Medicare & Referrals

Medicare & Referrals

If you have severe symptoms and suspect you have a mental illness, or you are experiencing distress, please see your GP. I recommend that you have a double appointment (20-30 mins) so you and your GP have sufficient time to discuss your symptoms and problems, and whether you qualify for Medicare coverage under the Better Access to Mental Health Plan.

Your GP will make the initial assessment and diagnosis, and suggest a general treatment plan (e.g. CBT for OCD, or EMDR for PTSD). He/she will also register you to claim rebates from Medicare and write a referral for you to see a psychologist (e.g. me).

Due to budget cuts, the maximum is for 10 sessions per calendar year. The rebate for Medicare for Clinical psychology treatment for 50 minutes or longer (Item 80010) is $124.50.

medicare-provider

Option 1: If you wish to claim a Medicare rebate, yes you need a referral from your GP or a psychiatrist. They need to register you for rebates within the Medicare system.

Option 2: If you don’t wish to claim from Medicare, and you are going to claim rebates from your Private Health Insurance Extras cover, please check with your insurer. Policies differ. Some insurers do not need a GP referral. Some insurers will only cover you for psychology after you use up all your Medicare cover (10 sessions per year).

Option 3: If you don’t wish to claim any rebate, you don’t need a referral to work with me.

Before or after you have your GP referral, you are welcome to have a free 10 minute phone conversation with me. During this call, you have an opportunity to ask me questions and consider whether we could be a good fit in working together.

Please note that I cannot advise, assess, diagnose or treat you during this 10 minute call. After this initial free phone call, there is no obligation to continue to see me. Even after a few therapy sessions, you are always free to pause or stop treatment.

Dr Philomena Tan is both a Clinical Psychologist and a Counselling Psychologist, able to offer you the benefit of training and expertise in both clinical and counselling psychology.

www.wearepsychology.com/clinical-psychology/

Dr Philomena Tan is both a Clinical Psychologist and a Counselling Psychologist, able to offer you the benefit of training and expertise in both clinical and counselling psychology.

www.wearepsychology.com/counselling-psychology/

Fees & Sessions

Fees & Sessions

My consultation fees are in line with the Medicare scheduled fee for 50 minutes. My standard appointments are 75 minutes in length. Please be aware of this when you are comparing my fees with those of other practitioners as they probably have sessions of 50-60 minutes only.

Many clinical psychologists typically charge between $185 – $251 for a 50 minute session.

Consultation fees 2019 Full fee with Medicare Full fee with Private Health Cover
My fee (75 minutes) $260 $250
Medicare rebate $124.50 Private health cover varies $30-Full fee
Gap (Your actual out of pocket costs) $135.50 Variable depending on your health fund for Extras cover (psychology)

Therapy for couples (on going couples therapy or occasional sessions where a partner attends) is not covered by Medicare. A standard 75min session for couples is $290.

For individual and couple sessions, extra time is charged at $50 for every block of 5-15 mins.

For TAC and WorkSafe clients, there are no gaps. However your case manager must approve the 75 minute sessions and related fees.

The consultation fee is due on the date of service. Cash and cheques are accepted for the first session. Electronic funds transfer can be used by continuing clients.

For non-attendance and cancellations with less than 48 hours notice, the full fee will be charged.  Medicare does not rebate non-attended or late cancelled sessions.  A late cancellation impacts 3 people: (1) the client who potentially loses therapy momentum and delays therapeutic progress; (2) another client possibly on a waiting list, who could have benefited from that session time; (3) a psychologist who spent time preparing for the session.

Due to budget constraints, Medicare rebates and scheduled fees have not been indexed since 2013. No increases are expected until 2020.

Many clients with long term mental health issues fund their therapy with a combination of Medicare and Private Health Extras cover. Another option is to do blocks of sessions and return each year for a pulse of treatment. You can stop or pause therapy at any stage, assuming you are stable enough to do so.

Category: Fees & Sessions

Typically, psychologists offer sessions of 50 minutes duration.

My standard session is 75 minutes for several key reasons:

  • It allows enough time to review your progress and any challenges that have arisen since the previous session, and still have plenty of time to do substantial work.
  • For people who have fortnightly appointments, it allows sufficient time to work.
  • Traditionally the recommended time frame for EMDR sessions is 90 mins because it allows sufficient time for adequate processing of trauma targets.
  • 75 mins matches the human “ultradian” biological rhythms of 75-90 mins for a complete cycle (e.g. sleep cycles). This means we can do the work justice, rather than skimming the surface or compromising on your review of progress plus allowing for planning on how you can continue the work in between sessions.
Category: Fees & Sessions

Many clients achieve effective results for a specific focussed issue within a time frame of 10 sessions or less.

