This post has been written with neurodivergent individuals in mind and therefore includes sections that are short, bullet pointed, and examples for practicality of writing, for a thorough understanding.
As per usual, a lot of this comes from personal experience, those of the people surrounding me in my life, common mistakes I’ve seen in media portrayals, as well as first year university study of a Bachelors in psychology. A mental health professional has also proofread this post. I will not be disclosing the therapies I’ve done, my specific experiences, or diagnoses, but take this subject on broadly, combining my own experience and those of loved ones and friends around me, along with those spoken of in communities such as queer or neurodivergent spaces.
Note: I use “client” and “patient” in this post based on the role of the professional being discussed. Patients are a term for those seeing medical professionals for diagnosis and/ or treatment, while a client is merely someone seeking a professional, outside of the medical field.
In Australia we have three main levels of “therapist”, with the term therapist itself being a catch-all term carried across from American media most of the time. This post is set out in order of experience and capabilities, from counsellors, to psychologists, and finally psychiatrists, followed by some general things to keep in mind for accuracy of portrayals.
Counsellors
Counsellors focus on general mental wellbeing, suited best to people who need someone to talk to or are struggling with issues such as life stress, work conflict or balance, relationship strengthening, communication skills, parenting balance, and other such low-level care.
There is no law in Australia that sets out minimum standards for practising as a counsellor, either in qualifications or experience. Anyone can become a counsellor with as little as a 12 month Diploma of Counselling if they want to join the Australian Counselling Association, and sometimes even just a Certificate or short community course.
Fast facts that can help your writing:
According to the Australian Institute of Professional Counsellors, 77% of Australia’s counsellors are women. Therefore, if a character you’re writing has trauma centred around female figures, this may present an accessibility challenge for your character, including longer wait times for appointments or travel barriers depending where they live.
People who run support groups around Australia are often trained as, or in the process of completing qualifications to become, a counsellor.
Counsellors cannot diagnose or prescribe medications, and it’s doubtful that they can even recommend to a qualified doctor their opinions on medication or diagnosis.
Counsellors don’t require a referral unless a client is seeking Medicare rebate for the service, some of which are covered, as it’s seen as a sort of first line of defence against more serious/ exacerbating mental health concerns.
A counsellor is for talking, general advice, and understanding, first and foremost, and should never suggest diagnoses, tell someone what they need, or explain what’s happening in someone’s head. Rather, they can only ask guided questions and lead clients to self-realised understanding.
Due to the varying standards of admission and lack of regulation, counsellors can be a mixed bag of skills, and may not have undergone sufficient training to know how to avoid their own personal issues influencing their work
For similar reasons, this role can draw in people who want an ego boost and to look good in society (though this can be said for all psychiatric roles, counselling is simply the easiest of these roles for one to enter), such as people with their own issues like narcissism and histories of manipulation, although the majority do want to genuinely help others. This makes for a believable potential antagonist to your story!
Psychologists
Psychologists in Australia go through a minimum of six years of specialised education and training, which includes study, practical training, and supervised experience. After this they can specialise further with additional university-level training. Psychologists have a stringent code of ethics with which they must comply, their registration with the Psychology Board of Australia is renewed annually, and may be audited randomly.
Psychologists are not medically trained, rather they specialise in thinking, emotions, and behaviour, and are qualified to diagnose under those areas, without broader medical knowledge. They cannot prescribe medication, however, due to not having adequate medical training to balance multiple medications, current diagnoses, and physical ailments alongside whatever they wish to prescribe.
Fast facts that can help your writing:
Their titles tend to include a string of acronyms after them which are a protected shorthand used in Australia to identify their qualifications and can help narrow down who would be a good fit for someone seeking a psychologist, based on any specialised qualifications a professional has.
Some will be hesitant to diagnose as, practically, it can at times cause more barriers to help than actually aid someone, based on society’s biases and stigmas attached to certain diagnoses, as well as things like the career a patient is in.
A huge misrepresentation seen often in media is immediate diagnosis – keep in mind that unless the psychologist understands a patient’s medical history, previous and current diagnoses, medication history, lifestyle, and other factors, they cannot and will not diagnose on a first appointment.
A first appointment will often follow a specific layout of paperwork (both legal and information gathering), running through the new patient’s history, running through the reason they’re there, and expectations a patient has for seeing the psychologist. For this reason, first sessions can sometimes be longer and may also be more expensive.
Medicare allows for 6 free sessions per calendar year to see a psychologist under a current Mental Health Treatment Plan completed through a General Practitioner (GP), and can be extended to 10 for the year upon review after those first 6, making it decently accessible.
Specialty fields and community aid does exist for Indigenous peoples, veterans, people with chronic illness, gender diverse individuals, etc., which is great for accessibility, however some areas are more limited than others.
