Commonly asked questions
Evidence based therapy is different from counselling because it involves the use of particular techniques, strategies and processes that are specifically designed to help people deal with the issues and concerns that may be affecting them emotionally or mentally. These techniques and strategies have been evaluated in a scientific manner.
Posttraumatic Stress Disorder (PTSD) is a mental health problem that can develop following traumatic experiences (such as threatened or actual – death, serious accident or sexual violation).
This might include directly experiencing a traumatic event; seeing this happen to someone else; learning about an actual or threatened traumatic death of a close friend or relative; or repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse.
Distressing memories, feeling on edge or have trouble sleeping after this type of event is normal. Initially it may be hard to resume normal daily activities without these experiences interfering. However, most people start to feel better after a few weeks or months. If however, several months later someone is still experiencing these symptoms, it is possible that they have PTSD. The symptoms of PTSD however can also have a delayed onset, and they may ebb and flow over time depending upon other life events and circumstances.
How many people live with PTSD?
In Australia, the percentage of people affected by PTSD in any one year is 6.4% (1.47 million people). The lifetime percentage is 12.2%. 1
What factors affect who develops PTSD?
PTSD can happen to anyone. It is not a sign of weakness. The factors that increase the chance that someone will develop PTSD are complex and often not under that person’s control, and may be related to features of the trauma itself. For example, traumatic events that are intense and last for longer make it more likely that a person will devleop PTSD, as does sustaining a physical injury.2, 3 PTSD is also more prevalent after certain types of trauma, like combat and sexual assault4.
Personal factors, such as previous traumatic exposure and gender5 can also affect whether or not a person will develop PTSD. What happens in the aftermath of traumatic events also matters, and stress can increase the likelihood of PTSD4, while social support provide a buffer6.
What are the symptoms of PTSD?
The symptoms of PTSD may occur soon after a traumatic event, or they may not appear until months or even years later. The symptoms may also come and go over many years. If the symptoms are present for more than four weeks and cause the person distress, or interfere with work or home life, it is worth consulting a psychologist to determine if the person has PTSD.
PTSD is a treatable condition, you do not have to live with a high level of symptomatology.
There are four types of symptoms of PTSD, but it is important to note that the relative mix of each symptom type varies between individuals.
(i) Re-experiencing or Intrusive Symptoms. This is repeatedly re-living the traumatic event. This can include frightening memories or nightmares. Sometime people feel as though they are experiencing the traumatic event again. This is called a flashback.
(ii) Avoiding situations, people and places that remind the person of the event. People with PTSD often try and control their feelings by avoiding things that might trigger memories of the traumatic event. People with PTSD may even avoid talking or thinking about the event.
(iii) Negative beliefs and feelings. Trauma affects the way a person thinks about themselves and the world in a negative way. People with PTSD experience more pronounced negative beliefs and feelings. Intense feelings of guilt and shame are common. After a traumatic event the world can suddenly seem dangerous and others untrustworthy. People often describe feeling numb, and can find it hard to feel happy, or simply lose interest in activities they used to enjoy.
(iv) Hyper-arousal (feeling worked up or agitated). People suffering from PTSD often describe feeling alert and constantly on the lookout for danger. Hyper-arousal can be associated with outbursts of anger or irritability, startling easily, or acting in impulsive or reckless ways (such as spending too much money, using alcohol and other drugs, or reckless driving) (7). High levels of arousal also tends to interfere with sleep and concentration.
What other problems do people with PTSD often experience?
People with PTSD may also have other difficulties. These can include:
- Feelings of hopelessness, shame, or despair
- Depression or anxiety
- Drinking or other drug problems
- Physical symptoms or chronic pain
- Employment related concerns
- Relationship difficulties
1. Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results,2007 (4326.0). Canberra: Australian Bureau of Statistics
2. Johansen, V. A., Wahl, A. K., Eilertsen, D. E., & Weisaeth, L. (2007). Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. A longitudinal study. Soc Psychiatry Psychiatr Epidemiol, 42(7), 583-593. doi: 10.1007/s00127-007-0205-0
3. Lin, K.-H., Shiao, J., Guo, N.-W., Liao, S.-C., Kuo, C.-Y., Hu, P.-Y., . . . Guo, Y. (2014). Long-Term Psychological Outcome of Workers After Occupational Injury: Prevalence and Risk Factors. Journal of Occupational Rehabilitation, 24(1), 1-10.
