Remembering the story
The Emperor’s New Clothes is a story about a community so invested in compliance and appearances that only a child will call out what everyone else sees: absurdity, harm, and naked power displayed as virtue. In Australian psychology, have the brightest minds been scared into compliance? Or has the silencing happened so slowly, that many don’t notice, making us frogs in the slowly heating pot, waiting while we boil?
What began as the ‘privilege’ of Medicare rebates for clients and the extra demands complicit with that, have accumulated into an environment where the most brilliant and altruistic minds are silent. I wish for psychologists to remember who they are. Investigators, pattern-finders, robust seekers of truth and expert metabolizers of data. Trained not to accept the initial glance, but to use analysis to challenge, curate misinformation, and lead.
I remember them. I remember the caliber of those undergraduate peers: a decade of high achievement, constant culling, and emotional resilience, usually fueled by real altruism or a wounded-healer drive. A top five percent result in the HSC for admission and then a brutal ten percent completion rate from undergraduate years to clinical college, unheard of in most other degrees.
Forgetting: The Slowly Heating Pot
Yet here we are: the very group whose brilliance, complexity, and drive once pushed boundaries, now reduced, seemingly complicit with the slow dissolving of rights as both a practitioner and a human. The micro-erosions of autonomy and respect, taken as the small price to pay for the privilege of gaining clients a rebate. With every new guideline and code, I watched many colleagues nervously double down on more training to comply, feeling lucky instead of exploited. Where was the dissent? The questioning, the demanding of more consultation as each new change was handed to us. Have we become experts not just in the human condition, but in our own tolerance of systems? Once, our ethics were based on peer mentorship. Now it feels like a gauntlet of compliance and public shaming, stifling a group that is capable of so much more.
What I remember
When the Better Access scheme launched in November 2006, it was anything but smooth. Both General Practitioners and Psychologists faced confusing new bureaucratic rules around referrals, session limits, and rebate eligibility. Many practitioners found themselves unsure of exactly what was required. General Practitioners (GPs) sometimes submitted incomplete or incorrect care plans, while psychologists navigated unclear guidelines about tracking client sessions and eligibility for rebates.
Despite this widespread confusion, the burden of regulatory compliance and the ultimate financial responsibility was placed on psychologists. If a client failed to disclose that they’d already used sessions elsewhere, or if a GP mistakenly completed a referral, psychologists alone were held liable. Medicare’s rules required us to reimburse any rebates claimed in error, even when those errors stemmed from genuine mistakes or gaps in communication, not intentional fraud.
In practice, this meant psychologists were expected to act as auditors, verifying a client’s session history by calling Medicare for every client at every session, with impossible Medicare phone queues and no streamlined system for real-time verification. The reality: it was simply impossible to guarantee perfect compliance in this environment. Yet, the scheme offered no protection or shared liability for mistakes made in good faith, it was the psychologist who absorbed the risk and repaid Medicare, not the client or the GP.
Reports in The Australian Psychological Society (APS) agreed the scheme’s rollout was “inadequate,” with unclear communication, poor real-world support, and documented examples of practitioners penalised for administrative oversights that were practically unavoidable in busy clinics (APS, 2017; InPsych, 2017).
I remember this roll out, and I remember the anxiety that impacted our work, our worlds, our sleep; the dread of an audit. What I don’t remember was any major dissent. The water warmed and we stayed in it, increasingly nervous, but believing we were lucky.
We now remember
The pressures and risks around compliance and sole liability for billing errors or GP/client mistakes have now become a much greater source of dissatisfaction and debate in the years since implementation, but why at the time was there a lack of organized protest from psychologists in the early rollout?
At the time it was felt by psychologists that the Medicare rebate was a privilege. This explains why they felt lucky, rather than abused by the unequal liability on us professionally and personally without commensurate renumeration for our additional responsibility. The primary financial benefit of the rebate went to the clients and the public in terms of increased access (reducing public system burden). Meanwhile we absorbed more administrative burden, liability risk, compliance anxiety, and a looming threat of personal repayments if a single aspect of the paperwork or referral process failed, without a notable rise in pay (APS, 2017; Evaluation of Better Access, 2022). It is an insulting summary to assume that our ability to provide clients a rebate is a personal privilege and a fair sacrifice for our personal rights and dignity.