Depending on when your story takes place, availability can be rough to navigate, especially since Covid-19, and wait times can start at 6 months, or some clinics may simply never reply to a referral. As an alternative, a character may access counselling supports, hotlines, or see a more general psychologist while waiting to be seen by someone from their minority community, or even a provisional psychologist still studying while practising under a supervisor, which is also cheaper.
Psychiatrists
Psychiatrists have a medical degree on top of the psychology qualifications of a psychologist. Their study pathway begins with the medical degree, followed by practical on-the-job training, then onto a further 5 years of specialist psychiatry training through RANZCP (the Royal Australian and New Zealand College of Psychiatrists).
They not only assess and diagnose patients, but due to their medical training are able to prescribe medications, monitor as a GP or other medical specialist would, tweak dosage, and admit to private hospitals they have admitting rights at and practise with.
Due to their experience, level of training, qualifications, and lifetime dedication to the specialty, psychiatrists are more expensive than psychologists, and often see patients with complex cases and trauma histories, with diagnoses on top. They do practice talk therapies on top, and will often try different routes beyond the go-to CBT (Cognitive Behavioural Therapy, the talk therapy often portrayed in media), to supplement medication.
Once a patient is stable with medications and the intense therapies have concluded and a patient’s life becomes more bearable, they may then advise a psychologist to continue regular care at a more cost friendly level. Essentially, psychiatrists set patients up with stable medication, diagnoses for accessing aid, practises a patient can continue independently, sometimes separate specialists are referred, and then the patient can downgrade from there with the tools at hand, and may return at any time. Complex cases may continue seeing a psychiatrist regularly, however, where a more specialised approach is necessary or if they have life-altering diagnoses such as Dissociative Identity Disorder which are likely to fluctuate more frequently than something like Major Depressive Disorder.
Fast facts that can help your writing:
The string of acronyms in a psychiatrists title will likely be even more convoluted looking than a psychologist, as they will be longer due to the numerous qualifications they hold, and will always include MD for Medical Doctor, and likely FRANZCP (Fellowship of RANZCP).
As with psychologists (above), psychiatrists will not and should not diagnose or prescribe medication on a first appointment until all background medical history is known to them. They may be equally hesitant to diagnose for the same reasons also mentioned above, as their job is to help not hinder patients’ access to help.
A first appointment will follow a structure similar to that of psychologists (above) and will also cost more and sometimes go for longer than a standard appointment.
Availability can be a barrier due to the more specialised education and qualifications required, and members of minority groups may struggle to find someone appropriate whom they not only “click” with in a professional relationship, but can understand the extent of their struggles with regards to specific minority struggles.
There is also a sense of superiority in the medical industry where practicing doctors look down on the specialty of psychiatry and will often refuse to diagnose or refer a parient to see a specialist for psychiatric help.
General advice for writing
The majority of talk therapy is about listening to the patient, asking guiding questions, and clarifying a patient’s understanding, not throwing information at patients.
“How does that make you feel?” has become a common joke when it comes to portraying or implying someone’s position as a counsellor or psychologist, but examinations tend to focus more on breaking down the “why” of it and unpacking reactions, than simply learning what the person felt in certain situations. A more accurate question might be “How have you reacted to that, both in the moment and since then?”
A professional in this field should not be touching their patient or client, in almost any circumstance. Too many times I read a hug exchanged or holding hands, and this is a red flag in the industry. Appropriate reactions might be to pass a tissue or offer a tissue box, offer a cup of water, depending on the patient's state maybe take them through some guided breathing. Many times the professional won't even be sitting close enough for touch to happen. A psychologist or psychiatrist is not there for comfort, but to guide and listen. And no, when Olivia Benson in SVU's psychologist gifted her a necklace I was not okay and did shout at the screen for her to leave immediately.
Medications are rarely a perfect fit the first try. It takes on average 6-8 weeks to see the full effect of a medication, especially those prescribed in psychiatry, which means playing the long game of seeing through any side-effects, not pulling out too soon, and being strictly consistent with when it’s taken. Only after around 8-10 weeks will a psychiatrist likely conclude if a medication is working or not for an individual, and then it’s a matter of weaning off based on the recommendations of the company who manufacture the drug, and a period of a week or two to reach the patient’s baseline “normal” again before another can be tried. Finding the right medication can take months to years, and this cannot be stressed enough!
Finally, personality clashes do happen, and most professionals will tell you they’d rather know if patients don’t feel it’s working, and switching because the relationship didn’t “click” is more normal than most media portrayals will have us believe. Many people try a few psychologists before settling on one they can open up fully with, and this sort of accuracy being shown in writing can be super validating to readers!
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