Progress Report – Through the Looking Glass

When I wrote the last “Off the Couch” I was optimistic.  We had just received a very supportive and clear Independent Review and it seemed unthinkable that ACC could do anything but simply follow the recommendations, and implement it’s suggestions.

I’m not stupid, but I now realise I have been very naive.

So what has changed?  Nothing, really.  Sorry to report, but other than the sixteen sessions, which was implemented prior to the review being released, nothing substantial has changed.  The Sensitive Claims Unit now seems to be easier to deal with, people have been able to access sixteen sessions of “support”, we have some new forms, but when it comes to the issue of diagnosis, and the inappropriate interpretation and implementation of the legislation: nothing has changed.  And to receive treatment beyond the sixteen sessions?  Back to the “new pathway” I’m afraid.

Why has nothing changed?  Well despite the Review’s findings the clinical advice ACC is getting from it’s Clinical Directorate and Senior Medical Advisor has not changed.

Within ACC it is the Clinical Directorate, a group of (mostly) doctors that make up the clinical viewpoint of ACC.  Attached to that group of ACC employees are it’s various liaison groups, which provide clinical input and consultation to ACC.

The arguments and concerns put forth about the now infamous “new clinical pathway” is now history, but they can be roughly split into legal and clinical.  ACC was found wanting on both fronts by the Independent Review.  And given that all clinical bodies involved in the treatment of Sensitive Claims clients publically protested the new pathway, the question has never been answered, where do these clinical views come from?

Under the Official Information Act I have obtained the records of one of these liaison groups, namely the Mental Health Sector Liaison Group (MHSLG), made up of clinicians whose primary role is to provide medico-legal “mental injury” assessments on behalf of ACC. It also includes clinical representatives from ACC’s Clinical Directorate and is chaired by the Senior Medical Advisor.

So what does this influential group of clincians think about sexual abuse therapy?

This quote is from the March 2009 meeting minutes (emphasis added throughout):

“There is very little, if any, data available worldwide with regard to sexual abuse and related mental injury.  New Zealand is one of the only countries that have legislation allowing cover for sexual abuse. Therefore demonstrating a causal link between the sexual abuse event(s) and the resulting injury is still very much psuedo-science or personal opinion. Because of this the question was asked whether the MHSLG could help develop clinical guidelines.”

Yes, the clinical guidelines.  This is what the clinicians who influenced the new pathway really thought.

From the same meeting:

“There is a particular problem with claim duration in the Unit. There needs to be a shift in thinking that just because therapy stops it doesn’t mean all the problems for the client have gone away.  Therapists should be teaching clients how to meet their own emotional needs.  We need to push the message that we have to rehabilitate only to the maximum extent practicable.”

At the June 2009 meeting the draft of the new clinical pathway was presented.  These points were recorded from the subsequent discussion:


“One of the biggest issues is endless ongoing treatment, so how will this be measured?… … More is less.  Difficult to get treatment providers to understand that the more they do the worse a client can get. Can be a difficult transition for the therapist to decrease treatments… …Belief system ingrained that sexual abuse equals the need for treatment.”

“Point made that while it can be difficult to judge relationships and therapies, ACC can definitely limit number of sessions.  DBT and MBT both say 50 sessions + boosters are sufficient and that going past that will cause problems.  After max of 50 sessions, treatment should change to monthly sessions and boosters.  This needs to be included in clinical pathways”


I am formally trained in both Dialectical Behaviour therapy (DBT) and Mentalization Based Therapy (MBT) and I can assure that isn’t what they say.  Moreover it has always been denied by ACC that the new pathway was about restricting the length of treatment.  These minutes suggest otherwise.

Now just in case you think, yes but those are from a while ago now, even before the Independent review.  Surely things have changed?

At the December 2010 meeting the results of the Sensitive Claims Advisory Group Consultation about diagnosis was presented to this group:

“Feedback was provided by counsellors with their alternative suggestion being a narrative description of client symptoms.  However the MHSLG thought that problems would develop from clients looking up the criteria and descriptions for their symptoms on the Internet and undermining the professional approach to assessment”

Further from the same meeting:

“[Name deleted] raised the issue of assessing claimants in complex cases… …noted difficulties where there are concerns around the validity of symptoms or the implausibility of client narratives about events and/ or the clients dependent relationship with an existing treatment provider who attends with the client.”

So ACC’s Senior Medical Advisor and clinical advisors believe that long term therapy is harmful, that ACC has the right to restrict treatment even if the client has not gotten better and that sexual abuse/ assault leading to a mental injury is a matter of pseudo-science or personal opinion.

Furthermore if we were to not use the DSM-IV, in all it’s rigorous authority, then clients would look up the required symptoms on the internet, and lie about their abuse to all us gullible clinicians to obtain free counseling.

To call these ideas offensive is an understatement.

They show that ACC’s Clinical Directorate have lost their way and have no understanding of what the psychological treatment of sexual abuse trauma involves.

I am calling for a stand by all health professionals, professional bodies, clients and members of the public to take a stand of “No Confidence” in ACC’s Clinical Directorate, and it’s Senior Medical Advisor.  I am also calling upon the Minister to step in and call for ACC to implementimmediately all actions outlined in the Independent Clinical Review. It is his review after all.

Part of the review is a six month assessment of how ACC are implementing it’s recommendations.  So feel free to drop the Hon. Dr. Nick Smith an email and let him know how his Independent Clinical Review is panning out for you.


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