Multiple or long standing problems (complex PTSD, severe trauma or developmental trauma) can take longer to heal.

Many clients with long term mental health issues fund their therapy with a combination of Medicare and Private Health Extras cover. Another option is to do blocks of sessions and return each year for a pulse of treatment. You can stop therapy at any stage.

The length of your therapy depends on many factors including:

  • The severity and complexity of your problems
  • How quickly you respond to treatment
  • How much work you are willing to do in between sessions. Research shows that, irrespective of treatment method, practicing skills and homework activities enhances treatment effects
  • Your awareness and ability to reflect on what is happening for you (mindfulness)
  • Whether we can capitalise on any previous treatment or personal development work.

You may already have many skills and insights into what is holding you back from flourishing.

Category: Fees & Sessions

Therapy Methods

Therapy Methods

Since completing my doctorate in psychology in 2000 (DPsych, Swinburne University), I have trained in numerous evidence based methods. Each method has been found to be effective for specific psychological problems. Quite often I use a combination of methods in a particular sequence so that you are supported in effective treatment in the shortest time possible, while maintaining your positive functioning in daily life.

In addition to these methods, I have substantial and ongoing training in trauma therapy, the science of attachment or healthy relationships (Attachment Theory) and couple’s therapy.

Category: Therapy Methods

EMDR therapy is one of two proven (evidence based) methods for treating post traumatic stress disorder (PTSD) recommended by the World Health Organisation. It is recommended by many other health authorities such as Veterans Affairs (Australia,USA), The Australian Psychological Society, The American Psychological Association, and The American Psychiatric Association.

Developed in 1987, there are now over 20 gold standard random control trials demonstrating the efficacy of EMDR. Additional studies demonstrated the effectiveness of EMDR in the treatment of anxiety, phobias, depression, grief, addictions and compulsions, pain, chronic illness and somatic disorders, sexual dysfunction and body dysmorphia.

In using EMDR therapy for PTSD, trauma memories are re-activated and changed (rewired), resulting in decreased vividness and emotional charge associated with painful memories. Flashbacks, hypervigilance (being on red alert all the time) and avoidance of trauma triggers become things of the past. You become free from the grip of the traumas and earlier adverse events. Your sense of yourself and your resourcefulness improves.

After EMDR, many trauma survivors experience shifts such as:

  • From “I’m helpless/powerless” to “I can stand up for myself”
  • From “It was my fault” to “I did the best I could”
  • From “I am worthless” to “I am worthwhile”
  • From “I’m unlovable” to “I am lovable”
  • From “I cannot trust anyone” to “I can choose whom to trust”
  • From “I’m never safe” to “It’s over. I’m safe now”

These are significant changes which go beyond simple thoughts. A new positive sense of self is felt in your mind and body. It does not need to be rationalised. It is felt as true.

Research has found that EMDR is also effective for rewiring other conditions besides PTSD. My advanced EMDR training in EMDR applications includes protocols for resource installation, and treating anxiety, phobias, grief, addictions, compulsions, pain, chronic illness, developmental trauma and complex trauma.

Recent coverage on the ABC’s 7.30 report (Australia, 20 Nov 2015, 7 minute video)
http://www.abc.net.au/news/2015-11-20/treating-ptsd-with-the-wave-of-a-finger/6958540

Brief coverage on NBC (USA, 6 Nov 2014, 3.34 min video)


For more technical information on EMDR therapy and longer video presentations of EMDR, please visit the association for EMDR therapists: www.emdraa.org or read Francine Shapiro’s book Getting Past your Past to see the wide range of EMDR transformations possible.

 

Category: Therapy Methods

Schemas are deep seated self-defeating patterns usually developed in childhood or adolescence in response to trauma, adverse events, difficulty or neglect. These patterns helped you to survive and be safe at the time they were developed. However in adulthood, these patterns show up as negative or dysfunctional thoughts, feelings and behaviour. They interfere with creating a positive and successful adult life. Dr Jeffrey Young developed Schema Therapy and labelled these patterns as unhelpful life-traps which sabotage your life.

