Combination Therapy FAQs

What is combination therapy?

Combination Therapy is a hybrid treatment approach whereby a trained clinical psychologist will guide you through one of our 'usually' self guided treatments. The online treatment would be similar to that of typical face-to-face intervention with the exception that all contact is online and all materials are provided to you via the interweb.



What do you treat with combination therapy?

We currently provide treatments for the following: - Depression - Social Anxiety - Obsessive-compulsive disorder - Panic disorder - Perfectionism - Generalised worry - Child anxiety problems (parenting program) - Child behaviour problems (parenting program)



What is the evidence base for combination therapy?

All of the intervention strategies used at Couch in the Cloud are evidence-based, and could be broadly termed cognitive-behavioural interventions. Cognitive-behavioural therapy is the psychological therapy with the greatest support for use with most acute and chronic mental health conditions. The online videoconferencing component of our service has not been subject to rigorous testing yet. It may be that the format is less effective than face to face, or the opposite may be true. If you are in doubt speak with another health professional such as your GP or psychiatrist. This is a quote from a research paper titled Current Directions in Videoconferencing Tele-Mental Health Research: "Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations." For more information you are encouraged to visit Google Scholar and enter the search terms "cognitive-behavioural", "videoconference", and "online". Using this strategy you can find more information on the research status of video therapy. Self-directed online therapy has a strong and growing evidence base. See this abstract from a recent summary of the research: "Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis" The effects of internet-based CBT were compared to control conditions in 13 contrast groups with a total number of 2334 participants. A meta-analysis on treatment contrasts resulted in a moderate to large mean effect size [fixed effects analysis (FEA) d=0·40, mixed effects analysis (MEA) d=0·60] and significant heterogeneity. Therefore, two sets of post hoc subgroup analyses were carried out. Analyses on the type of symptoms revealed that interventions for symptoms of depression had a small mean effect size (FEA d=0·27, MEA d=0·32) and significant heterogeneity. Further analyses showed that one study could be regarded as an outlier. Analyses without this study showed a small mean effect size and moderate, non-significant heterogeneity. Interventions for anxiety had a large mean effect size (FEA and MEA d=0·96) and very low heterogeneity. When examining the second set of subgroups, based on therapist assistance, no significant heterogeneity was found. Interventions with therapist support (n=5) had a large mean effect size, while interventions without therapist support (n=6) had a small mean effect size (FEA d=0·24, MEA d=0·26).



Who provides videoconference based therapy at Couch in the Cloud?

In keeping with Couch in the Cloud's commitment to professional excellence, all of our clinicians are trained Clinical Psychologists. This means they are specialist mental health professionals accredited to practice clinical psychology by the Australian Health Practitioners Regulation Authority (Australia's peak body overseeing health carer registration). A clinical psychologist undertakes more psychology training than most mental health professionals. Specifically, each of our clinical psychologist have undertaken 4 years of basic psychology training including an honours research year; in addition to a further 2 years of postgraduate training in clinical psychology practice that is followed by a further 2 years of supervision by an experienced Clinical Psychologist. Following this, most of our clinicians complete PhD research in the field of clinical psychology (a further 3 years of training). Many of our clinicians have published research in the field of adult and child mental health. In total, our clinicians will have completed approximately 8-11 years of training.



Can I find out about my clinician before I get started?

Sure, no problem. We can send you information about each of our clinicians. You can confirm their credentials on the Australian Health Practitioner Regulation Agency website. http://www.ahpra.gov.au/registration/registers-of-practitioners.aspx



Is my GP involved in this process? What about my child's GP?

We certainly always encourage collaboration and involvement with GPs. Therefore, in most but not all instances we require contact and collaboration with your General Practitioner (GP). Your GP may be managing your Mental Health Care Plan or your medication or both and therefore it is important that your clinician speaks with them regularly to update on your situation.



How long does each session last?

A typical session runs for 1 hour, however we believe it is important to be flexible to your needs.In some cases only a brief session (e.g., 20 minutes) is required, and in some cases a longer session (e.g., 2 hours) is required.



Am I eligible for a rebate?

At present Medicare does not provide rebates for online psychological services to all people. However, shortly (in November) Medicare will start to offer rebates for people in certain remote areas. The Medicare rebatable psychological services via telehealth will be available for patients living in Modified Monash Model regions four to seven, which cover smaller country towns and remote and very remote locations See the below weblink for more information. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2017-hunt035.htm



How do I book sessions?

For your initial session you and your therapist will agree upon a time to meet. For all sessions after that we have an online booking system to make it a seemless process for you. We will send you a text reminder 24 hours before your session in case you forget. You should treat the process like face-to-face therapy, turning up on time, dressed approppriately and not avoiding late cancellations.



Where do I attend sessions?

We use Adobe Connect for all of our video sessions. It is a reliable and secure videoconferencing platform. When you have been allocated to a clinician they will send you a welcome package in a pdf or word format document with instructions on how to connect.



Who develops the self-directed therapy at Couch in the Cloud?

All of our programs are developed by a team of psychologists with a background in research in clinical psychology at a university level. This means they have studied at an undergraduate level for 4 years in psychology plus another 3 years completing a PhD in psychology research; and some of the team have completed a further 2 years of clinical psychology training.



Do you charge for an initial chat?

No. After you contact us we will email or phone you so you can find out more about our service and whether it would be a good fit for you.



Where do I attend the initial assessment session?

We have two options: 1. We can meet you online. We use Adobe Connect for all of our video sessions. It is a reliable and secure videoconferencing platform. When you have been allocated to a clinician they will send you a welcome package in a pdf or word format document with instructions on how to connect. 2. We can speak to you over the phone.



How long will the therapy last?

We expect most people to complete the combination therapy program with 3-4 months.