Australian Clinical Psychologist
Available by appointment now
Hi, I'm Russell Downham.
I'm an Australian Clinical Psychologist with a PhD in Philosophy. Through this site I offer therapy to individual adults and couples -- either in-person at my Blue Mountains Leura clinic, or by video or phone anywhere in Australia.
As a Board-Approved Supervisor, I also provide off-site supervision to Provisional Psychologists and Clinical Registrars.
"The greatest weapon against stress
is our ability to choose one thought
William James, 19th Century Philosopher and Psychologist
"What services do you offer?"
As a clinical psychologist, I offer therapy to individual adults and couples anywhere in Australia by phone or video sessions, or in-person at my Blue Mountains Leura clinic. As a Board-Approved Supervisor, I also provide supervision to provisional psychologists and clinical psychology registrars. I work exclusively with adults aged 18 years and above, focusing on therapy and supervision only -- I do not provide assessments for legal purposes or to support applications for the Disability Support Pension.
With individuals, I help people to deal with relationship challenges, respond to existential emotions and questions of life direction and meaning, and change unhelpful patterns of thought and behaviour that perpetuate anxiety, depression, and various mental health issues. Where useful, I draw on a range of therapeutic approaches including Cognitive Behavioural Therapy (CBT), Acceptance Commitment Therapy (ACT), and Solutions-Focused Brief Therapy.
When working with couples, I use Gottman Method Couples Therapy, having completed Level 2 Training with the Gottman Institute.
Since Medicare subsidies for psychological services have failed to keep pace with rising costs over the past decade, like most psychologists in private practice I no longer offer bulk billing (free) services through Medicare. For individual therapy sessions eligible for an approved GP Mental Health Care Plan, I will electronically process your Medicare rebate for you after each session. If you have private health insurance, then -- depending on your policy -- you might alternatively be eligible to claim full or partial reimbursement from your insurance company. And of course, you may cover the cost of sessions yourself. If none of those options is available to you, however, then I would suggest asking your GP whether you might be eligible for psychological therapy through another avenue. Although outside of the scope of my own practice, depending on your situation, you might find a suitable therapist through one of a range of public service providers and funding sources including Community Mental Health Services, the National Disability Insurance Scheme, Victims Services, WorkCover, and others.
Usually you can schedule sessions with me about a week after your initial enquiry -- I will update this website if my availability changes significantly. Before I invite you to book a session using my online practice management system (the Client Portal in PowerDiary), please begin by completing the enquiry form below. Not all psychological conditions are amenable to telehealth or to scheduled appointments, not all conditions are within my expertise to treat, and at certain times a person may require more extensive support from a local community-based organisation. To avoid wasting your time, I'll reply to your enquiry with a brief intake questionnaire designed to identify whether a session with me is likely to be appropriate to your needs.
Many people have thoughts about suicide during their darkest moments, and I won't jump to conclusions if you talk with me about these thoughts. That said, if you really do feel like you may be at serious risk of ending your life soon, please seek support first from an appropriate person or organisation in your community, and if you are alone call a crisis hotline such as Lifeline on 13 11 14 (or call 000 if you are at immediate risk). Scheduled time-limited sessions with a therapist in a solo private practice -- especially video or phone sessions -- are inadequate to address the needs of a person experiencing a mental health emergency when their life may be at stake -- at such times people need and deserve more immediate, intensive, local support. Likewise, if a person's state of mind is severely disturbed, as for example can happen suddenly during a manic episode or in the context of heavy substance use, then this is not a time when I can safely and effectively offer therapy. Later, once the immediate crisis has passed and the person is relatively safe and stable, then I may reasonably hope to assist this person to get their life onto a better track while developing greater psychological resources to cope with future crises.
"What are your rates?"
My rates are the same for Individual Therapy, Couples Therapy, and Clinical Supervision, but differ depending on whether the session takes place online or in-person, and whether the session occurs during or outside of normal working hours. I update my rates at the beginning of each calendar year -- for the remainder of 2023 these are my rates for standard 50-minute sessions. Note that couples therapy begins with an 80-minute session ($300), after which the rates are the same as for individual sessions, as follows:
IN-PERSON SESSIONS AT BLUE MOUNTAINS LEURA CLINIC, NSW
Though the Australian Psychological Society's recommended fee for psychological services in 2023 is $280 for sessions between 45 and 60 minutes, I offer a reduced rate of $230 for 50-minute sessions in-person at my Blue Mountains clinic in Leura, NSW, between 8am and 5pm every Monday, for individual adults and couples. Couples can also schedule in-person sessions after 5pm or on weekends, as arranged, with these after-hours sessions attracting the higher rate of $280 per 50-minute session.