Examples of schemas patterns include:

  • Mistrust following chronic abuse and danger in early life – You are always on the lookout for where people can take advantage of you
  • Self sacrifice or approval seeking, if you had to avoid being rejected by adults when you were growing up – You tend to look after other people’s needs and then feel resentful because your needs are neglected
  • Unrelenting standards as compensation for hidden self doubt or feelings of not being good enough in some significant area – This typically manifests as perfectionism.
  • Negativity/pessimism – You feel as if the glass is usually empty, or have a pervading feeling of “What’s the point of trying, it never turns out right for me”.

Advanced Schema Therapy considers modes of functioning or states of being which maintain your problems. For example, an Inner Critic may be constantly undermining you and your efforts to change. A Detached Self-Soother may numb you out from feeling difficult emotions by using food, alcohol, drugs, gambling, shopping and other addictions. An Angry Child state may explode at people when you face too many frustrations and challenges, making things worse in your important relationships.

Schema Therapy has been found to be effective for improving chronic relationship problems and shifting long-term emotional and psychological distress. This includes anxiety, depression, substance abuse and personality disorders. Schema Therapy replaces tenacious negative patterns of thinking, feeling and behaving with healthier alternatives.

 

You might like this introductory video clip from USA

http://www.youtube.com/watch?v=qodIDRVVvVQ

 

Category: Therapy Methods

Page coming.  You might want to check out this video on Center For Self Leadership.

 

Category: Therapy Methods

Page coming.  You might want to check out this video from Brainspotting International.

Category: Therapy Methods

ACT is an off-shoot of Cognitive Behaviour Therapy (CBT). The primary aim of ACT is to increase psychological flexibility so that you are more aligned to your life goals. ACT focuses on six processes which maintain problematic coping:

  1. Avoiding unwanted experiences (thoughts, emotions, memories)
  2. Being entangled with your thoughts which then take over your brain space and detrimentally influence your behaviour
  3. Dwelling on the past (ruminating) or the future (fantasising), rather than working with what is happening now
  4. Being identified with particular descriptions or stories of ourselves (that tend to be negative of self limiting)
  5. Lacking clarity about values and goals
  6. Withdrawing, distracting, and other ways of avoiding taking effective action towards goals (e.g. excessive TV, procrastination, use of mind numbing substances)

The three keys to Psychological Flexibility are:

  1. Opening up (accepting what is happening rather than denying reality, and seeing thoughts as separate from you)
  2. Being present (being mindful of what is happening right now without judgment and not being attached to negative views of yourself)
  3. Doing what matters (being aware of your values and being committed to actions that support your values and goals, in spite of difficulties in life)
Category: Therapy Methods

Historically psychotherapy started with Freud and psychoanalysis, the “talking cure” which relies heavily on insight and the therapist’s interpretation. The second wave of behavioural therapy emphasised behaviour. Cognitive behaviour therapy (CBT) focuses on both thoughts (cognition) and behaviours, and how they contribute to problematic symptoms.

Unhelpful thinking patterns that contribute to psychological pain include negative automatic thoughts, unhelpful core beliefs, and negative self talk. CBT aims at changing these unhelpful thinking patterns (e.g. “Why bother, it never works out for me”) and strengthening positive thinking patterns. One of the keys in CBT is gathering accurate information (evidence) and counteracting distortions of reality in order to make adaptive decisions.

The second key to CBT is behavioural experiments, where you will be encouraged to take on new behaviour. This allows you to revise old assumptions and rules which have held you back in life (e.g. “I should always put other people’s needs firsts”).

CBT has been widely researched in countless clinical trials. There are various evidence based CBT applications in the treatment of anxiety disorders, depression and trauma. Most university-trained psychologists practice CBT. However, trauma-focused CBT is a specialist protocol which involves prolonged exposure to trauma memories and stimulus. Not all psychologists are trained in this specialist protocol and it is very different to EMDR, which focuses on rewiring trauma memories.

Category: Therapy Methods

Over the last 20 years, research has found that mindfulness training enhances the effectiveness of therapies aimed at alleviating both physical and psychological problems. While mindfulness increases both awareness and clarity, mindfulness alone is not sufficient to rewire your brain.

With psychological suffering, it is important to regulate our emotions. Compassion focused therapy (CFT) is an off shoot of Cognitive Behaviour Therapy (CBT). It emphasises the difficulty in regulating our emotions given the way our brains have evolved and current environmental challenges.

With continuing challenges from our modern world and early trauma, our bodies and brains often register threat at some level. We so easily slip into fear, anger, depression or shame. Many of us cope by distracting ourselves, withdrawing or overcompensating via achievement, busyness or various substances and activities (e.g. gambling, shopping or overwork).

