"Off the Couch" The weblog of Kyle MacDonald.   A psychotherapist's view of events and happenings in Aotearoa and beyond...

"Conflicting Interests?"

"Professor Felicity Goodyear-Smith is a senior academic and doctor who was commissioned by ACC to research sexual abuse counselling. She is also the daughter-in-law of Centrepoint guru and paedophile Bert Potter, is married to a convicted sex offender and has controversial views on the workings of the 'sexual abuse industry'. Tim Hume examines allegations of Goodyear-Smith's influence in ACC's recent drastic cut in support for victims of sex crimes.

LAST OCTOBER, ACC changed the rules governing the support available to victims of sex crimes, introducing a heavily criticised new regime that severely restricted access to counselling.

But what most concerned critics was an apparent similarity between a requirement in the new "clinical pathway", and a recommendation contained in research ACC had commissioned from a controversial senior academic. The research was led by Professor Felicity Goodyear-Smith, who has been a vocal detractor of the field of sexual abuse counselling and who, as the daughter-in-law of Centrepoint founder Bert Potter, has ongoing personal relationships with convicted child sex offenders.

During the eight months following the clinical pathway's introduction, ACC paid out $7 million less to 2889 fewer claimants than it had over the same period a year previous. Approved new claims, running at 1313 in the eight months prior to the pathway's introduction, subsequently dropped to 240 over the same length of time. Among the hundreds to have their claims denied were two women believed to have later committed suicide.

Despite a record $4.8 billion loss sustained by ACC the previous financial year, ACC Minister Nick Smith stressed the policy was not an attempt to cut costs, but was driven by a desire to implement best practice for sexual abuse victims, known as "sensitive claimants". Critics dubbed the new pathway a "rapists' charter".

The scheme's many detractors were primarily concerned by a new requirement that, before they could access ACC counselling and support, claimants had to be diagnosed formally with a mental injury as defined by the American Diagnostic and Statistical Manual (DSM-IV). Whereas previously, ACC might have accepted a GP or counsellor's description of symptoms such as flashbacks, panic attacks or nightmares resulting from a sex crime, now a formal diagnosis of a mental illness such as post-traumatic stress disorder was needed.

It's unclear exactly why. Nowhere was a DSM-IV mental illness diagnosis specified in the so-called "Massey guidelines", the widely accepted 2008 best practice manual which ACC had commissioned from Massey University researchers, and which it cited as having guided the formulation of the pathway.

The requirement was problematic at both a practical and an ideological level. Generally, only psychiatrists and clinical psychologists are qualified to make a DSM-IV diagnosis, so those who provided the bulk of sensitive claims support – counsellors and psychotherapists – were typically no longer able to satisfy the requirements. The latter professions considered the pathway unethical for the way it retraumatised victims, requiring them to recount their abuse to external assessors, all the while enduring the stress of knowing their future treatment hung on this scrutiny. Moreover, they strongly objected to being forced to label victims of sexual assaults with a stigmatising diagnosis of mental illness, for displaying symptoms they regard as a normal response to traumatic events.

"It's a fundamental shift," says Auckland counsellor Barri Leslie, "because it takes away all the responsibility from the perpetrators and puts all the consequences on to the victims."

ACC now admits it got it wrong and earlier this month announced that sexual assault victims are now automatically entitled to 16 sessions of counselling. "We moved too quick, and left a bunch of people with nowhere to go," says ACC spokesman Laurie Edwards.

Those who need additional treatment must still undergo a DSM-IV mental injury assessment for further cover, though. This worries Leslie and others, like Kyle MacDonald, sensitive claims spokesman for the New Zealand Association of Psychotherapists. More pressingly, they share concerns about the potential influence in the pathway of a piece of research, published in 2005, that ACC commissioned from Goodyear-Smith and two colleagues on the corporation's provision of sexual abuse counselling..." (Click here for the whole article from the Sunday Star Times 29/08/10)

Light at the end of the tunnel?

"ACC Media Release
Wednesday 11th August 2010

Extra support for sexual abuse survivors

Extra support is being made available to survivors of sexual abuse, ACC announced today.

From Monday 16 August, people with a new ACC sensitive claim, or with a new claim already in the system but awaiting a decision, will be able to access up to 16 hours with a counsellor, to ensure their safety and wellbeing.