Remembering DARVO: Deny, Attack, Reverse Victim and Offender
This is the essence of DARVO: the profession that helped the system, reduced public waitlists, and carried the compliance load became the scapegoat for its flaws. Our effort denied or ignored, psychologists catching up amid chaos of the rebate rollout, were cast as offenders responsible for every mishap in the messy referral scheme. Instead of partnering with us, the system reversed roles, turning its burden-holders into offenders, and in true DARVO form, double punched us as the lucky ones.
More memorable moments
Then the unimaginable happened; being named and shamed by The Australian Health Practitioners Regulation Agency (AHPRA) notifications. In May 2023, amendments to the Health Practitioner Regulation National Law granted AHPRA the power to publicly name health practitioners under investigation and list names and statements on their website and registration records. This was even before any verdict or formal disciplinary outcome, even if the practitioner was already suspended, posing little risk to clients.
The law’s intent is public protection, but peak bodies including the Australian Medical Association (AMA) have criticized it as a “gross violation of practitioners’ rights to natural justice,” directly contravening the fundamental principle of “innocent until proven guilty” enshrined in Australian law (Australian Medical Association, 2023). Surely suspension alone mitigates any risk to the public.
I remember the fervent debate around the Wood Royal Commission (2000) decision which allowed convicted sex offenders to be placed on a registry, with civil libertarians arguing for due process protections and warning that registers infringe basic rights, despite them being non-public, police maintained (Law Council of Australia, 2019; AIC, 2020). In comparison, a deafening silence about our own gross violations of basic rights for public naming and shaming prior to conviction. We again hold less rights than the average citizen.
Dr Mukesh Haikerwal, a former AMA president, said: “The name and shame provisions, whilst pending outcomes, really flies in the face of normal legal process. Just because you’re medically qualified or you’re a registered health professional doesn’t remove your legal rights and your human rights.”
Premature reputational harm is almost always considered defamatory and actionable. But again, psychologists face a stark exception, effectively overriding protections otherwise afforded in Australian civil law. Under Section 237 of the National Law, those making complaints are shielded from defamation suits, even if the complaint is baseless and ultimately dismissed.
Forgetting the role of challenge: a risk to ethics
The regulatory data indicate that mental health practitioners receive complaints at rates three times higher than physical health professionals, often related to dissatisfaction and misunderstandings, rather than egregious misconduct (RACGP, 2023; Medical Republic, 2023). This rings alarm bells. Being at threat of suspension due to client dissatisfaction, risks sanitising the profession and hollowing out the work, which by nature involves complex interpersonal triggers. Have we forgotten the importance of transference in clarifying latent interpersonal dynamics for the client?
Affirming and validation is only one part of our ethical requirement to achieve real change, along with widening viewpoints to increase cognitive flexibility. This is where regulation goes against public safety and reduces the reputation of our profession as ineffective echo chambers and in some cultural criticisms, promotional of narcissism with an obsessive focus on validation over corrective development (Lasch, 1979).
More moderately but just as concerning is the observation that psychology is frequently discussed in the popular press as diluted or lacking in innovation, especially around the repetitive treatment models that no longer capture deeper experiential or relational work.
This echoes the critique of existential/humanistic psychologists who have frequently argued that mainstream psychology and psychiatry have become bureaucratic, risk-averse, and conservative (see Yalom’s essays in Existential Psychotherapy).
Am I remembering them correctly?
I felt like my university peers were a passionate, competitive group, set to be future thought leaders based on their ability to see complex patterns and not accept face value claims. But there’s a gap. Thought leadership and constant compliance don’t seem compatible. Why didn’t psychologists comparably increase their own pay when clients accessed a rebate? Why didn’t they mass dissent over the personal repayment of rebates and sole liability? Why haven’t we objected to name and shame without verdict rules and lack of defamation recourse? Why are we so silent in advocating for ourselves but possess such altruism and advocacy for others? Why is there relative silence over our revised code and regulatory overreach?
