Medical Model vs. Psychotherapeutic Model: What's the Difference? (and Why It Matters)
In Australia, our current mental health system is deeply rooted in the medical model. To access subsidised mental health support through Medicare, a person must first go through a GP and receive a diagnosis to be eligible for a Mental Health Care Plan. This means, from the very first step, we frame emotional distress and suffering through a lens of illness and disorder.
This is in stark contrast to the psychotherapeutic model, which is grounded in a person-first, context-aware approach. As psychotherapists and counsellors, we don’t start with “what’s wrong with you?” we start with “what happened to you?” or even more importantly, “what’s your story, and what do you need right now?”
This difference isn’t just semantic, it shapes the entire trajectory of care.
A System Built on Diagnosis
In the medical model, suffering is reduced to symptoms to be diagnosed, categorised, and treated. While this approach has its place, particularly in crisis support, pharmacological intervention, and some presentations of mental illness, it can inadvertently pathologise natural responses to trauma, grief, stress, oppression, and adversity.
The Power Threat Meaning Framework developed in the UK by Lucy Johnstone and Mary Boyle offers a powerful alternative. It invites us to ask:
What has happened to you? (How is power operating in your life?)
How did it affect you?
What sense did you make of it? (What is the meaning you’ve drawn from these experiences?)
What did you have to do to survive?
What are your strengths?
This framework aligns closely with how many counsellors and psychotherapists already work, supporting meaning-making, resilience, and healing without reducing a person to a diagnostic label.
And Yes! We’ve Heard the Criticisms
It would be remiss not to acknowledge the criticisms levelled at our profession by some within the psychology fraternity. We’ve heard it said:
That our training lacks scientific rigour.
That our work is not “evidence-based.”
That we are “unregulated” or “unaccountable.”
That we pose a risk to public safety without AHPRA registration.
These are serious concerns, and they deserve open dialogue, not defensiveness.
But here’s what’s often missed in those critiques:
Much of what is classified as “evidence-based” in psychology is drawn from brief, symptom-reduction models like CBT, often tested in controlled settings. These approaches can be profoundly helpful, but they aren’t the only legitimate forms of care. Many psychotherapeutic models, especially those rooted in trauma theory, attachment, and somatic work, draw on decades of emerging neuroscience and clinical wisdom that doesn’t always fit neatly into randomised controlled trial frameworks.
Good psychotherapists and counsellors are not unregulated. Many of us adhere to stringent ethical codes through professional associations, undergo regular supervision, and commit to ongoing professional development, standards that in practice often mirror or exceed those of AHPRA.
And most importantly: registration is not the same as relational safety. Clients don’t heal because their therapist is registered, they heal because they feel seen, safe, and supported in a therapeutic relationship that honours their complexity and strengths. Therapeutic relationship, not modality, is the strongest predictor of positive outcomes.
Who’s Doing the Work?
Another often-overlooked difference between psychotherapeutic and medical models is how we approach the self of the therapist.
Is your psychologist required to undergo their own therapy as part of their training?
Have they truly explored how their personal history, unconscious material, and relational patterns shape the way they show up with clients?
Maybe they have. Many do this work voluntarily—and do it well. But I assure you: it’s not a criterion of AHPRA.
In contrast, many counselling and psychotherapy training programs require students to engage in their own personal therapy, sometimes for years. Not as a luxury, but as an ethical necessity. Because we believe that therapists who have done their own inner work are more equipped to sit with the pain of others, less likely to project or pathologise, and more capable of creating a truly attuned, healing relationship.
This is not a criticism of individual psychologists, it’s a call to recognise the limitations of a training system that emphasises diagnosis and evidence over embodiment and self-awareness.
International Comparisons
In the UK, the dominance of the medical model through the NHS creates similar limitations. Psychologists and psychiatrists are often gatekeepers to funded therapy, and psychotherapeutic services outside this framework remain under-recognised and underfunded.