Sessions eligible for Medicare funding under a Mental Health Treatment Plan issued by your GP now attract a rebate to you of $136.35 per session with a Clinical Psychologist. That means the 'gap fee' for Medicare-rebated in-person sessions during normal working hours is only $93.65 per session for up to 10 eligible sessions per calendar year. Medicare does not cover Couples Therapy, so I cannot provide this service under an individual Mental Health Treatment Plan.
ONLINE VIDEO OR PHONE 'TELEHEALTH' SESSIONS AUSTRALIA-WIDE
Video and phone sessions are more convenient and less expensive for both you and I. With reduced overhead costs, I can offer a reduced rate of $180 for 50-minute sessions to adults and couples between 8am and 5pm on Wednesdays and Thursdays. After-hours evening sessions are also available on these days, as arranged, for either couples or individual adults, at the higher rate of $230 per session.
Telehealth video sessions, like in-person sessions, may be eligible for Medicare rebates under a Mental Health Treatment Plan issued by your GP. After subtracting the rebate to you of $136.35 per session with a Clinical Psychologist, the 'gap fee' for Medicare-rebated Telehealth sessions during normal working hours is only $43.65 per session, for up to 10 eligible sessions per calendar year. As with in-person sessions, Medicare does not cover Couples Therapy by Telehealth either.
SWITCHING BETWEEN IN-PERSON AND TELEHEALTH SESSIONS
If both online and in-person options are appropriate to your needs, then you can schedule sessions of either kind as your priorities change. For example, some people prefer to begin with in-person sessions, but later switch to online sessions.
HOW PAYMENTS ARE PROCESSED
Whenever you book a session, a partial deposit will be automatically processed using the banking or credit card details which you provide to the international payments service, Stripe, when prompted. Those details are secured securely and confidentially by Stripe, and are not recorded by me, on this website, or in my online scheduling platform. After completion of your session, I will then process the remainder of your payment through Stripe again. At the same time, if you have provided me with a valid Mental Health Treatment Plan from your GP, then I will electronically process your claim for any rebate to which you are entitled -- Medicare will then automatically transfer the amount of this rebate into the bank account that you have previously registered with them. If you are eligible to claim full or partial reimbursement for psychological therapy through private health insurance, then you can submit your claim to the insurance company by downloading the invoices for your completed sessions using the link to the online booking system where you can also easily book or change appointment times. I will email you this link once if I believe that I can help you on the basis of your situation and needs -- to start that conversation, please begin by completing the enquiry form below.
"What might I expect if I book a session with you?"
Booking a session with a psychologist can be a significant decision, summoning courage and humility. So when you see yourself commit to an appointment, you can take heart from this choice: you’re demonstrating your willingness to step forwards and try something new.
Anticipating your session, it’s not unusual to feel nervous, especially if you’ve never had this kind of conversation before. You might also feel a sense of relief, and perhaps hope, because now you’re getting professional assistance. You’ve made the first step, and when we talk I’ll do my best to help you find your next step.
Some people need only one or two sessions, just to get a clearer perspective. Others seek help to deal with more complex issues, or to navigate a difficult passage in life. It’s easy to just listen, or to just talk, but therapy works best when it’s a dynamic, purposeful conversation, supportive yet also challenging. In each session we'll negotiate our agenda to fit your aims. And with these aims in mind, I'll try my best to make your time well-spent, seeking ways to help you translate insight into meaningful change.
"What kind of individual therapy do you practice?"
My own particular approach to individual therapy stems from the rather indirect path that led me eventually to train as a clinical psychologist: first, I completed a PhD in Philosophy and then qualified as an APPA-certified Philosophical Counsellor. In retrospect, my passion for philosophical exploration always had a psychological aim, driven by an (admittedly somewhat obsessive) desire to understand how well-directed efforts of self-reflection might guide and inspire us to live wisely. Yet as much as I loved intellectual exploration and discussion, like many people I noticed that thinking about how I should live did not take me all the way to living accordingly. Philosophy helped me see why even small choices are meaningful, but Psychology taught me more about how we translate meaning into motivation – by understanding and collaborating with our minds rather than just lecturing ourselves! The pleasure I felt when I was teaching, seeing my students shift perspectives and learn, I now experience seeing my clients change their lives and grow.