“ACC has listened to concerns expressed by several groups that more support is needed. Those groups included the public, the sexual abuse treatment sector, and the independent panel appointed by the Minister to review the sensitive claims pathway,” said Denise Cosgrove, General Manager Claims Management.

It is envisaged that these support sessions will, in fact, be sufficient to meet the needs of many people, who will therefore not go on to require ACC cover or ACC-funded treatment.

However, for others who do demonstrate signs of a possible mental injury arising from sexual abuse (as specified in ACC legislation) the sessions will also be used to gather information to help ACC make a cover decision.

While these changes do not alter the process of deciding who qualifies for ACC cover, or how they will subsequently be helped, the changes do ensure everyone has support while their status and needs are assessed.

A number of details are yet to be finalised, such as what support will be available for people who have suffered a relapse, or whose sensitive claims have previously been declined or reactivated. Likewise, what special arrangements might be put in place for children and others with particular needs. ACC will be working with the sexual abuse sector on these questions over the coming weeks.

These changes have been discussed with the Minister’s independent panel, who felt they were a step in the right direction.

ACC will be contacting affected clients and the professional bodies involved in this area to ensure they know how to activate these support sessions.

Late last year ACC made changes to the sensitive claims process, to ensure that only those people covered by its legislation receive funding, and to improve results for people who are covered.

“We still believe these are reasonable goals but acknowledge that the introduction of the pathway exposed gaps in the services available to people who have suffered sexual abuse,” said Denise Cosgrove.

“We will be continuing to develop the sensitive claims process, and will take into account the views of the sector, the final report of the independent panel and the cross-government work being carried out following the recent findings of the Taskforce on Sexual Violence.”

--- ENDS ---"

http://www.scoop.co.nz/stories/PO1008/S00131/extra-support-for-sexual-abuse-survivors.htm

11th August, 2010

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Ideology of Denial

Recently I was asked if my quote in this Herald article meant that I thought that ACC were deliberately looking for ways to decline claims, a contentious assertion to be sure. I don’t think that, and I said so. Such a crude and simplistic explanation clearly makes little sense. I harbour no ideas that the day to day workers in ACC have any cruel or malevolent intent, mostly I’m sure they are following orders and doing as much as they can within the limits imposed upon them. What interests me is what do the architects of this new aproach think to enable them to act in the ways they have over the last twelve months?

Denial is a concept therapists are intimately familiar with, and in many ways one of the more fascinating of defences. As a concept it is as old as humanity, and our capacity to utilise it is somewhat amazing, when you think about it. Smoking is always the most obvious example to me, and an illustration of it’s slipperiness. Smokers know it is bad for them, but momentarily forget, minimize or indulge in outright denial (it won’t happen to me.)

However denial also makes acts of atrocity possible, abusers employ denial and minimization to enable the crude satisfaction of their impulses. The abused must also utilise denial to not simply curl up and die, and often the confrontation of the painful reality of the impact of abuse does kill those unable to bear the pain, most often at their own hands. Denial can literally keep people alive.

When we track the history of the acceptance of the severity and the impact of sexual abuse throughout western history we see denial, at a societal level, operating as a defence for the culture as well. Freud’s initial thesis was that hysteria was caused by sexual abuse:

“I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurences of premature sexual experience, experiences which belong to the earliest years of childhood, but which can be reproduced through the work of psychoanalysis in spite of the intervening decades.” Freud, from the Aetiology of Hysteria; cited in Herman, 1992.

This however was unpalatable to the conservative Venetian society he lived in and so he altered his theories and the course of western psychology with it.

Feminism and the rise of sexual equality sought and succeeded to tear down these walls of denial, and make clear the disturbingly high frequency of all forms of abuse of women and children and in doing so fought against the cultural tide of denial. In a way I guess patriarchy can be seen as a form of denial: denial of the power of gender politics and sexual inequality.

In backlash to these ideas and the threat they represented, a new wave of what I would call “abuse denial” arose largely represented by the invention of “False Memory Syndrome.”

This was a “phenomenon” whereby unscrupulous counsellors convinced people that the explanation of their symptoms was childhood sexual abuse that they simply “repressed” and through suggestion were able to re-call.

