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Canberra Health ServicesClinical Guideline Women’s Health Service - Counselling ServicesContents

Contents....................................................................................................................................1

Guideline Statement.................................................................................................................2

Scope........................................................................................................................................ 3

Section 1 – Counselling Team Staffing......................................................................................3

Section 2 – Client Characteristics..............................................................................................3

Section 3 – Clients’ concerns.....................................................................................................4

Section 4 – Principles of Care....................................................................................................5

Section 5 – Model of Care.........................................................................................................6

Section 6 – Intake......................................................................................................................9

Section 7 – Case Formulations, Care Planning and Clinical Reviews.......................................11

Section 8 – Case management, advocacy and support functions...........................................11

Section 9 – Outreach...............................................................................................................12

Section 10 – Group work.........................................................................................................12

Section 11 – Responding to logistical challenges....................................................................13

Section 12 – Mitigating Vicarious Trauma...............................................................................14

Section 13 – Clinical Supervision.............................................................................................15

Implementation...................................................................................................................... 15

Related Policies, Procedures, Guidelines and Legislation.......................................................16

References.............................................................................................................................. 16

Definition of Terms................................................................................................................. 17

Search Terms.......................................................................................................................... 18

Attachments............................................................................................................................18

Doc Number Version Issued Review Date Area Responsible PageCHHS18/211 1 17/08/2018 01/09/2022 WY&C - CHP 1 of 20

Do not refer to a paper based copy of this policy document. The most current version can be found on the CHS Policy Register

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Guideline Statement

BackgroundThe Women’s Health Service (WHS), located within the Division of Women, Youth and Children, provides counselling services for women. The service is inclusive of all women 18 years and over, irrespective of their sexual orientation, gender identity or intersex status. WHS sees women who have significant difficulty accessing mainstream health services.

The WHS seeks to provide a safe and accessible service that supports physical, psychological and emotional health and wellbeing for women across the adult lifespan. The counselling team works alongside a nursing/medical service and a dietitian to provide holistic care.

The Vision Statement of WHS is: For Women, By Women, With WomenFor Health, Personal Growth and Social Change.

WHS is a community health program. It is located in the City Health Centre building and counselling services are also offered on an outreach basis in Community Health Centres and Child and Family Centres throughout Canberra.

The counselling service gives priority to women who have experienced interpersonal violence or developmental trauma, including adult or childhood physical, sexual and psychological violence, abuse or neglect.

Key ObjectiveThis document will guide counselling team members in the provision of service and care of women presenting to the WHS for counselling.

Alerts ACT Health Child Protection policy requires all ACT Health staff to report all forms of

child abuse or neglect to Child and Youth Protection Services (CYPS) should they form a reasonable belief in the course of their employment. This is in accordance with the Children and Young People Act 2008.

When clients are identified at risk of suicide staff will follow the Initial Management, Assessment and Intervention for People Vulnerable to Suicide Operational Procedure. The Women’s Health Service Suicide Risk Protocol provides additional detail of procedures to be followed by WHS counselling staff.

When clients are identified as being at risk from harm by others, staff will work with clients to mitigate risk. Collaborative safety planning, referral and liaison with other specialist family violence agencies will be utilised.

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Scope

The Clinical Guideline Women’s Health Service Counselling Service applies to: All counselling team staff at WHS All women, 18 years and over, requesting a counselling service from WHS Students on placement with the WHS counselling service.


Section 1 – Counselling Team Staffing

The counselling team is a multi-disciplinary team staffed by a team leader (HP4) and senior health professionals (HP3) comprising psychologists, social workers and professionally qualified counsellors.

The positions are open to women only. Essential qualifications are attached to the end of this Guideline.

In addition to the required qualifications, counselling staff need skills and knowledge of counselling and psychotherapy approaches for women who have experienced interpersonal and developmental trauma.

Each counsellor, irrespective of her professional discipline, primarily provides a counselling/psychotherapy service. She draws on the strengths of her particular academic training, professional development and clinical experience, and on a shared suite of trauma therapy interventions.

The team benefits from each team member’s specific knowledge through consultation, in-house professional education, or internal referral.

Due to the complexity of clinical work, WHS employs experienced clinicians at the HP3 level and above. For the purposes of workforce planning, the appointment of a clinician at HP2 level may be considered. However, a counsellor employed at HP2 level will be required to have experience and knowledge of trauma-informed clinical practice.