In the US, access to therapy is often dependent on insurance and diagnosis codes. The high cost of care creates inequity, but there’s a growing grassroots shift towards more inclusive, trauma-informed, and holistic care driven by social workers, counsellors, and community therapists, just like here in Australia.
The Push for National Standards in Australia
Australia is currently in the process of developing national standards for counselling and psychotherapy, a long-overdue and welcome step.
We must ensure that these standards elevate and differentiate the psychotherapeutic model, not homogenise it into something indistinguishable from the dominant medical framework. We are not simply “psychology lite, but without the Medicare rebates.” We are a distinct profession, with our own ethos, methods, and long-standing traditions of practice rooted in depth, relationship, and transformation.
This is a vital opportunity to legitimise our work without compromising our values.
Yes, Psychologists Can Work Psychotherapeutically…
Of course, many psychologists and allied health professionals do extraordinary work in trauma-informed, relational ways. This is not an attack on individuals, it’s a systems conversation.
The current Medicare system doesn’t require or prioritise therapeutic alliance, safety, narrative, or meaning-making. Psychotherapy does.
And this is why we need a parallel, equally respected pathway - one that doesn’t force people to engage with a medicalised system just to access support. A system that allows people to seek help because they’re human, not because they fit diagnostic criteria.
Let’s Talk
To my colleagues, leaders, and fellow change-makers in counselling and psychotherapy, I invite you to weigh in.
How do we make our models more visible and understood?
How do we protect the integrity of counselling & psychotherapy as a unique and necessary pathway of care?
How can we engage in these national standards discussions while resisting the pull to water down our identity and align with theirs?
Let’s claim our space in the mental health landscape, because we’re not just “nice to have.” We are essential.
How to Access a Mental Health Care Plan (MHCP) in Australia:
1️⃣ Step One: GP Visit
You must book an appointment with a GP (or psychiatrist/paediatrician) for a formal mental health assessment.
2️⃣ Step Two: Diagnosis Required
The GP must determine you meet the criteria for a diagnosable mental health condition (e.g., depression, anxiety, PTSD).
🧠 No diagnosis = no access to MHCP.
3️⃣ Step Three: Plan Created
If eligible, the GP writes a MHCP outlining:
Diagnosis
Treatment goals
Referral to a Medicare-registered provider
4️⃣ Step Four: Referral Pathway
You can only access rebates through:
Psychologists
Accredited Mental Health Social Workers
Some Occupational Therapists
❌ Counsellors & psychotherapists are excluded.
5️⃣ Step Five: Time-Limited Sessions
6 initial sessions
Review required for up to 4 more
10 maximum per calendar year
🧩 This is a medicalised, diagnosis-first model.
It supports many—but excludes many more.
🤲 Psychotherapy offers a different path:
No diagnosis needed
Person-first, meaning-based care
Accessible support for grief, stress, identity, trauma, relationships & more
References
Australian Government Department of Health and Aged Care. (n.d.). Better Access initiative – Mental health care and treatment. Retrieved from https://www.health.gov.au/topics/mental-health/mental-health-care-and-treatment/better-access
Services Australia. (n.d.). Mental health care and Medicare. Retrieved from https://www.servicesaustralia.gov.au/mental-health-care-and-medicare
Johnstone, L., & Boyle, M. (2018). The Power Threat Meaning Framework: Overview. British Psychological Society. Retrieved from https://www.bps.org.uk/PTMF
NHS England. (n.d.). Improving Access to Psychological Therapies (IAPT). Retrieved from https://www.england.nhs.uk/mental-health/adults/iapt/
National Institute of Mental Health. (n.d.). Mental Health Information. Retrieved from https://www.nimh.nih.gov/health
Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.). Routledge. https://doi.org/10.4324/9780203582015
Psychotherapy and Counselling Federation of Australia (PACFA). (n.d.). Advocacy for National Standards. Retrieved from https://www.pacfa.org.au/advocacy
Australian Counselling Association (ACA). (n.d.). National Registration Submission. Retrieved from https://www.theaca.net.au/