I can honestly say, I have never suggested to anyone that the explanation of their symptoms is sexual abuse, everyone I have treated has always been clear that they were abused. No suggestion required.

Furthermore I have never known anyone who practices in this way. I’m sure some misguided counsellors of the time may have, in the same way I’m sure that there are men (and women) accused of crimes that need defence against false claims of abuse and assault. But I’m also sure these situations are in a very small minority of cases and managed via appropriate legal processes of evidence, trial and appeal.

A recent edition of the New Scientist magazine discussed denial movements, such as climate change and holocaust deniers and defined that:

“It [denial] is the automatic gainsaying of a claim regardless of the evidence for it… ….Denailism is typically driven by ideology or religious belief, where the commitment to the belief takes precedence over the evidence.”

One can then claim scientific backing and empirical proof for one’s ideological beliefs. Opneness is exchanged for dogma: scientific curiosity for defensive certainty.

Fortunately trauma therapy has come a long way since the early nineties when the ideas of false memory syndrome and abuse deniers gained traction, but this recent pathway and the actions of ACC certainly has a feel of “here we go again.” One of the core problems I believe, is that the ideas of abuse deniers and the beauracratic aims of a financially motivated “insurance” agency are aligned: less claims means less expenditure, and to deny the impact of sexual abuse enables a clinical rationale for these financial motivations.

The "research" article I cited a while ago, that bore a striking resemblance to the new clinical pathway, is in my opinion is a clear example of dogma trumping curiosity, and of research which starts with an ideological basis. It’s lead author, Dr. Felicity Goodyear-Smith has an interesting background:

She was the GP for the Centrepoint Community from 1989 to 1994.

She is married to John Potter, son of Bert Potter, a convicted sexual offender from Centrepoint and leader of this movement on this website.

She has written a book titled “First do no Harm: The Sexual Abuse industry”

She was publically removed from membership of the Doctors for Sexual Abuse Care (DSAC) in part due to her repeadtedly acting as an expert witness for the defence in sexual abuse/ assault trials. See this article from the Sunday Star Times.

This expert witeness status was due to a piece of research which I find disturbing. In this paper she promotes the thesis that pre-pubescent children can contract gonorrhea without sexual contact. It has been dismissed by the court of appeal in this judgement and criticised in this article from the New Zealand lawyer magazine:

“ It would appear that Dr Goodyear-Smith’s surmise [about non-sexual transmission of ghonnereha] is based on something other than evidence.  Suffice it to say that doctors trained by DSAC, and paediatricians employed by Te Puaruruhau, practise on the basis of the evidence and not ideology."

She currently works in an advisory role for ACC and has completed multiple research projects for ACC.

A review of her written work points to a subtle but disturbing trend, a clear acknowledgement of the existence and incidence of sexual abuse and assault, along with a denial of the severity of the impact, and an implication that counsellors and therapists are to blame for the attribution of symptoms to childhood sexual abuse, and of widening and defining what is abuse.

I can’t help but formulate (I am a therapist after all) that it seems understandable that to be a health professional and married to a convicted paedophile, and having been involved in any capacity as a GP at the Centrepoint Commune, presumably seeing young girls who were “sexually active” at a disturbingly young age, would lead to a certain level of conflict.  See here for recent research project findings about the impact of life on Centrepoint...

Technically speaking minimization is of course a form of denial and in my opinion her research and writing is riddled with it.

While no clear evidence of a direct link between Dr. Goodyear-Smith and the new clinical pathway has yet come to light, I certainly hope that one person's psychological conflict and defences against the painful reality of their life have not come to plague a nation that already struggles against the denial of the very real impact of the abuse of our children.  I also hope that the Clinical review panel are able to see and disseminate the ideology and dogma from the facts, and see that evidence based practices, not dogma based research will lead us from this current darkness back into the light.

The last word on denial goes to a survivor of the Centrepoint community cited in the above mentioned research:

"What's really fascinating to me is how reasonable human beings, adults, can suddenly alter their thinking in a way that allows them to normalise abhorrent behaviour...why are people more comfortable doing nothing when they know something is so terribly wrong, than get uncomfortable stopping it."

16th July, 2010

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How you can help (again.)

It hardly seems like eight months ago most of you signed an online petition, and as a result of all your signatures and the concerted efforts of many, we were promised an independent clinical review of the New Treatment Pathway for Sensitive Claims.