Compassion Focused Therapy emphasises kindness, compassion and social connections to regulate our over-stressed body-brain systems. Research shows that compassion alleviates anger, increases courage and resilience to anxiety and depression. CFT draws on the research and theory of Prof Paul Gilbert (UK). There is also a growing body of research from Dr Kristin Neff, Dr Christopher Germer, Dr Richard Davidson and Dr Thupten Jinpa (Standford).

Category: Therapy Methods

While Cognitive Behaviour Therapy (CBT) and its offshoots like Acceptance Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) focus on cognitions and behaviour, the primary focus of EFT is emotions. As you experience various events in life, you may experience many levels of emotions, some intense and some vauge. EFT disentangles these levels using various approaches, leading to clean, authentic resolutions.

EFT considers difficulties with emotions (e.g. overwhelm and confusion), unclear feelings, difficulties with expressing feelings, problematic reactions, self interruptions and unfinished business with people who are still in our lives or people from our past which still preoccupy us.

The steps involved in EFT include promoting awareness of emotions, cultivating emotional intelligence, monitoring how primary and secondary emotions wax and wane, evaluating the helpfulness of emotions experienced, identifying beliefs and views attached to maladaptive emotions, and transforming these maladaptive emotions and destructive beliefs.

EFT draws on systematic research and clinical experience of work of Prof Les Greenberg (Cananda), Prof Robert Elliott (UK) and Dr Sue Johnson. In Australia, it is also known as Process Experiential Emotion Focused Therapy (PEEFT).   My approach to EFT incorporates the work of other experts in the field of emotions including Prof Paul Ekman (who developed the program Cultivating Emotional Balance with Buddhist scholar Dr Alan Wallace), Prof Silvan Tomkins and psychiatrist Dr Donald Nathanson (the scientific study of shame).

As a result of trauma and adverse events, there is often unprocessed fear, dread, despair, shame and guilt. Accessing and processing these emotions are key to successful resolution of problems. I have many ways of safely processing these feelings via Eye Movement Desensitisation Reprocessing (EMDR), Compassion Focused Therapy (CFT) or EFT.

Category: Therapy Methods

There are many public misconceptions of hypnosis. First, it must be emphasised that clinical hypnosis is different from stage hypnosis which is primarily designed for entertainment. Modern clinical hypnosis largely derives from the innovative work of the late psychiatrist Dr Milton Erickson. My training in hypnosis has largely been with Dr Michael Yapko, Dr Maggie Phillips and Dr Jeffrey Zeig.

Clinical hypnosis involves a client entering a deep state of trance for the purposes of addressing and healing specific problems.   In this state, which is deeper than relaxation, unconscious resources, typically untapped by the client in waking life, can be accessed. Many other clinical objectives can be also achieved, including accessing strengths that are dormant, reviewing maladaptive behaviour and deciding to take up adaptive behaviour (e.g. exercise or eating well).

I often use hypnosis as a way for clients to consolidate their strengths and abilities. This typically happens before Eye Movement Desensitisation Reprocessing (EMDR) to dissolve old traumas, and after EMDR to enhance positive strengths. Each hypnosis session is recorded so that you can have a copy of the hypnosis session to review or to replay again at a later stage.

Some clients have found hypnosis useful for turning down pain levels which are not managed adequately by medication.

Category: Therapy Methods

Let’s be clear upfront. Positive Psychology is not about “Smile and be happy” or chanting affirmations or attracting the perfect life.

Around 20 years ago, in response to the traditional emphasis on psychopathology and mental illness in mainstream psychology, Professor Martin Seligman, Professor Mihály Csíkszentmihályi, Professor Ed Diener and others started investigating positive human states like well-being, happiness, flourishing, peak performance and flow (being in the zone).

This relatively new science is called Positive Psychology. The focus of systematic scientific research is on factors contributing to happiness, well being and flourishing, based on research and practical activities. This science is now enhanced by brain based research, including fMRI and PET Scan studies, involving many clinicians and researchers at major universities.

Positive psychology research shows that a positive mood is influenced by the ratio of experiencing positive emotions to negative emotions. Thus, the emphasis of my therapy practice, Rewire and Flourish, is to rewire past trauma and negative patterns (decreasing the frequency, duration and intensity of negative emotions), and cultivating positive thoughts, behaviours and habits (increasing the likelihood of positive emotions). This is akin to weeding the garden of your mind, and cultivating flowers and other useful plants. Ultimately this leads to greater well-being and flourishing in life.

Category: Therapy Methods