Section 2 – Client Characteristics

Almost all WHS counselling clients have a history of interpersonal trauma. The majority have experienced both developmental trauma (as a result of violence, abuse and/or neglect during childhood) and adult trauma, including domestic and family violence and/or sexual assault.

Family violence, as defined by the ACT Family Violence Act 2016, means



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(a) any of the following behaviour by a person in relation to a family member of the person: (i) physical violence or abuse;(ii) sexual violence or abuse; (iii) emotional or psychological abuse;(iv) economic abuse; (v) threatening behaviour;(vi) coercion or any other behaviour that—

(A) controls or dominates the family member; and(B) causes the family member to feel fear for the safety or wellbeing of the family

member or another person; or (b) behaviour that causes a child to hear, witness or otherwise be exposed to behaviour

mentioned in paragraph (a), or the effects of the behaviour.Examples—par (b)1 overhearing threats being made in another room of the house2 seeing an assault or seeing injuries on a family member who has been assaulted3 seeing people comfort a family member who has been abused 1

Aboriginal and Torres Strait Islander women, young women, women from culturally diverse backgrounds, women with disabilities, lesbians and bi-sexual women, trans, gender diverse and intersex people are at high risk of exposure to interpersonal trauma and/or face particular challenges in accessing mainstream services. The counselling service aims to flexibly respond to the needs of these women.


Section 3 – Clients’ concerns

Each client brings a unique set of concerns and therapy goals. However, a number of core concerns commonly associated with interpersonal and developmental trauma are summarised below.

Client Concern May includeIdentity concerns Underdeveloped sense of self, high levels of shame and

self-judgement, low-levels of self-compassionEmotional difficulties Emotional dysregulation, high levels of distress,

disconnection from emotions, complex grief, and dysfunctional coping strategies including self-harm, chronic suicidality, substance abuse and eating difficulties.

Relational difficulties Problems with attachment, trust, boundaries, vulnerability to re-victimization, social isolation, high levels of conflict, parenting/intimate partner/family of origin concerns which can be complicated by ongoing contact with perpetrators.

Intrusive and dissociative trauma symptoms

Flashbacks, nightmares, somatic symptoms, emotional numbing.



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Client Concern May includePractical daily living difficulties Lack of safety for self and children, lack of financial

security, stable housing or employment.Mental and physical health concerns

Chronic health conditions, chronic pain, sexual health concerns, mood disorders, dissociative disorders, personality disorders and psychotic disorders.


Section 4 – Principles of Care

The counselling service’s principles of care follow those developed by Adults Surviving Child Abuse (ASCA, more recently known as the Blue Knot Foundation). Twenty-One Clinical Practice guidelines summarise best practice for trauma-informed care based on the research and clinical practice of internationally renowned trauma therapists.2

These guidelines recognise that “the differences between complex (cumulative, interpersonally generated) trauma and ‘single-incident’ trauma (PTSD) are significant.”2

A safe, stable therapeutic relationship is a necessary foundation for working effectively with women who have experienced complex trauma.3 ASCA outlines five domains of trauma-informed care: Safety, Trustworthiness, Choice, Collaboration and Empowerment.2

Trauma Therapy has been envisaged as three over-lapping phases of therapy: safety and stabilisation; trauma processing, and re-integration/community connection.4 5 6.

WHS counselling and psychotherapy contracts with clients may focus on one or more of these phases of treatment. Although limited trauma processing may sometimes take place during the stabilisation phase, the preferred trajectory is to support the client’s capacity for emotional regulation and management of intrusive memories, flashbacks and dissociation before working in depth with traumatic material.

Not all clients proceed to trauma processing, but still benefit from improved emotional stability and safety7. Other therapy contracts typically centre on relationships and increased engagement in the community.

