Depression and recovery in Australia
Talking therapies
In Australia, a variety of therapists provide a range of counselling and talking therapies. These include Cognitive Behavioural Therapy (CBT), psychodynamic therapy, humanistic therapy, interpersonal therapy and mindfulness-based therapy. Information about different approaches is available on the internet, or through health professionals. Talking therapy is also referred to as talking treatment, counselling, psychological therapy or treatment, or psychotherapy. For simplicity, we refer to these approaches as 'talking therapies’.
Talking therapies can help people distressed by difficult events in their lives as well as people with mental health problems. Talking therapies aim to help people function better and improve their wellbeing, and usually involve one-on-one interaction between a patient and a therapist over a period of time. Talking therapies can be expensive if they continue over the longer term. This is despite the Australian government's 'Better Outcomes in Mental Health Care' and 'Better Access to Psychiatrists, Psychologists and General Practitioners' initiatives that subsidises up to 10 counselling sessions with a clinical psychologist, as a part of a mental health plan developed in partnership between the patient and their GP or psychiatrist (see 'Experiences with Psychiatrists, Psychologists and other Counsellors').
Most people we talked with used some form of talking therapy to work through their depression. They tended not to talk about a specific therapy, but more generally about ‘counselling’ and about what they saw as beneficial or unhelpful.
A few people who tried different talking therapies compared the benefits of each approach. CBT and mindfulness were the approaches most commonly mentioned. CBT was described as assisting people to react differently to their thoughts and feelings, challenge negative thoughts, and change their behaviour. Mindfulness-based therapies (combining talking therapies and meditation) were said to help some people reduce stress, and assisted them in making some changes to their behaviour.
The majority of people who were positive about talking therapy stressed the benefits of being able to talk about their problems in a safe environment, developing a better understanding of the sources of their problems, and learning how to think about their problems differently.
For some people counselling was challenging when they were pushed to look deeper into their own, sometimes confronting experiences in order to work on resolving their problems. Paul said that initially he did not see the benefits of ‘opening wounds’, but as counselling progressed with a trusted and caring therapist, he was able to address the consequences of a traumatic childhood experience. Jane found working through experiences contributing to her distress helpful.
Jane found counselling helpful for dealing with issues from her past and addressing relationship...
Jane found counselling helpful for dealing with issues from her past and addressing relationship...
SHOW TEXT VERSION
PRINT TRANSCRIPT
It was basically, basically talking therapy. So a lot of it was to do with my parents' divorce when I was quite young and it seemed to stem from the relationship, or lack thereof, I had with my father. So when I went and found a, a counsellor, and she wasn't a psychologist she was a counsellor but she came very highly recommended, she had me talking about how I felt and journaling and doing the - you know, talking to the chair and writing letters and doing all those sorts of sort of therapeutic I guess practices.
And I saw her for about three months, about 12 sessions, and that seemed to help me get it under control. So she also worked with me on my breathing. So we didn't do any cognitive behaviour therapy, which I’d done like, I did that later on, so I didn’t do, it wasn't that. It was more getting out what appeared to be the issue and it really helped.
Most people we talked with reported using a combination of treatments for their depression - usually medication and counselling, along with other complementary treatments and activities. Those who were the most positive about counselling and used this form of treatment over long periods of time tended to be people who refused to take medication for their depression or were sceptical about its effectiveness following negative experiences of side effects.
Millaa described why he went down 'the therapy route', while acknowledging that for other people...
Millaa described why he went down 'the therapy route', while acknowledging that for other people...
SHOW TEXT VERSION
PRINT TRANSCRIPT
For me, I've done, done more of the therapy route because I find that that route works better for me because I don't like drugs, like I said. But some people would do the opposite, they like drugs more because it's easier I guess, maybe. And they don't like the ther-, therapy as much because perhaps they don't like to talk about what's making them depressed or anxious. But for me, I like to talk about it, 'cause I think, like I said, it can only help. I think you can only really, you can only really help yourself if you can face your own insecurities and depression.
Some people resorted to counselling every time they needed to resolve specific issues and developed long-term therapeutic relationships with counsellors they felt comfortable approaching.
Belinda felt medication was not going to work for her. Her GP suggested counselling and she found...
Belinda felt medication was not going to work for her. Her GP suggested counselling and she found...
SHOW TEXT VERSION
PRINT TRANSCRIPT
I want something that’s going to that is not going to be medication that is going to help me get through this and so she suggested that I see a psychologist. So I saw a psychologist, let me think, I probably started seeing the psychologist earlier, so maybe in 1999 or 2000 and I felt that I could, I felt really greatly assisted by the psychologist rather than medication.
So I think the last time I had, what I would call a bit of a bout of the sads or you know not feeling great about the world, was about maybe six months ago, maybe a bit more. It didn’t last for too long, it was, and it was about a particular event and I knew it was about an event. So I just worked quite hard with my counsellor to sort of sort out what I really felt about this particular issue and, yeah, I am feeling pretty good about it.