4. Simon, R. I. (1999). Chronic posttraumatic stress disorder: A review and checklist of factors influencing prognosis. Harvard Review of Psychiatry, 6(6), 304-312. doi: 10.3109/10673229909017208
5. Christiansen, D. M., & Hansen, M. (2015). Accounting for sex differences in PTSD: A multi-variable mediation model. European Journal of Psychotraumatology, 6, 1-10. doi: 10.3402/ejpt.v6.26068
6. Koenen, K. C., Stellman, J. M., Stellman, S. D., & Sommer, J. F., Jr. (2003). Risk Factors for Course of Posttraumatic Stress Disorder Among Vietnam Veterans: A 14-Year Follow-Up of American Legionnaires. Journal of Consulting and Clinical Psychology, 71(6), 980-986. doi: 10.1037/0022-006X.71.6.980
7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Cognitive Processing Therapy for PTSD
What is Cognitive Processing Therapy?
Cognitive Processing Therapy (CPT) is a cognitive-behavioural treatment for Posttraumatic Stress Disorder (PTSD) which was developed in the late 1980s. It has been shown to be effective in reducing PTSD symptoms related to a variety of traumatic events including child abuse, combat, rape and natural disasters. CPT is endorsed by the U.S. Departments of Veterans Affairs and Defence, as well as the International Society of Traumatic Stress Studies, as a best practice for the treatment of PTSD.
Cognitive Processing Therapy recognises that that it is normal for people to have psychological reactions to traumatic events, over time these reactions generally resolve without intervention. In the CPT model, PTSD occurs when something gets in the way of the natural recovery after trauma. Often it is a person’s beliefs about why the traumatic event happened that causes them difficulties. These beliefs causes people to feel strong emotions, which then tends to lead to avoidance (of anything associated with the trauma) and then prevents clear thinking about the trauma. CPT focuses upon how the person’s understanding of the traumatic event and their experiences in the aftermath. CPT is aimed at helping the individual develop more helpful and balanced beliefs about the trauma.
Cognitive Processing Therapy has shown to be an effective psychological treatment for PTSD across a variety of different types of trauma, and with multiple or complex traumatic experiences, such as combat, sexual assault, and refugee experiences. It typically consists of 12 weekly sessions of between 50 to 60 minutes.
What to expect in Cognitive Processing Therapy?
Over approximately 12, weekly therapy sessions, clients under taking Cognitive Processing Therapy:
- Learn about the common changes in beliefs that occur after experiencing trauma which can include beliefs about safety, trust, power/control, esteem, and intimacy
- Learn to identify and challenge unhelpful beliefs and thoughts
- Learn to find a balance in the beliefs you may have had after the trauma
- Are asked to write about the impact of your traumatic experience(s)
- May choose to write the story of your traumatic event(s)
- Are asked to complete practice assignments outside of sessions to apply the learning from therapy
What are the Goals of Cognitive Processing Therapy?
- Increase your understanding of PTSD
- Examine the impact of the trauma on your beliefs/thoughts and feelings
- Decrease avoidance and difficulties you may be experiencing with positive emotions
- Learn skills to evaluate your thinking
- Consider alternative viewpoints of the trauma, oneself and the world
- Reduce distress related to your memories of the trauma
- Reduce feelings of anxiety, anger, guilt and shame
- Improve day-to-day living
Many people are uncertain about what a clinical psychologist does and how their role differs from other mental health professionals.
A clinical psychologist is a university-trained professional who is registered with a national regulatory body, the Australian Health Practitioners Regulation Agency. Clinical psychologists require eight years of training. They require four (4) years of basic university training, a minimum of two years of postgraduate training and then a further two years of supervised practice following (via an internship program).
While clinical psychologists provide counselling and psychotherapy, their training differs from counsellors and psychotherapists, as they have a greater emphasis on evidence-based interventions. They usually are involved in assisting people to understand and then change unhelpful thoughts, emotions or behaviours. Clinical psychologists are also skilled in assisting people to manage or recover from mental health disorders.