In keeping with the principles of trauma-informed clinical care, counselling and psychotherapy provided by WHS counsellors will: Assess and address safety concerns, including risk of harm to self and others, particularly

children; Take into account family and intimate partner dynamics, social contexts, the impacts of

inter-generational trauma and social determinants of health;



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Provide a safe, boundaried counselling environment for women who have experienced frequent boundary violations and betrayal of trust from caregivers;

Take account of attachment issues and how they manifest in the therapeutic relationship;

Provide psycho-education on the impacts of trauma and effective coping strategies; Provide therapy that addresses the client’s somatic and emotional trauma memories as

well as supporting insight and a coherent narrative; Support clients to be self-compassionate and active in their self-care; Assess the risks and benefits of trauma processing and use appropriate trauma

processing techniques and containment interventions; Be collaborative with clients in developing therapeutic goals and reviewing the progress

of therapy; Support clients to strengthen their community connections.


Section 5 – Model of Care

The model of care provides two distinct phases of treatment and a third set of options for women who have previously accessed the counselling service (known as returning clients). Broadly, the two phases can be differentiated as a counselling process and a psychotherapy process. However, there is significant overlap: the initial counselling sessions may form part of the establishment phase of a psychotherapy contract, while, Phase 2 therapy may also address a woman’s more immediate concerns.

The separation of these two phases is aimed at increasing timely access to counselling for women who have immediate needs. The initial counselling sessions also provide the opportunity for women to make an informed decision about their interest and readiness to engage in longer term therapy.

Phase 1 treatmentPhase 1 is a set of up to eight counselling sessions. Typical areas of focus include: Helping women clarify concerns, think through issues and problem solve Attention to safety issues Processing of emotions around current situation Psycho-education for trauma, domestic and family violence, emotional regulation, sleep Skills development Enhancing self-care Helping women to initiate change Use of short-term psychological therapeutic approaches including for instance,

Acceptance and Commitment Therapy (ACT), Cognitive Behaviour Therapy (CBT) or Narrative Therapy

Information-giving, referral, advocacy Assessing further needs for psychological support – assisting women to make choices Assessment of appropriateness of longer-term psychotherapy with WHS



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Phase 2 treatmentPhase 2 comprises an additional period of regular counselling/psychotherapy with either a specified end date, or, periodic specified review dates.

Psychotherapy contractsPsychotherapy contracts focus on the impacts of trauma on a woman’s understanding of herself and her enduring patterns of emotional response, behaviour and thinking that have arisen as a consequence of trauma.

Phase 2 therapy is not offered automatically to every client who receives Phase 1 counselling. An assessment of the client’s readiness to engage with the therapy, and to receive benefit from the therapy takes a number of factors into consideration, such as: Is there a shared understanding between client and counsellor of the goal/s of therapy

and a process for working towards these goals? Does the client currently have the capacity to engage in psychotherapy? For example:

o capacity and commitment to attend; o capacity to comply with established guidelines for therapy (e.g. maintaining

boundaries);o willingness to contract for own safety.

Does the client understand that psychotherapy is an active process requiring her to reflect and respond in session and to undertake out-of-session tasks (recognising that this capacity develops through the course of therapy);

Is the client willing to participate in review of process, and; Does the client understand that the psychotherapy offered at WHS has an end point and

is time-limited?

When agreed by counsellor and client, the client may take a break from therapy and re-commence without restarting Phase 1 counselling. This therapeutic break can allow the client time to consolidate changes or deal with immediate issues.

Other Phase 2 contractsExtended assessments are time-limited contracts to further explore a client’s readiness/willingness to commit to psychotherapy. These may be needed to build sufficient trust to proceed, to build commitment (as in Dialectical Behaviour Therapy-DBT), or to further problem solve barriers to psychotherapy.

Extended assessment contracts may suit some women transferring into the community from the Alexander Maconochie Centre who have previously accessed WHS counselling at the prison.

Specific issue counselling contracts focus on a specific current issue, for example, the process of separation from an abusive relationship. These contracts are offered when more intervention is required than can be provided in the Phase 1 counselling sessions.



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Top –ups are follow-up contracts with a limit of 1-2 sessions for a client who has completed Phase 1 or Phase 2 counselling/psychotherapy. They usually take place in the months following completion of counselling/psychotherapy, but are not limited to this. Providing a client with the reassurance of a top-up appointment if needed, may give her the confidence to finish therapy. Top-up appointments may also support a client through a stressful event.

Returning clientsWomen who have experienced interpersonal or developmental trauma often face significant emotional, relational and health related challenges throughout their life-course. Women choose to return to WHS for further assistance for a number of reasons, often because they are now in a better position to engage with counselling, or, a change in their life circumstances requires additional psychological support and processing.