A few people considered counselling a ‘middle class luxury’, an indulgence they rarely had time for. In contrast, after experiencing this form of therapy, many found that having the space to talk about themselves, their feelings and their thoughts was very helpful. For most people in therapy, trusting and feeling cared for by their therapist was critical for the therapy to be considered useful. In some instances, counsellors supported people by encouraging them to bring their partners and providing an environment where relationship problems could be openly acknowledged and discussed.
Emma talked about what she liked about counselling, including her counsellor's efforts to involve...
Emma talked about what she liked about counselling, including her counsellor's efforts to involve...
SHOW TEXT VERSION
PRINT TRANSCRIPT
And, I'd never been to a counsellor ever before anyway and it's quite a luxury to sit in front of someone for an hour and not have the guilt feeling that you're like I am now - overtaking the conversation [laughs]. Where you're, you know, you're pumped - you do all the talking. It's, it's quite a therapeutic thing in itself, I think, to be able to discuss yourself for an hour. So I'd never tried counselling before so I, I guess that was also, a positive aspect of it. But, uh, what did she do? She, she sort of let you, I mean I guess counsellors do, they let you talk and they just guide you, guide you along the path that they see is to be the most relevant and most pressing issue you've got.
And she also saw me with [husband] because I, I requested that [husband] comes along and she was very open to that. Because she said it's a whole family thing that needs to get through this and I thought that was helpful. Um…
He was fine. He's not a typical bloke in that sense, [husband]. He'll, he'll - maybe he's under the thumb but he'll go to these things if I want him to. But, I, I mean he's hurt me a few times with the postnatal depression. Because he made a joke when he first walked in there about something and I - because that's our relationship. We're quite, quite light hearted people normally and I, that just showed to me - and [counsellor] actually said it. She, she said it just shows you haven't actually come to terms with the seriousness of this, that you don't joke about this about to Emma at the moment. She's, she's living through it and it still, it still - you can see in my face it still hurts me today.
So also, so, so I guess that's the other thing when I found [counsellor] and she was very warm and caring and you felt like she really cared. That, the other thing that [counsellor] kept saying and I, it was like a mantra in my head - you will get better. You will go, you will get through this. The thing about depression as opposed to postnatal depression is that you get through it. It, it's not with you forever. You may have relapses in depression or what have you but because it's postnatal depression you will get through this. And I can remember lying at night, I can remember running and that was my mantra on my foot hitting the, the pavement. I will get through this, I will get through this.
The length of therapy varied depending on people's individual needs. Some people returned to counselling after unresolved issues reappeared, or when life circumstances beyond their control caused them repeated distress. Some people had just a few sessions. Others saw a therapist a few times a week for several years. Kim Haj described how counselling helped her to make choices and to help herself. She also advocated for greater availability of counselling to people from other ethno-cultural backgrounds. She questioned the stereotype that people from non-Western backgrounds keep their problems within the family, and emphasised the importance of everyone having the same support options available to them regardless of their background.
Kim Hai preferred counselling over antidepressants and discussed why she thought counselling...
Kim Hai preferred counselling over antidepressants and discussed why she thought counselling...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Ah, I could - I'm prone to be depressed again, I would say, with my current situation. I would probably be - never be able to use antidepressant, I don’t know. I would just resort to counselling. In a way, like counselling is not the advice, it's to me like brainstorming so that I can make choices and help myself more or less. I feel supported by counselling.
Ah, I think counselling helped, yes. I firmly believe in my case counselling helped. In Vietnam, like my father had the psychiatrist treating him when he had the episode of nervous breakdown. It was never counselling, it was just a drug treatment and lucky dad got out of it.
Anyway, here I think the mainstream counselling is something very alien to Vietnamese people. It's never in our culture because we don't have psychologists, we just don't have it. And talking to friends and family seem to be the best thing, the closest thing, to counselling in our culture. But talking to friends and family has a drawback as well, because like myself I don't want to burden them. There are some secrets you don't really want them to hear. It could become gossip. They can talk to someone else. There's no confidentiality there. It's not assured.
Ah, friends is better than families or relatives but sometime you just don't have that friend that's close enough to bear your burden or to keep confidential for you. Ah, to me, the counselling here is the best for me, because it has all that you know good thing without all the bad things, as friends and relatives and community. Ah, through my little experience with other Vietnamese people who are depressed, they never want to talk to friends or family. They don't access counselling.
Some of them go on antidepressant. It's a quick fix thing. It is very effective. If they got through and they're compatible with the drugs, many of them have been helped. they don't have much access to counselling because of the language barrier. They don’t get that option in the mainstream.
It's not against the culture, I don't think so. There's an urge to tell someone, to talk with someone. We all agree that it's good that you can talk things out.
Another woman from a migrant background, Akello, described counselling she received in her African country of origin. She appreciated the benefits of revisiting past experiences that she believed had caused her depression and working towards resolving the issues that these experiences had led to. As a consequence of this positive experience, she sought counselling in Australia which she again found very beneficial.
Akello's first experience with counselling in her country of origin in Africa encouraged her to...
