Regional and Rural Report
Counselling–A Regional Snapshot CAPA is reaching out to regional and rural Counsellors and Psychotherapists through the evolving efforts of its RnR Committee. The committee was formed two years ago to give regional issues more focus, drive and acknowledgment. CAPA’s intention is to increase connectedness amongst members who may normally work alone, who work at a distance from peers and the association’s urban administrative centre. We talked with three members about their experience of being Counsellors in regional NSW, about CAPA’s organisation of regional Professional Development Events (PDEs) and the role that CAPA plays in supporting them professionally. We spoke with: Heidi Tornow from Wollongbar, on the Far North Coast, who has been a Counsellor for eight years Brian Edwards from Forresters Beach, on the Central Coast who, in his own words, has been working “a very long time”—twenty years in private practice Sharon Ellam, an original member of the RnR Committee, who has been working as a Counsellor in the Lake Macquarie area for about six years. These three members attended the May 2011 PDE held in Port Macquarie: Heidi and Brian participating, and Sharon as an organiser and attendee. From their conversations, a snapshot emerged of some of the issues and challenges that may be unique to regional members, together with their experiences of being CAPA members. Challenges for Regional Therapists One of the significant themes emerging from the interviews was the isolation experienced in working regionally. Geographic isolation brings unique problems: few peers close by, insufficient client numbers to accumulate the required number of counselling hours for Clinical status, difficulties finding a supervisor within an acceptable distance, finding enough work to pay the bills, and meeting the financial burden of professional development. If working only in private practice, without other income streams, these problems are even more critical. Heidi summed this up well when she said, “It’s huge —it’s huge! If I had to rely on private practice to get my hours, I’d still have years to go! I can’t see any way of getting your hours other than working at least part time for an organisation ... and, again, it’s the financial thing too—supervision doesn’t come cheap either! If I had to pay that and annual membership, I simply couldn’t afford it. On top of that, you can’t charge what you can in the city.” Heidi said that working for an NGO covers all of her living and professional costs. She said, “I wouldn’t be able to be in private practice otherwise.” She also said that working for an NGO also allowed her “to be part of a team”, which she feels is important. Private practice has been made especially challenging by the supply of services provided through Medicare eligible practitioners. This highlights the economic and professional identity issues associated with the mainstream 6
extension of mental health services being accessed through the public health system. Of this, Brian said, “Most counsellors in country areas survive by being connected to some agency or some workplace or some church group that does counselling. You’re very, very limited in the number of people who come to you in private practice, and with the advent of the Medicare scheme where doctors refer to psychologists. I know one guy who lost 90% of his clients when the Medicare Rebate (for psychologists) came in.” Further challenges, which were linked to the central theme of isolation, included limited access to referral networks, either to refer to or to receive referrals from other health professionals. This seemed to be one of the factors that make it hard to build up a private practice. These members also cited the added costs incurred for travel to attend professional events or supervision meetings. This expense is proportional to distance from an urban centre, together with a higher time cost to attend professional events (including days off work to get there). Heidi described briefly some of the costs associated with attending a small PDE in Brisbane. She estimated that the cost of a workshop ($150) was increased by a night’s accommodation with food ($300), travel costs ($100) of a five-hour trip each way, and the cost of a day’s pay if it’s during the week. She said, “When I see that people can go to Crow’s Nest for $30 for 2 hours, I am green with envy! If I came, I would have to take a day off work PLUS the costs of travel!” Another challenge cited was a small population from which to draw clients, as well as the hesitation of clients to travel outside their local township for services. There is also a need to subsidise income earned from psychotherapy practice with other forms of work. Brian was the exception to this, having worked for a long time and having thus built up a good referral network, including organisations for which he had worked in the past. Brian commented: “If you go into private practice, I think it takes from three to seven years to get going. A lot of people give up after about three years; but after three years, and as networks build and connect with each other—to be in associations and to be a part of something [like CAPA]—that feeds me, that nurtures me, and it enables me to check on myself.” Access to supervision was also an issue, with scant or absent local availability of experienced supervisors, plus technical and utility service limitations when attempting to access supervisors through Skype or phone. Technology promises a new level of connectivity and choice when it comes to peer support and supervision, allowing people living regionally to have a much wider choice of supervisors; however the technological side has not caught up and is patchy in regional areas. As an example of this, when trying to do the interviews via Skype, Jane Ewins had constant problems with lost connections. Skype appears to be the preferred choice, if it works, as it could allow for face-toface meeting via video, plus allowing supervisees to keep costs to a minimum. CQ: The Capa Quarterly