NZ Herald Column Kyle MacDonald

How many counselling sessions do you need?

This is my column this week in the New Zealand Herald, which is published in the digital edition every Thursday...

“What do you think of the subsidised counselling available via GPs? Do four sessions really make an impact?”

Without doubt the hardest question to answer when someone starts therapy is “how long will it take?”

Difficult because many people fear that coming to therapy means spending years on the couch, becoming dependent to the point where you are unable to leave, destined to forever turn up each week and disgorge the contents of your psyche to your shrink.

Conversely others have the expectation that their depression, anxiety or relationship difficulties can be fixed in a handful of sessions. Fair enough, therapy can be hard, and increasingly expensive. But where does this idea come from? Is it a realistic expectation?

There is certainly no evidence that four sessions is any kind of magic number. The problem with most “time limited” treatments, whether they be via your GP (technically your Primary Health Organisation, or PHO), via your Employee Assistance (EAP) scheme or elsewhere, is that the number of sessions is based on money, not on clinical evidence.

Just imagine for a moment you were unfortunate enough to be diagnosed with cancer.

Your oncologist informs you that you can only have four doses of chemotherapy. You’re told you will need more than that, but all cancer patients only get four funded doses and beyond that you will have to pay for it yourself.

You might think that’s a ridiculous comparison, but last year at least 579 New Zealanders died as a result of suicide. Who knows how many would still be alive if they could have easily accessed the treatment they needed?

I don’t expect to see everyone who walks into my office for months, or years.

For some 4-6 sessions may be more than enough to sort out the current struggles they’re having, and make changes. But in the ideal universe the decision about what treatment they require shouldn’t be made by what they, or we as a society, can afford.

But this is increasingly the only conversation we are allowed to have about health: what’s the cost?

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I have tremendous admiration for the recent campaigns that are encouraging people to talk about their mental health struggles, most recently the Federated Farmers and the excellent NZRU initiative “Head first”.

But at the same time I wonder if it’s even ethical to encourage people to reach out and talk, when there may be no one listening.

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