WHS does not provide repeat episodes of counselling on a regular basis, such as a yearly set of counselling sessions. Where women have completed counselling within the past two years or have had multiple episodes of care, a request for further counselling will need to be carefully considered. This also applies to clients who have previously been offered counselling, but whose attendance pattern was irregular. As a general rule, women would be expected to have a significant gap between episodes of care unless it is part of a negotiated therapy break or a top-up appointment.

All returning clients have their request for service reviewed prior to being offered a service. Especially at times of high demand, returning clients may be offered a definitive number of sessions, may be asked to wait, or may be told WHS cannot provide them with a service at this time. Where possible, the intake counsellor will provide women with information about alternate community services.

Clients who have previously had a significant amount of counselling (>80 sessions) may be offered one of the following: A limited number of counselling sessions, up to but generally less than 8 sessions; A telephone consultation; No counselling service at this time.

Any additional service for these clients requires an ‘exceptional circumstances’ proposal by the counsellor on the basis of one or more of the following: a significant change in the client’s life circumstances to be processed; indications that further counselling/psychotherapy will make a significant difference to

her quality of life; additional sessions will make a significant difference in supporting children in the

woman’s care (and the therapy contract relates to this).

Frequency of therapyPhase 1 counselling sessions are usually fortnightly 1 hour sessions. This pattern has been established based on the majority of women’s preferences. However, at times, weekly sessions are offered.



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Phase 2 psychotherapy contracts are usually weekly or fortnightly 1 hour sessions. The frequency of sessions is individually tailored to the needs of the client. Weekly sessions allow for more holding by the counsellor and more focused therapeutic work with reduced attention to ‘bringing the counsellor up to date with what is happening outside of therapy’. Fortnightly sessions allow for more external processing time between sessions and more opportunities to practise and consolidate skills. Fortnightly sessions are sometimes favoured for logistical reasons, such as the client’s competing commitments or counsellor availability. Frequency of sessions can be varied over time, particularly as clients prepare to finish their therapy.

Duration of TherapyThe maximum number of Phase 1 counselling sessions offered to a client is established at the beginning of the episode of care. While some women, particularly returning clients, may be offered a smaller number of sessions, the ‘default’ number of counselling sessions is eight. If undertaken fortnightly, this allows counselling over a four-month period.

WHS counselling service fills a gap in the ACT community for provision of medium and longer term therapy for women with complex needs arising from a history of interpersonal trauma. For women with complex trauma, brief interventions are often insufficient to establish the therapeutic alliance, emotional stability and safety to support long-term improvement in functioning.6

Duration of therapy for clients receiving Phase 2 therapy varies and may take place over a number of years. However, continuing therapy is dependent on regular clinical reviews to determine its effectiveness with regard to agreed therapy goals. The majority of WHS counselling clients will complete their therapy within 2 years.


Section 6 – Intake

The primary means of referral to WHS counselling is through self-referral. A woman contacts the service by phone or by visiting the office.

A woman’s willingness to self-refer is one indicator of her motivation and readiness to participate in counselling. Another agency may support a woman to self-refer.

Other referral pathways include: Internal referrals from a member of the WHS nursing/medical team; ‘Meet and Greet’ referrals, booked by Child and Family Centre staff with the WHS

outreach counsellor located at the Child and Family Centre; Assisted referrals, where another individual or agency makes the referral on behalf of a

woman, with her consent. This usually only happens where there is an additional barrier to the woman speaking on her own behalf, for example, hearing impairment or language difficulties.



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A woman’s Request for Service is responded to by a member of the Counselling Intake Team. The emphasis is on a warm, non-judgmental interaction consistent with trauma-informed care. Interpreting services are used where needed. Most Intake discussions take place by phone. Occasionally, a woman may be invited to attend a face to face meeting with an Intake counsellor to help determine her needs and whether counselling with WHS is a suitable fit. This meeting is referred to as ‘an extended request for service’.

The purposes of the Intake discussion are to: Provide information about WHS counselling service including the cancellation policy; Determine whether the woman meets the criteria for the counselling service and

whether WHS is the most appropriate service at this time; Provide information about other services in the community; Obtain information about a woman’s availability and preferred location for counselling; Check on safety concerns, including safe contact details and recording on ACTPAS; Arrange an initial appointment with a counsellor, or place her on a waitlist for the next

available appointment.

