December 1, 2014 Dr. Jan Resnick

The Last Word

A Comment Article in the last Psychotherapy in Australia journal
My last Comment article is about the shrinking, declining state of the Psychotherapy profession in Australia. But first, a brief word of acknowledgement.

Liz Sheean has done more for the Psychotherapy profession here than any other single person I can think of, and I doff my cap and bow in deep respect, appreciation and gratitude. There has been no other forum for unification, networking and communication better than this journal, the conferences and regular trainings held in capital cities across the country and the bookshop. It is our principle source of a national professional identity for Psychotherapy. And I have witnessed the journal grow and improve in quality over its 20 year life-time. Please join me in giving Liz a standing ovation, she deserves it.

It is nothing short of tragic to lose the Journal especially at this time when Psychotherapy is under attack.

We live in a bizarre world. Every profession recognized in legislation as a health-care provider is GST-exempt, from Homeopaths and Masseuses (and I mean no disrespect) to Social Workers, Occupational Therapists, Doctors, Psychologists, and Psychiatrists. But Psychotherapists and Counsellors are somehow omitted. It is unbelievably discriminatory for the playing field to be so off-kilter such that we have to collect 10% of our fees for the government who use it to subsidize Psychologists and other mental health practices, against us. Talk about uncompetitive practices!

Meanwhile, the Psychology profession has mastered spin and branded themselves: ‘evidence-based’ – it’s primary marketing slogan. A radio ad just aired urges us to learn how to re-wire people’s brains by studying Psychology at uni. Meanwhile, my practice is largely filled with patients who have not benefitted from CBT or other government-endorsed psychological practices. This is a constant theme and a distressing one. The Psychology profession is operating more like a powerful corporation that serves its own share-holders or stake-holders even at the expense of its own clients.

Much as I like mindfulness, there is a lot more to therapy than inviting people to be in the present, or meditate accordingly.

As an experiment, I searched for an appointment with a Psychotherapist locally on Health Engine: I was offered a choice of 6 Psychologists, 5 Counsellors, 1 Social Worker, 3 GPs or 10 Psychiatrists. Practically none have had what I would call a full Psychotherapy training or identify primarily as a Psychotherapist. The title “Psychotherapy” is not protected and is now borrowed by other professions. We are a stolen generation of Psychotherapists who are losing the professional identification that differentiates and distinguishes us.

Health Funds are obviously businesses that do their best to avoid paying rebates. I have had a Medibank Private provider-number thanks to PACFA since July, 2012, and not one single patient in my full-time practice has succeeded in claiming a rebate, ever. In fact, it has been a fiasco, pissed-off patients – many of whom stopped coming as a clear result. I am doubtful of the value of getting into bed with Health Funds anyway but their support of other practices makes ours more uncompetitive.

I do realize that many people in our professional associations have worked tirelessly to support the professions of Psychotherapy and Counselling. I acknowledge this. However, it has increasingly become a major hassle and expense to fulfil professional development requirements that do not serve me well, or at all. The associations have become adept at making submissions and doing research while becoming more bureaucratic and pedantic about our requirements. We need direct support, not more rules and requirements that don’t actually serve us well. THIS DOES NOT MAKE PSYCHOTHERAPY MORE CREDIBLE TO ANYONE – rather it drives members away.

Meeting requirements has taken time and resources away from my practice. Of course, I agree with PD and supervision, but I refuse to attend things just to accumulate numbers of hours to fulfil requirements, as I see so many colleagues doing.

I am bitterly disappointed with the decision not to challenge the GST legislation. I do understand the legislation leaves us no way in to challenge it, as written. I’ve studied it myself. BUT the fact that we are discriminated against in such an obvious way by an utterly uncompetitive and prejudicial policy is reason-enough to mount a challenge on those grounds. And this is precisely what we need an association for. A successful challenge here would benefit our practices directly, more than all the studies and submissions rolled up together.

Meanwhile, I am aware of many who are leaving the profession or opting to obtain further qualifications in Psychology, Social Work or Mental Health not out of genuine interest but as a failsafe to fortify their position as a viable professional.

So, what are we going to do about it? Are we going to just dwindle away until we die, and hope something is re-born from the ashes??? Or are we going to stand up and be counted as serious, competent and effective professionals (and make a living from our work!) in our own right???

This is what I’m doing about it.

Psychology identifies as a short-term “problem-solving” approach. But complex trauma survivors need neither a solution to a problem (which trivializes it) nor a short-term approach. Complex trauma requires long-term, in-depth Psychotherapy in the way that many of us have been trained. And complex trauma survivors also urgently need to be treated by professionals who have had a significant and thorough experience of their own personal therapy, as Psychotherapy training requires.

One of the strongest endorsements in recent times for Psychotherapy has been the publication and wide distribution of ASCA’s important manual The Last Frontier, subtitled Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care. Read it. Go to (if you get the Australian Shepherd Club of America – that’s not it!!). If you go from the Home Page to Resources and then Publications, you can download it for free or buy a hard copy. Of great importance to Psychotherapists is the emphasis on a longer and deeper, and more sensitive approaches to complex trauma, than Psychologists are typically trained to deliver. Trauma Informed Care reflects “practice-based evidence” more than “evidence-based practice” and brings better outcomes.

Based on my own practice-based evidence of nearly 40 years, about 80% of patients have suffered complex trauma, and some don’t even know it! This is where our training and experience affords value to patients especially if we take on board the necessary revisions to traditional insight-based practice, namely the primacy of the body and physical experience generally. And there are now many excellent texts that develop this theme, Ogden & Co, van der Kolk, Levine, Rothschild, Briere, Shore, Shapiro, Atkinson, Courtois & Ford, etc. And guess what? The Last Frontier has condensed and summarized much of it, done your homework for you.

One of the most important points is this: ONE SIZE DOES NOT FIT ALL.

Psychotherapy is an improvisational art whereas Psychology is focussed on generalities. Yes, there are ways that we are all the same, and Psychology works accordingly through its highly standardized methodologies. Psychotherapy is the science and practice of individual differences; it is scientific in the sense of a systematic body of knowledge. But even if you had read every Psychotherapy text ever written, you wouldn’t necessarily know exactly what to do when the next new patient walked through your door. You might know what not to do.

This is because we HAVE TO get to know each patient as a unique individual and we HAVE TO get to know how our patient is different each and every time s/he comes for a session. Our practice fits our patients, as they are, at that time. Psychotherapy does not require patients to fit our practice other than the standard professional frame. Psychologists already know what they will do before the patient arrives. (Personally, I’m allergic to questionaires.) This is not best practice for complex trauma (nor quite a lot else, in my opinion).

So, I am developing my work around complex trauma and its post-traumatic consequences and supervising others, including two firms of lawyers working with trauma survivors. I am supervising Developmental Paediatricians who work with trauma, of both children and their parents, and of course, autism, ADHD, and specifically developmental issues. And I am supervising Psychiatrists and Registrars (in Psychotherapy) who are also at the coalface of treating the most disturbed patients. There is much interest in the new Complex Trauma Network, part of the Mental Health Professionals Network, also an ASCA initiative, in part. And maybe, just maybe, Psychologists and Psychotherapists can realize that we could learn a good deal from each other, if we can survive in the most adverse professional climate I have ever known.

So, my advice after 20 years of Comment articles is: adjust your focus, take responsibility for your own professional destiny (because no one else is) and position yourselves to make a difference where you can.

And I wish you all GOOD LUCK! (It’s a jungle out there). This is my last word: THANK YOU, LIZ! And thank YOU ! – as readers must a writer make.