Opinion: Psychotherapy for the people

Image of young man during psychological therapy
Photo credit: Getty.

OPINION: Mental Health Awareness Week is a good opportunity to pause and reflect on mental health – in both senses of the phrase, that is, as it refers to positive mental health or well-being, as well as to mental illness. It is also a good time to reflect on what services help to promote positive health and support people in trouble or crisis.

I first went to see a psychotherapist 35 years ago. She helped me sort out some problems I was experiencing, mainly internal conflicts which were affecting my functioning and well-being.

From there, I did some initial training as a therapist, and over the years I have experienced individual, group, couple and family therapy with different therapists with a variety of approaches. My experience of personal therapy has been predominantly positive: psychotherapy works.

Research into psychotherapy suggests that, compared with medical and surgical procedures, psychotherapy and counselling has a large positive effect; that more resistant clients do better in nondirective therapies; and that psychotherapy is the most cost-effective form of treatment for severe psychological distress.

While clinical psychologists have generally engaged with the medical model and are part of the healthcare system, counsellors and psychotherapists have been less successful in marketing themselves to work within the public sector.

New Zealand's District Health Boards (DHBs) employ 587 clinical psychologists, compared to just 84 counsellors, 54 psychotherapists, and 6 counselling psychologists. 

Some psychotherapists thought that their registration (under the Health Practitioners Competence Assurance Act 2003) would mean that more psychotherapy could and would be offered in the public sector, but this has not turned out to be the case. The employment of more psychotherapists to provide an alternative, talking treatment is not based on professional status; it is a political decision.

The fact that certain DHBs, such as Auckland DHB, refuse to employ people if they are not registered under the HPCA Act, means, for instance, that they don't employ counsellors. However, other DHBs, notably Northland, Nelson-Marlborough, Hawkes' Bay, and Taranaki, do employ counsellors – so, again, the employment of these professionals is a political decision.

Of course, I would advocate that the government fund public sector psychotherapy – and those of us in the profession can make a case, including a long-term economic case for this; but it could start by instructing DHBs to take the restrictions off the employment of counsellors.

In a letter written just before the end of the First World War, Sigmund Freud spoke of his hope that "the conscience of society will awake and remind it that the poor man should have just as much right to assistance for his mind as he now has to the life-saving help offered by surgery".

He went on to argue that neuroses threaten public health as much as diseases such as tuberculosis, and for the establishment of free clinics and the provision of a "psychotherapy for the people".

One hundred years later, and against the background of poor health statistics and high suicide rates, especially amongst young people and Māori, it is time to provide life-saving therapy for those in need of it.

Keith Tudor is Professor of Psychotherapy at Auckland University of Technology.

Newshub Nation.

Where to find help and support:


  • Need to Talk? - Call or text 1737

  • Lifeline - 0800 543 354 or (09) 5222 999 within Auckland

  • Youthline - 0800 376 633, text 234, email talk@youthline.co.nz or online chat

  • Samaritans - 0800 726 666

  • Depression Helpline - 0800 111 757

  • Suicide Crisis Helpline - 0508 828 865 (0508 TAUTOKO)

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