We forget: The Personality of the Psychologist
Psychologists typically cluster around high conscientiousness, agreeableness, and perfectionism (Miller & Hilsenroth, 2017; Salvatore, 2024). The field attracts those who value rules, respect authority, and strive to maintain the highest professional standards.
Senior practitioners have repeatedly warned that these same traits, especially when overlaid with compliance-heavy professional cultures, can stifle dissent, creativity, and the willingness to challenge unhelpful norms or speak hard truths.
Clinical writers like Irvin D. Yalom have further cautioned that the modern, institutionalised field risks producing psychologists operating as mere technicians, focused on compliance, documentation, and protocol that authentic innovation, relational creativity, and transformative work are lost (Yalom, 2002).
One more thing to remember: The Feminisation of Care
Psychology is a profession historically and currently dominated by women. Feminised care professions are often shaped by societal expectations of self-sacrifice, emotional labour, and relentless availability. The result is that even highly skilled, specialist psychological work is frequently undervalued or misunderstood.
This has real consequences, not just in public perception, but also in how psychologists see themselves and the work they do. Despite years of complex training, statistics, and advanced practice, I still hear psychologists refer to their role as a “helping profession” or allow GP and psychiatrists referrals for mere adjunct “talk therapy”. Society cannot change unless we stop misrepresenting ourselves and demand correct recognitions as a rigorous analytic specialty with an intense competitive study pathway. We must stop making complexity seem so simple.
The urge to remember now: our new code coming December 2025.
Soon any speaking out, publicly or privately about the problems within psychology, if deemed damaging to the reputation of the profession, could now risk sanction as our revised code of ethics is about to be enforced by AHPRA, not peer led (see my full article on the new revised code- Exit Wounds).
Just as honest, expert voices are most needed in a climate of social media pseudoscience and AI addiction, regulation is about to dilute us in this space, rendering us irrelevant. You already see the shift: our posts are safe, repetitive, stripped of insight. Psychologists with the most to offer the public, the ones who integrate methods, challenge orthodoxy to create breakthroughs, use advanced techniques forged from thousands of hours of cross-field study, are most at risk of sanction.
In the revised code about to take effect, if it’s not evidence-based it stays in the shadows, even in personal social media commentary. Not only is this regulatory over-reach, but it is also not science. Science thrives on correction and re-testing of the current knowledge base, not fear of damaging the reputation of the field by turning over old data.
A final remembrance:
Ruth Bader Ginsberg said, “Whatever you choose to do, leave tracks. That means don’t do it just for yourself.”
I remember her when I remember the sixteen suicides by health professionals following AHPRA notifications. I remember, beyond being a psychologist, the ethics of being a human, the refusal to be a bystander, hoping someone else will speak, while violations occur in silence.
Further Reading List
- APS. (2017). Ten Years of Better Access (InPsych).
- Australian Government Department of Health (2022). Evaluation of Better Access Initiative.
- Lasch, C. (1979). The Culture of Narcissism: American Life in an Age of Diminishing Expectations.
- Yalom, I.D. (2002). The Gift of Therapy.
- InDaily. (2025). Looking for solutions in a psychology crisis.
- APS. (2025). Media releases: “APS calls for urgent reforms to future proof the psychology workforce.”
- Stewart, A., et al. (2018). Creighton & Stewart’s Labour Law. Federation Press.
- RACGP. (2023). ‘Deeply confronting’ findings show acute distress of AHPRA notifications.
- Fair Work Ombudsman. (n.d.). Consultation and change in the workplace.
- WHO. (2022). Fair share for health and care: gender and the undervaluation of health and care work.
- Law Council of Australia. (2019). Submissions on public register law reform.
- Australian Institute of Criminology (2020). What impact do public sex offender registries have on community safety?