Well the day has finally arrived, and the Independent Review Panel has put the open sign up on their front door, and opened shop.  And I thought I might make it easy for the New Zealand public to make submissions.  Simply chose your preferred difficulty level (Easy, Medium, Hard and "Snail Mail") from below and follow the simple steps.

Easy

1. Click on this link.  This will open a word document, with a completed submission. 

2.  Customise the first sentence by deleting the options that don't apply [Clinician/ client/ concerned member of the public etc.]

3. (Optional.)  Review content.

4.Copy this submission to an email, address to: ClinicalPathwayReviewSubmissions@researchnz.com and send email.

5. Circulate this Blog address to all your friends and family and ask them to also make a submission.  Numbers are power.

Medium

1. Click on this link.  This will open a word document, with a completed submission.

2.  Customise the first sentence by deleting the options that don't apply [Clinician/ client/ concerned member of the public etc.]

3.  Edit content to reflect your personal situation and beliefs.  If you are a client or clinician effected by the changes to the New Clinical Pathway, describe how you have been effected and how you feel about it.

4. Copy this submission to an email, address to: ClinicalPathwayReviewSubmissions@researchnz.com and send email.

5. Circulate this Blog address to all your friends and family and ask them to also make a submission.  Numbers are power.

Hard

1. Review the terms of reference for the review by clicking here to open the document.

2. Click on this link.  This will open a word document, with a completed submission.

3.  Using my submission as a starting point, write your own.  I have included links to the relevant  documents in the left hand column.  Read them and formulate your own arguments. 

4.  Copy this submission to an email, address to: ClinicalPathwayReviewSubmissions@researchnz.com  and send email.

Alternatively the Independent Review panel have indicated that they are happy to receive submissions in video or audio form.  If you would prefer to present in either of these forms you can either email it to them or mail it to the following address:

PO Box 1039,

Wellington 6140

ClinicalPathwayReviewSubmissions@researchnz.com

5. Circulate this Blog address to all your friends and family and ask them to also make a submission.  Numbers are power.

Low-tech version

1. Click on this link.  This will open a word document, with a completed submission.

2.  Customise the first sentence by deleting the options that don't apply [Clinician/ client/ concerned member of the public etc.]

3.  Edit content to reflect your personal situation and beliefs.  If you are a client or clinician effected by the changes to the New Clinical Pathway, describe how you have been effected and how you feel about it.

4. Print and send to : 

Independent Review Panel

PO Box 1039,

Wellington 6140

All submissions are required by June the 18^th, and so don’t procastinate, do it now.  The more submissions that state clearly the negative and disastrous consequences of this Clinical pathway the better.  It might be our last chance to make a difference.

1st of June, 2010 

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Survivors

In these enlightened times we deliberately choose to use language to more accurately describe the types of attitudes we think are morally important for society as a whole. For this reason we refer to people who have experienced sexual abuse as survivors, and try to avoid calling Maori cannibals.

This is the essence of “Politically correct” (a term I hate) namely respect expressed through language. It is of course very possible to also convey respect through behaviour.

We have higher expectations of Minister’s and others in the public eye because we understand that they lead, through the media exposure they naturally receive, and the respect and admiration they don’t always deserve.

Survivors in my experience don’t expect special treatment, mostly because most survivors don’t have any need or desire to “go public” with their story. Louise Nicholas did, because her story needed to be told, and the ensuing debate about power, rape, abuse and our cultural attitudes around sex and sexuality was one we needed to have as a country.

So we would hope even though Nick Smith seems oblivious to the impact of the actions of ACC, he might have some idea about how to respond in a respectful manner to a public survivor of sexual assault, especially when she is just engaged in doing her job as an advocate, and endeavouring to present her concerns to the Minister for ACC.  See TVNZ's report here and his defence of his actions here:

The scary thing is that at the risk of being generous to the Minster I don’t believe he is lying, I think he genuinely believes he did nothing wrong in terms of both saying no, and in the manner with which he did it. I hope I’m wrong because in a way that is even more scary than him lying.

Which brings us to today’s story in the Sunday Star Times, about a very courageous young woman who has also chosen to tell her story publically in the hope of exposing ACC’s treatment of her to public scrutiny.