The Intake Team is normally staffed by 2-3 counsellors, who maintain a counselling caseload in addition to their intake duties. Members of WHS administration team provide administrative support. Under the supervision of WHS Manager and Counselling Team Leader, the Intake Team undertake a number of functions: Receive requests for service; Assess suitability of referral and arrange for allocation to counselling; Identify women for triaging (those who may require more immediate assistance); Identify women who are returning clients to WHS to review what level of service is to be

offered; Make initial appointment bookings; Manage Phase 2 Therapy requests and allocations; Maintain Intake data; Complete ACTPAS records; Chair Allocations Meetings.




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Section 7 – Case Formulations, Care Planning and Clinical Reviews

Care Planning starts with the initial counselling appointment and is documented on the Intake Interview form. If further elaboration is required, a more extensive care plan may be completed at any stage during Phase 1 counselling sessions. This is documented using the WHS Care Plan.

If Phase 2 therapy is proposed, a written formulation is completed by the counsellor with therapy goals, treatment approach and review dates. A separate care plan is completed in collaboration with the client.

Ongoing therapy reviews are a normal component of counselling sessions. Counsellors and clients regularly discuss how the work is proceeding. Other resources may be used to facilitate reviews including documented review of the care plan, use of structured review questions, clinical supervision, or bringing in a second counsellor to facilitate a review session with the client and counsellor present. If Phase 2 therapy continues beyond six months, an updated formulation and therapy plan is presented to the team at a clinical review meeting.

Some therapy contracts have pre-established end dates. All other contracts have agreed review dates. The focus of therapy is on working towards agreed goals and counsellor and client having a shared understanding that therapy is a limited resource and not a life-long source of emotional support.

At the completion of a client’s treatment, the counsellor documents a case closure summary.


Section 8 – Case management, advocacy and support functions

The primary role of the counsellor is to provide counselling/psychotherapy. In doing so, counsellors may also undertake associated services: Provide information about other community resources and assist with referrals; Participate in case conferences as a member of an interagency care team; Provide advocacy and supporting documentation at the request of the client, for

example, for Housing Applications, National Disability Insurance Scheme (NDIS) applications, visa applications, students’ extension requests;

Fulfil legal and professional responsibilities with regard to reporting, for example, to Child and Youth Protection Service;

Confer with a client’s legal guardian.

WHS Counselling service does not normally undertake diagnostic assessments and does not provide psychological assessment reports.



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Section 9 – Outreach

WHS provides outreach counselling services. Counsellors may be accommodated at Child and Family Centres or Community Health Centres where the counsellors liaise with local teams but their administrative and supervision support is provided by WHS. Planning for the allocation of counsellors to outreach locations takes into account the availability of suitable accommodation, patterns of demand and staff availability. In most instances, outreach in a particular location is provided one day a week.


Section 10 – Group work

Counselling group programWhere resources permit, in addition to providing individual counselling sessions, the counselling service runs group programs. The content of these groups is determined by commonly identified therapeutic needs of women attending the WHS. These groups are primarily skills oriented and recognise the value of women being able to support, validate and learn from each other. Typical themes include mindfulness and distress management skills, social interaction skills, self-compassion and self-care.

Group programs also provide an opportunity for women to become more confident joining group activities and making social connections. This facilitates broader community engagement.

Group programs vary in their structure and include: One-off informal meetings to mark a particular occasion such as International Women’s

Day; One-off information or themed discussion sessions; Closed group programs over a fixed number of sessions, such as a Mindfulness Skills

group.

Participants in the group program are already clients of WHS. Priority is given to clients who are deemed to be a good ‘fit’ for this particular cohort of group participants, and; Have had limited prior opportunity to participate in a group program (with WHS or

another agency), or;

Have been a recent participant of a related group program and the current program is presented as a follow-on group (as in DBT Skills Group modules).