Should it be required, we can write psychological reports for instances such as TAC, Work Cover, and court proceedings. These reports are charged separately, and in addition to our psychological consultations.
In the first session, your psychologist will focus upon trying to understand your difficulties and how they are best treated. This will involve an assessment process in which you have the opportunity to reflect upon your experience. It will also include a series of questions from the clinical psychologist to help in understanding your current situation. Similarly, you may be asked to fill out questionnaires.
The clinical psychologist will be seeking to understand what your difficulties are and what kind of therapeutic approaches are best suited to the difficulties you describe. They will discuss what kind of evidence-based therapy is known to work for what you have described to them. Subsequent sessions are usually on a regular basis and become less frequent as your difficulties are resolved.
You always retain the choice regarding how many sessions you need and you are not obliged to attend a minimum number. You are also free to decide the frequency of your counselling sessions, however it is advisable to make these decisions in consultation with your clinical psychologist who can discuss with you and make recommendations based on their experience and with an understanding of what the evidence suggests.
If you have a Mental Health Care Plan from your GP this will entitle you to Medicare rebates for up to ten sessions. If you use all ten sessions, you can continue to see your psychologist at the private fee rates.
We all experience and make sense of life in our own unique way. So the challenges that life presents can negatively affect a person’s mental health in a variety of ways.
It can be helpful to see a psychologist if you are:
- Having difficulty coping or feeling overwhelmed
- Troubled by a traumatic experience
- Struggling with low mood
- Worrying excessively or experiencing panic attacks
- Having difficulty sleeping
- Frequently irritable or angry
- Feeling isolated and avoiding social activities
- Struggling with parenting or relationships
You are free to stop seeing your therapist at any time. Just as you are free to start seeing your therapist again at any time.
As a professional, your clinical psychologist will be open to your feedback and discussing with you why you may wish to end the therapy. They may suggest with you ideas about why they recommend you continue. In an ideal situation, this feedback can also become part of the work of therapy and can lead to important progress. We encourage you to have these discussions with your psychologist, rather than just dropping out of therapy.
At the Centre for Clinical Psychology, we are also aware of the need for a “good fit” between you and the psychologist you are seeing. We are willing to assist you with this, even if it means transfer to another psychologist or even an external referral. Your care is our priority.
The perinatal period includes both the antenatal and postnatal period. This means the period between conception, pregnancy, birth, the postnatal period and early parenting. Technical definitions regarding the duration of this period vary between 12 months to 4 years.
Perinatal mental health matters. It includes the emotional health and wellbeing of mothers, it should also include the emotional health of infants. Increasingly the emotional health and wellbeing of fathers is also receiving the attention it deserves.
Awareness of mental health issues during the perinatal period is increasing. Approximately one in seven new mothers, and one in ten new fathers suffer postnatal depression and/or anxiety. Mental health issues can also arise in pregnancy. Mental health difficulties can be treated by psychologists. However, a perinatal psychologist has specialist skills and understanding of the issues and challenges which can arise during this period.
Increasingly, infancy is being recognised as an extremely important developmental period. In infancy the foundations for later psychological, emotional and social functioning are formed. Infant development occurs within the context of relationships with key caregivers. An infant cannot survive without support from caregivers, ideally their attachment figures. The quality of the relationships between infants and their key caregivers is of central importance to development and infant mental health. Relationships and development are interconnected.
Infants are active participants in their world and their relationships:
Infants are born with the capacity to communicate their internal states and seek a response from their environment. Infants have a capacity to adapt to their environment, they are not just passive recipients of care, but are active agents capable of influencing their environment and caregivers.
Building parents’ confidence:
With this in mind, psychologists trained in infant mental health can support parents to understand the unique capacities and communications of their infant. Such understanding can enable parents to respond to their baby with greater confidence which can in turn strengthen the parent-infant relationship.
It is in the context of reliable, secure caregiving relationships that infants learn skills for self-regulation, empathy, trust and other pro-social behaviours. Secure attachment can set infants upon a path towards good mental health in adolescence and into adulthood.