Akello's first experience with counselling in her country of origin in Africa encouraged her to...
SHOW TEXT VERSION
PRINT TRANSCRIPT
So I went - at the time I was so religious. I belonged to a Pentecostal church and I went and sought help from them and I saw a counsellor who luckily for me wasn’t as religious as I was at that time and she did pray for me, but she didn’t look at it like a church - church people look at it. Church people – at the church I went to - were the sort of people who would say to you, oh no, this is the work of the devil. Should pray for you. Stop accepting this you’re a child of God. Stop accepting this. Stop letting the devil attack you. All sorts of things.
So instead they, of treating - they didn’t look at it as a medical problem. They looked at it more like something between God and evil, so I saw the counsellor at the time and I remember what she told me - she said to me, from the time you’re a little girl, you’re not unwell, you’re unwell. So she said - she didn’t say I was unwell, but she said, these problems have come from many years ago, she said to me, and she said you have to go back into those times and get rid of those things that hurt you. If need be, talk to the people who have hurt you and get rid of that excess baggage.
A couple of people went to counselling to address relationship, grief, anxiety and other mental health issues. This enabled them to acknowledge that they were experiencing depression as well, and motivated them to seek help.
Initially Stewart went to his counsellor for separation anxiety and bereavement but as time went...
Initially Stewart went to his counsellor for separation anxiety and bereavement but as time went...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well hers was a lot about cognitive thinking and because we, initially we were talking about the separation anxiety and then grieving my sister's death and all of that. And so it was along the cognitive thinking sort of lines, but you know using tools within your own mind to change the way you think about stuff. And, you know, to, to better understand situations so that you can cope with them and understand why you think certain ways and then be able to change that thinking consciously, you know. So she gave me a lot of reading on cognitive thinking and that sort of thing as well, which I just find interesting anyway. So yes I was, was more than happy to take that on board. So that that was very much the approach.
But you know again in hindsight I think probably, you know, if I had maybe seven or eight sessions with her I suspect that after probably four or five she was starting to think, you know, there might be something else going on here. So ultimately when I went to the, when she got me to go to the GP, you know, we sort of, it was, I guess the sessions after that became more about the depression and managing that and how I was feeling about being on the medication. And how was the feeling about myself in light of the fact that I'd been diagnosed and all those sorts of things, so.
Others appreciated counsellors who worked with them at their own pace and let them address their own issues when they felt ready to do so. Kymberly appreciated the skills she gained through counselling but still emphasised that she was the only one who could make real changes in her life; that counselling could only help her get part of the way.
Kymberly was initially reluctant to engage with talking therapy, but she found it very valuable...
Kymberly was initially reluctant to engage with talking therapy, but she found it very valuable...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well I found it, as reluctant as I was, I found it incredibly valuable. I recommend it highly. Even just, like I said, just for those practical things that you can't get your head around, not, not necessarily your emotional state. But, you know, she, she taught, she taught me this thing, you know, she said, you know, we'll put some boxes up on a shelf Kym - an imaginary shelf, you know? Your family is in one big box, your job is another big box, your lifestyle’s in another big box. And we sort of categorised all the things that you have to take care of in your life. She said, how many of these big archive boxes can you get down off the shelf at a time? And I said, oh only one. She said, exactly, deal with one thing at a time. Let's look at your, let’s look at your relationship with your husband. Let’s deal with that right now and then we'll get another box down off the shelf.
After all, I've made all the changes in my life. I've moved out, I've, I've separated, I've re-established my relationship with my children. We've established our, our custody arrangements et cetera and I want to talk to her about where I'm at right now and about moving forward from here and what I need to do to continue to move forward. So, I've come to another, I'm, I'm, I'm making my own decisions and I'm, I'm happy about them but I, I think [psychologist] would be valuable to speak to - to, to help me keep moving forward.
Some people found that counselling was useful for a certain period of time only. Alice described stopping counselling after ten years as she had stopped finding it challenging. She also felt her problems were constantly being revisited without much resolution.
Alice went to counselling for many years, but never found an approach that really worked, and...
Alice went to counselling for many years, but never found an approach that really worked, and...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Everyone says go to counselling, you know, I did, I did ten years of counselling to the point where a counsellor once said it was enjoyable counselling me because he found it challenging because I was teaching him something. So that’s the day I decided counselling wasn’t challenging me and it was time to go now, so I’m, I don’t do that, but ten years, I gave it a fair shot. Ah, but you get tired saying the same thing over and over again, you know, it’s not in the viewing of it necessarily that helps, it’s, there’s got to be something that can shift... your patterns and you know that people would say, ‘Oh, and have you tried cognitive behavioural...?’, ‘Yes, yes, I have’, ‘Have you tried...?’, ‘Yes, yes I have’. You know? And it was just frustrating me that nothing would work. So I thought, well that’s it, you know, nothing will work, I’ll go on that premise.
Another woman talked about people needing to prepare for a specific form of counselling; otherwise it would not work for them.
Last reviewed January 2016.
Last updated January 2016.
Copyright © 2024 University of Oxford. All rights reserved.