The essence of this story is very simple, she was getting better, all her clinicians agreed she was getting better and treatment was effective, ACC stoped treatment, and she got worse again. I don’t think anyone can claim her symptoms aren’t a result of trauma:

"Getting raped every single night when I go to sleep. I can only sleep for 45 minutes before I wake up screaming,"

And yet the only justification ACC can give is that their so called clinical experts decreed:

"the long-term counselling has created a dependency that has been counter-productive".

Counter-productive to what exactly?

Lastly I would like to invite you to all visit this site, and get behind the Inaugural Survivors of Sexual Abuse Summit.

Feel free to register, get involved, or simply donate time, services or money. Survivors have had a pretty rough year, and this is something small we can all do to further show our support.

16th May, 2010

 
Who to believe.

 
You’d think after all this time, we’d have this sorted out, but no: I’m afraid I still don’t know who to believe when it comes to the politics around ACC.
 
The Sunday Star Times ran a shocking story recently about some very disturbing emails that a client of ACC claims show a despicable internal culture of the sensitive claims unit.  ACC in full politicking mode, claims that most if not all of them are lies, yet at the same time the SST cites letters that acknowledge offensive emails:
 
"I would like to apologise for the emails sent between Rotorua branch and sensitive claims unit that contained negative information and held inappropriate content," Walker wrote.
 
Hmmm.
 
Rosemary McLeod in the Dominion Post provides this useful opinion:
 

“There are two ways to go with this, and either reflects the complexity and sadness of the whole subject of sexual abuse and the harm it does. If these are real emails, there have been people within ACC, and in its most sensitive area, whose attitudes to confidential information are appallingly unprofessional. If the emails are concocted, that suggests the lasting effect of incest on a vulnerable child who has become a dysfunctional adult.

Either way, the complaint confirms what we should never doubt - that sexual abuse is not some welfare-generated industry designed to sucker the taxpayer, but a social problem causing pain and harm to many people, a good many of whom will not recover from it within the 16 therapy or counselling sessions ACC now regards as optimal, and yet more of whom will never get that help."
 
Which brings us to the review announced by Hon. Dr. Nick Smith Monday in this press release here with the Terms of Reference here.
 
So apparently, according to the minister, this pathway is still based on the Massey Guidelines. So lets look at what the Massey guidelines actually say:
 
“Sexual abuse is a complex life experience, not a diagnosis or disorder. It is not helpful to view sexual abuse as a single homogenous traumatic event that leads to a discrete disorder or pattern of trauma symptoms.
 
“The process of assessment and therapy needs to be safe. Various aspects of the therapy process also contribute to a sense of safety for the client and can prevent (or trigger) acute safety issues.

“Sexual abuse always affects the person abused in some way.

“Client-focused approaches are important for good outcomes. Clients should be equally involved in determining which effects are most problematic (eg, safety issues or effects that most interfere in daily living) and developing strategies to reduce these effects and improve quality of life. This means the therapeutic approach should be transparent, acceptable, and well understood by the client."
 
 
Again, who to believe? The Massey University researchers have made it clear that the new pathway does not reflect their research, but we keep getting told it does.
 
Someone sent me this very interesting piece of research from 2005, which just made me even more confused especially when it predates the publication of the Massey Guidelines, and says things like this:

"Given the range of qualification levels involved, we hypothesise that more highly qualified professionals (psychiatrists and registered psychologists) are expected to achieve better outcomes and/or similar outcomes with fewer treatment visits per claimant.

"Given the serious nature of the mental injuries treated by ACC-funded providers, it may be appropriate for the initial and final assessments at the least to be conducted by a professional qualified to perform a DATA according to DSM IV criteria – i.e. a psychiatrist or clinical psychologist.
 
Is it just me, or does that sound familiar?

Who do you believe?
 

And lastly the very sad and disturbing story in the Herald Tuesday, about a woman who died (read suicide as the press are discouraged from publishing that word) after being declined for the counselling she so clearly needed.
 
So do we believe ACC that she wasn’t suffereing from a mental injury? Or do we believe her counsellor who applied for funding for a woman who was so affected by her sexual abuse as a child that she wanted to die? Is ACC responsible for her death?
 

What do you believe?

 
 28th April, 2010
 

For previous "Off the Couch" blog posts click here...