Section 11 – Responding to logistical challenges



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When a client cancels or fails to attend multiple appointmentsCommitment to attending counselling appointments is encouraged as being an important component of therapeutic progress. Women are advised at Intake of the importance of attending appointments and of advising WHS of cancellations. While recognising that women have legitimate reasons for cancelling an appointment, multiple cancellations or missed appointments will trigger a conversation with the counsellor about readiness for counselling. Counsellors will not continue to reschedule appointments for clients who do not attend. A local WHS protocol (Cancellation/DNA of Counselling Appointments Protocol 2017) outlines rescheduling and follow-up practices in relation to missed appointments. (This Protocol is located in the WHS policy documents folder in Q drive.)

When clients request a change of counsellorIf a client requests a different counsellor, the team leader will speak with her to clarify the nature of her concern and to see if this can be resolved within the existing therapeutic relationship. Particularly for clients who experience difficulty with interpersonal relationships, valuable learning can be gained by working through therapeutic ruptures. However, it is recognized that sometimes the particular counsellor-client dyad is not a good fit, or that the client will continue to feel unsafe within the relationship. In this case, the team leader will arrange for the client to be reallocated to a new counsellor. At times, there may be a wait for a counsellor to become available. When a client repeatedly expresses dissatisfaction with a number of counsellors, the team leader, in consultation with WHS manager, may set a limit on the number of times a new counsellor will be offered.

When a counsellor leaves the service or takes extended leaveUnexpected loss of the counsellor can be distressing and psychologically destabilising for clients. Where possible, counsellors will give clients significant advanced notice and support the client in her transfer to a new counsellor. Some additional counselling sessions may be offered to facilitate relationship building.

When a client’s counsellor is no longer available, the client will be offered a new counsellor as soon as possible. If the counsellor is on extended leave, clinical decisions will be made in consultation with her clients, concerning what level of interim support will be offered including telephone contact, one-off appointments or transfer to another counsellor.

Dual relationshipsDual relationships may arise from a pre-existing social connection between a WHS counsellor and a woman requesting counselling, or from a connection between clients, such as a mother and adult daughter both attending counselling. These relationships are to be avoided where possible. When identified, arrangements are made to allocate to a different counsellor and for counsellors to excuse themselves from consultation/clinical supervision discussions. When a dual relationship has not initially been identified, but becomes apparent in an already established counselling relationship, the counsellor will bring the matter to clinical supervision.



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Clients accompanied by childrenGiven the traumatic material and level of emotional distress and arousal that a client may experience during counselling sessions, children should not accompany clients to therapy. If necessary, an infant may be brought to counselling, however, the content of the counselling session will need to take into account the presence of the baby and risk of harm: even if unable to understand verbal content, an infant may be impacted by her carer’s level of hyperarousal or dissociation.

If a woman brings a child to a counselling session the counsellor will assist her to problem solve regarding childcare options, including emergency childcare services. The content of any counselling session where children are present will be restricted to low-key interventions such as mindfulness practice or information regarding sleep hygiene.


Section 12 – Mitigating Vicarious Trauma

Vicarious trauma has been described as “the transformation of the counsellor’s or helper’s inner experience as a result of empathic engagement with survivor clients and their trauma material.”8 Saakvitne and Pearlman go on to say:

“We view vicarious traumatization as an occupational hazard, an inescapable effect of trauma work….Trauma work assaults our self-protective beliefs about safety, control, predictability, and protection.”8

WHS has a number of processes in place to mitigate the effects of exposure to traumatic material. These include: A clear understanding that vicarious trauma can be experienced by a counsellor at any

time and is not a personal weakness. Staff members are encouraged to seek support from the counselling team leader, external supervisor and WHS manager when they have concerns;

Regular education on the topic of vicarious trauma and a focus on personal skills development such as Mindfulness and Self-compassion skills;

Regular clinical supervision, check-in meetings with WHS manager and professional education sessions;

Management of workload patterns to limit face to face counselling hours with adequate time for administrative and clinical record keeping and opportunity to undertake projects, health promotion activities or group work;

Regular team building and check-in processes to foster mutual support.


Section 13 – Clinical Supervision



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Clinical supervision is provided in accordance with the Clinical Supervision for Allied Health Clinicians Operational Guideline and Women Youth & Children Business Rules for Allied Health Clinical Supervision.

The counselling team leader provides individual clinical supervision for each counsellor. Supervision takes place for one hour each fortnight. For counsellors working a reduced workload, frequency of supervision may be varied. Urgent supervision, debriefing and consultation needs are provided outside the pre-arranged supervision times. Team members also support each other with debriefing and consultation.