Compared to your typical philosophy student, most people exhibit a much lower Need for Cognition (a trait expressed in people who enjoy and prefer effortful thought about complex things). Accordingly, for many of my clients, a little reflection goes a long way: once we have identified what matters for them, sessions typically focus on working through emotional challenges, reframing problems to reveal solutions, and developing skills and strategies to meet life’s challenges and move forwards. I like to help people access their personal strengths and resources. People are often encouraged when they recall how they have dealt with similar challenges in the past, and by relating those experiences can re-activate effective mindsets and identify transferrable strategies. But when unhelpful patterns of thinking or reacting to situations stubbornly block my client’s progress, I seek to understand the recurring windows of opportunity when changing course is possible. To reveal these hidden choices, I draw upon principles and techniques from a range of broadly cognitive-behavioural models and interventions (including conventional CBT, Acceptance and Commitment Therapy (ACT), Meta-Cognitive Therapy, Schema Therapy, Mindfulness-Based Cognitive Therapy, EMDR, and other evidence-supported interventions as needed). Most of my clients do not fit neatly into one clear diagnostic category, and therapy rarely resembles textbook examples. For these reasons, I value the flexibility of a broadly cognitive-behavioural trans-diagnostic approach, which can illuminate not only those issues conceived of as manifestations of mental illness, but also many of our shared struggles of living in this strange contemporary world with its stresses, complications and uncertainties.
Cognitive-behavioural interventions focus our efforts by simplifying human experience, highlighting where pivotal thoughts and behaviours may be modified. Perhaps most people willingly sacrifice some nuance for the sake of greater clarity, and they judge the intervention by whether or not it works in practice. But people with a relatively high Need For Cognition are frequently dissatisfied with explanations that fail to recognise the subtleties of their experience. These people need to understand ideas deeply to be persuaded by them. Inadequately nuanced explanations and rationales undermine their efforts to wholeheartedly engage with proposals that strike them as implausibly straightforward or personally invalidating. Psychologists may frame this ‘resistance’ as an avoidance strategy, yet it can also express a commitment to authentic self-knowledge. Indeed, for highly thoughtful individuals, the desire for cognitive understanding may be so great as to over-ride pragmatic concerns, at times leading them seemingly to favour interesting reflections on complex problems over the banal pursuit of simple solutions! The challenge as I see it for these people is to render the solutions more interesting than the problems. Thus instead of endlessly struggling to make these people stop 'over-thinking’ life, I respect their Need for Cognition and view it as a potential strength, assisting them to direct their critical awareness where it can most fruitfully be channelled.
As a deeply curious person with a lifelong interest in all kinds of human experience, I enjoy working with a diverse spectrum of clients. Yet my own background has inevitably led me to specialise in helping those fellow individuals whose high Need for Cognition complicates even as it enriches their lives. I have first-hand experience of the precarious positive potentials of this widely misunderstood temperament, which I can tap into to work through whatever questions concern you. My own examined life doesn’t give me the answers to yours, but does at least supply a wellspring of enthusiasm for the project. So without fear of judgment or disinterest you can feel free to talk with me about anything you like. At the same time, I am alert to the ways that intellectualising problems can divert attention from difficult emotional truths. As your psychologist I will, when necessary, gently guide you towards confronting unappealing realities which you might naturally find yourself ignoring even when they stand in your way. Through a process of collaborative reflection, we can together converge on an understanding of your situation that moves you towards what matters most in your life.
Two minds are often better than one, and anyone can find themselves in a situation where psychological counselling might help. If that’s you now, please contact me to start a conversation.
"What if I need to cancel my session?"
By providing as much notice as possible for cancellations you assist your psychologist to to keep session costs down while maximising the availability of services to others too.
If you cancel with at least 48 hours notice in advance of your scheduled session, the consultation fee for that session will be fully waived and your deposit will be refunded.
If you provide between 24 and 48 hours advance notice, half of the normal fee for that session will be automatically charged to you, with the remaining half of the fee being waived.
Cancellations with less than 24 hours of notice do not qualify for any waiver or refund, though the courtesy is appreciated.
It is important to note that Medicare does not pay late cancellation or missed appointment fees. These are your responsibility even if your treatment is normally eligible for Medicare rebates. Missed sessions do not subtract from your allocation of sessions under your GP Mental Health Care Plan.
Start a conversation
So that I can first determine how I might help you, would you please, in a few sentences, tell me what prompts you to seek psychological counselling or supervision at this time, and what you hope to achieve from this? I am currently accepting new clients, and will usually reply by the next working day. If I believe that I can help you, I'll include a link to my online booking system so that you can make an appointment at a time that suits you.