents showed any interest in me. So that was quite fun.
How old were you at that stage?
Fifteen, 16, yeah. It was, it was also, it was also coincidentally, the pinnacle of my bullying and also the pinnacle of home life and the chaos, you know. So it was a really - it was like being in a twister. It was very chaotic at that time. 2005-06 and the beginning of 2007 was probably hell on earth, or the closest you could emotionally come to, yes. So yeah, it was good times. Yeah.
The first time I really sort of got into the counselling was when… when that librarian first sort of submitted my… mental instability, I suppose, to the school counsellor. And so that's the first time I ever met a counsellor, or a psychologist. And they were quite - it was very much - it was quite... oh, I don't know what the word is – I guess - it came across very fake, in that it, it came across as like - in that…
...in that they wanted to be very clinical in a way as well. Like they wanted to just be very black and white - in, out, done, go sort of thing. It's not - there wasn't a huge amount of um… in-depth-ness to it. ‘Cause I guess they're just counsellors so you can’t expect miracle workers, but yeah, I, you know, I’d spend hours in there trying to, trying to… figure out, you know, what's what.
But they can really, they can really only do so much. And then I was referred to [mental health service] and that's where it really started there. There I met psychologists, psychiatrists who wanted to poke, prod and you know look - make me look through everything to try and figure out what was going on in my little cranium.
And yeah, like I you know, like I said, they came up with Asperger's syndrome and depression through that, through you know rigorous testing and things like that. And you know, I’d go in every week, once a week, and talk to them for maybe 45 minutes about how my week was going, about what I was feeling, about what… you know what experiences I'd had, I’d had, I’d had recently. And I…the first few times, I, you know, I did, I went along with it. Then I got bored and when I get bored I get sort of - bored. And I start to sort of make up things because I find that more interesting than recounting my own past, you know.
Suzi’s experience captured that of a few people who had initially negative encounters with their therapists, but later found someone they liked and then formed a long-term therapeutic relationship. Suzi’s strongly negative views of psychiatry resulting from some unhelpful experiences were challenged by an understanding psychiatrist who offered exceptional support, even giving her a dog to protect her from her tendency to self-harm.
Suzi appreciated her GP, but 'hated' psychiatrists. This view was transformed when she found one...
Suzi appreciated her GP, but 'hated' psychiatrists. This view was transformed when she found one...
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I became so - I hated psychiatrists! I developed this sort of, – it seemed really intellectual, but it wasn’t that – I really developed this hatred for psychiatry and what they did, and… And I was seeing a GP who was actually more a sports medicine person than anything else. So I was still running and doing a lot of sport. And he was fantastic but he could see that mentally I was going downhill.
And I went to see this guy and I was so aggressive towards him.
And I told him right from the start, I said, you know I only came to you because, I was going to kill myself and I didn’t want my psychiatrist – my GP to get, you know, and I said to him that he was a psychiatrist so he must be used to people killing themselves, so I didn’t care that he would be upset, and that that was the reason I’d come to him.
Seventeen years later we still joke about that! Ah… Yeah.
Yeah my psychiatrist is a rather unique person, I think. You know, he took me on when no one else wanted to touch me. No one wanted to look after me, I had a – you know, and he took me on and he stuck in there all the way through all the bad stuff.
He’s always respected me. He’s always, treated me with the utmost respect. He’s always, um… had a mind to my abilities and stuff and so, you know, there’s times when - there was a time recently where he produced a, a book to be given to healthcare professionals about how to diagnose and initiate treatment and everything of people who have a mental illness, and he kind of gave me a copy of it and asked me to go home and read it and see what I thought. When I came back I kind of said, oh look, you know, I thought this was, you know, page 4 was this and he, you know, kind of looked at it, ‘Oh you’re right, we’ll have to change that’. And stuff like that. So it is nice, I know that he appreciates the skills that I have. We have a mutual respect of each other. He’s quite a remarkable person.
The first dog I had my psychiatrist got me to have because I was so unwell I shouldn’t live alone. He was so scared I was going to kill myself and he thought that if I had a dog with me, I might think again before killing myself and having the dog locked in the dead – in the house with a dead person.
That was very good thinking on his behalf. Because there was quite a few times when I very strongly resented that little puppy sleeping next to me because I just wanted to end my life, and I thought of doing all sorts of things like going out to a motel and doing it in a motel and leaving a message for someone to go and get the dog out of the house and all this sort of stuff.
But I just couldn’t bring myself ever to do it when the dog was there. So, so it was very smart thinking from my doctor and it worked a real treat, yeah.
Last reviewed January 2016.
Last updated January 2016.
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