An external clinical supervisor provides supervision to the Counselling Team Leader, on average, once a month. A different external supervisor provides group supervision to all members of the counselling team, usually for one hour each fortnight. The external group supervisor is expected to have a high level of skill in working with women with complex trauma and a well-developed capacity to provide consultative supervision to a multi-disciplinary team.

Clinical supervision with the interprofessional team of counsellors, nurses, nurse practitioner, staff specialist and dietitian takes place once a month. This supervision is facilitated by WHS team members. On occasion, members of the administration team may be invited to participate when there is a supervision theme of relevance to the whole service.

Counsellors are responsible for ensuring that their professional development and clinical supervision activities throughout each year meet ACT Health’s credentialing requirements according to psychology, social work or counselling professional disciplines’ expectations.


Implementation

This Guideline will be incorporated into induction processes for new WHS staff and used as a reference point for existing WHS staff. Relevant sections of the Guideline will be shared with partner services to better inform them about the WHS counselling service. The Guideline will be used to inform planning with regard to Quality Improvement and professional learning.

The Guideline will be available for staff to access on the policy register.




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Related Policies, Procedures, Guidelines and Legislation

Policies ACT Health Child Protection Policy CHHS Clinical Supervision ACT Health Code of Conduct ACT Public Service Code of Conduct

Procedures CHHS Initial Management, Assessment and Intervention for People Vulnerable to Suicide CHHS ACT Health Staff working with Child & Youth Protection Services Annual Renewal of Health Practitioner Registration – Allied Health Credentialing and Defining the Scope of Clinical Practice for Allied Health Professionals Division of Women Youth & Children Business Rules for Allied Health Clinical Supervision

Guidelines Division of Women Youth & Children Community Health Programs Practice Guideline:

Practicing with Children in the Room (in draft) Clinical Supervision for Allied Health Clinicians Operational Guideline

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011 Children and Young People Act 2008 Australian Capital Territory Family Violence Act 2016 Mental Health Act 2015 Corrections Management Act 2007


References

1. Australian Capital Territory Family Violence Act 2016 Republication No 5 Effective: 25 April 2018, Part 2, Section 8, p.6.

2. Kezelman C, Stavropoulos P. The last frontier: Practice guidelines for treatment of complex trauma and trauma Informed care and service delivery, Australia: ASCA Adults Surviving Child Abuse (more recently known as the Blue Knot Foundation); 2012.

3. Kinsler PJ. Complex psychological trauma: the centrality of relationship, New York and London: Routledge; 2018.

4. International Society for Traumatic Stress Studies (ISTSS) Expert Consensus Treatment Guidelines for Complex PTSD in Adults [Internet], 2012 [cited 2018 May]. URL http://www.istss.org/treating-trauma/istss-complex-ptsd-treatment-guidelines.aspx

5. Chu JA. Rebuilding shattered Lives: Treating complex PTSD and dissociative Disorders, 2nd Edition. New Jersey: John Wiley & Sons; 2011.



http://www.istss.org/treating-trauma/istss-complex-ptsd-treatment-guidelines.aspx

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6. Courtois CA, Ford JD, Cloitre M. Best practices in psychotherapy for adults. In: Courtois CA, Ford JD, editors. Treating complex traumatic stress disorders: An evidence-based guide. New York: The Guildford Press; 2009.

7. Fisher J. Putting the pieces together: 25 years of learning trauma treatment. Psychotherapy Networker[Internet] 2014 May/June[cited 2018 March]; Available from: URL https://janinafisher.com/pdfs/twenty-five-years.pdf

8. Saakvitne KA, Pearlman LA. Transforming the pain: a workbook on vicarious traumatization. New York/London: W. W. Norton & Co, 1996. p.25.

9. Ford JD, Courtois CA. Defining and understanding complex trauma and complex traumatic stress disorders. In: Courtois CA, Ford JD, editors. Treating complex traumatic stress disorders: An evidence-based guide. New York: The Guildford Press; 2009.

10. Psychotherapy and Counselling Federation of Australia (PACFA); [Internet] North Fitzroy, Victoria, 2013. Counselling & Psychotherapy Definition [cited 2018 March]. Available from: URL http://www.pacfa.org.au/practitioner-resources/counselling-psychotherapy-definitions/

11. Ford JD. Neurobiological and developmental research: clinical implications. In: Courtois CA, Ford JD, editors. Treating complex traumatic stress disorders: An evidence-based guide. New York: The Guildford Press; 2009.


