Up Front by Emma Hart


Professional Counsel

by Kyle MacDonald

It works: End of story. 

I often think, it’s a strange job, being a therapist.  From a certain point of view all I do is have conversations with people.  I also often feel deeply privileged.  Just like the stories courageously told here, I get trusted with some of the most intimate details of people's lives in the hope that talking might help.  But it is a very particular type of conversation, which I and my colleagues trained many years to be able to have. 

And actually it’s no mystery.  

What is a mystery is how a Chief Medical Director at one of the nations largest insurance companies, Sovereign, can remove cover for counselling and therapy from their policies, on the basis their isn’t really any evidence it works.  This is a bold statement especially when they are happy to keep funding medication, which they claim does “work.”  

The American Psychological Association (APA) in the USA made one of its strongest statements to date last year, in a release titled “Research Shows Psychotherapy Is Effective But Underutilized. 

“While medication is appropriate in some instances, research shows that a combination of medication and psychotherapy is often most effective in treating depression and anxiety. It should also be noted that the effects produced by psychotherapy, including those for different age groups and across a spectrum of mental and physical health disorders, are often comparable to or better than the effects produced by drug treatments for the same disorders without the potential for harmful side effects that drugs often carry.”

Furthermore, the frontline medication treatment of SSRIs or “Selective Serotonin Inhibitors” are currently at best questionably effective for mild to moderate depression. 

This isn’t new information.  The National Institute for Clinical Excellence (the beautifully acronym-ed “NICE”) have said since 2005 that the frontline treatment for mild to moderate depression should be psychotherapy 

So let’s be clear; this isn’t an ideological or even a political argument.  Therapy and counselling are not some wacky alternative treatment that should be a luxury for those who can afford it, or “believe in it”.  Belief has very little to do with it. 

But money does.  Frontline generic SSRIs costs less than twenty cents a day.  Therapy comparably can cost between $80 to $150 per session. 

Doing nothing also costs nothing, but it would be hard for even Sovereign to argue that is a treatment option.  

But no surprise the National Government has. 

The review of the Family Court is poised to remove all funding for couples counselling, a service that anecdotally was highly effective (and empirically supported), however Judith Collins sees no evidence it works and WINZ are also reportedly tightening up the access of funding via disability top ups for counselling costs. 

So while it is now OK for us to talk about mental health and even for All Blacks to be depressed, as a nation we can no longer afford to help. 

That’s not depressing.  It’s heartless.


Kyle MacDonald is a psychotherapist and blogger at www.psychotherapy.org.nz.  He is a regular contributor to the Wallace Chapman Sunday morning show on Radio Live and Chair of Public Issues for the New Zealand Association of Psychotherapists.

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