Definition of Terms

Complex Trauma: Repetitive or prolonged exposure to harm or abandonment by significant adults during the victim’s development.9

Counselling: Counselling focuses on specific problems, changes in life adjustments and fostering clients’ wellbeing.10

Developmental Trauma: Traumatic experiences that interfere with the normal progression of a child’s psychological development.11

Dual Relationship: The existence of an additional way of relating to a client, or knowing about a client, based on a secondary relationship or role, such as, having a pre-existing personal connection with the client, or knowing of the client through a counselling connection with a related client.

Interpersonal Trauma: Traumatic experiences associated with violence, abuse or neglect, usually by somebody known to the victim, as in intimate partner violence, incest or family violence.

Phase 1 Counselling: An initial set of up to eight counselling sessions offered to women commencing counselling at WHS.



http://www.pacfa.org.au/practitioner-resources/counselling-psychotherapy-definitions/

http://www.pacfa.org.au/practitioner-resources/counselling-psychotherapy-definitions/

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Phase 2 Therapy: Counselling or psychotherapy treatment which may follow on from Phase 1 counselling depending on an assessment of the specific needs of the client, her readiness to commit to therapy and defined therapy goals.

Psychotherapy: Psychotherapy is concerned with the restructuring of the personality or self and the development of insight.10

Vicarious Trauma: Negative psychological, cognitive and/or health impacts in the counsellor arising from exposure to her clients’ traumatic material.

WHS: Women’s Health Service.


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Women’s Health Service, Counselling


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Attachment 1: Qualifications and experience: Women’s Health Service Counsellor HP3

Disclaimer: This document has been developed by Canberra Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 15 Aug 2018 New Document Liz Chatham, ED WY&C CHHS Policy Committee06/05/2020 Templated and

document updated to reflect current organisational structure

Policy Team Leader Co-chair CHS Policy Committee

This document supersedes the following: Document Number Document Name



CHHS18/211

Attachment 1: Qualifications and experience: Women’s Health Service Counsellor HP3

This position is a protected position and is open to women only as ACT Health, consistent with section 34(2)(i) of the Discrimination Act 1991, considers that it is a genuine occupational qualification for a woman to be employed in this position to most effectively provide the counselling service.

Mandatory Qualifications/Other Requirements: Tertiary qualifications or equivalent in Psychology/Social Work or relevant equivalent

degree

For Psychology: Be registered or be eligible for general registration with Psychology Board of Australia Highly Desirable: Approved or eligible for approval as a Psychology Board of Australia

Principal and/or Secondary Supervisor for 4+2 interns and/or Higher Degree Students

For Social Work: Degree in Social Work Professional membership or eligibility for professional membership of the Australian

Association of Social Workers (AASW) Registration under the ACT Working with Vulnerable People Act 2011

For Counselling: Eligible qualification pathways

Pathway 1Minimum five-year full-time (or part-time equivalent) sequence of study made up of:(i) Minimum three-year undergraduate Bachelor-level accredited degree in a health-

related discipline (psychology, social work, occupational therapy or other discipline considered relevant)

AND(ii) Minimum two-year full-time (or part-time equivalent) post-graduate study in

counselling via a Psychotherapy and Counselling Federation of Australia (PACFA) or Australian Counselling Association (ACA) accredited course;

OR(iii) Three-year part-time Australian and New Zealand Association of Psychotherapy

(ANZAP) training in the Conversational Model.

Pathway 2Minimum three-year undergraduate Bachelor of Counselling degree via a PACFA or ACA accredited courseAND(i) Minimum one-year full-time (or part-time equivalent) post-graduate study in

counselling via a PACFA or ACA accredited courseOR

(ii) Three-year part-time ANZAP training in the Conversational Model.



CHHS18/211

Demonstrated evidence of eligibility for listing on the Australian Register of Counsellors and Psychotherapists (ARCAP) as either a Division A PACFA minimum Clinical Registrant or Division B ACA minimum Level 3.



women’s health service - counselling services · web viewthis guideline will be incorporated into...

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