Last time, I promised to provide some guidelines about "finding a place of safety", well, as you've seen from "My Story" I believe in being honest! and you know I've sought help from hospitals before -- that includes from Dunedin's Ashburn Clinic! Well, sadly, fat lot of good, and risky, that turned out to be. I tried to kill myself a week after getting out of Ashburn, and you know I hope you can learn from my experience, and I've dedicated my site to "Wayne", someone I knew from Ashburn, who killed himself in August of last year. I met Wayne in Ashburn, we grew to be friends, largely because of how helpful he was to me, and how unfortunately similar our time, and experience, in Ashburn turned out to be be.
So, what's wrong with Ashburn?!
- a lack of adequate up-front assessment, resulting in (this won't be a surprise to those familiar with my website or this blog) -- inadequate and inappropriate treatment, often resulting from an outdated conception of psychological trauma, and complex trauma in particular
a years-old awareness of clinical research literature -- I did complain to the Health & Disability Commissioner about Ashburn but was assured their approach was "research-based" -- this is like saying that giving a blood transfusion to someone who's hemorhaging is research-based -- after all, we know the human body has a lot of blood and that losing too much blood has "unfortunate consequences", like death -- this is "research-based", William Harvey studied the systemic circulation of the blood supply in the 17th Century, so is Ashburn's approach "research-based", although in this case the research is only thirty years old -- but would you want your loved one being subjected to such outdated treatment? Would you want a tranfusion of blood that hadn't been matched to YOUR blood supply, risking incompatibility and "unfortunate consequences", like death?
The clinical guidelines and literature you'll see discussed on this site is years ahead (like it's current research that's being discussed!) of what Ashburn practice is based on. You have a RIGHT to demand your therapists keep up to date with clinical research -- I do, so it's available to anyone who's "professional" enough to assume their required responsibility.
- a lack of trained staff -- Ashburn "trains" staff, especially psychotherapists, yet they practice everyday in the absence of direct supervision, yet the patients are encouraged to regard them as "expert staff"; the senior nurses involved with everyday therapy have little, or no, training in psychiatric nursing, let alone formal qualifications in counselling. There are some exceptions, but not surprisingly, GOOD staff usually go elsewhere fairly quickly -- well-intentioned staff are not the same as GOOD staff.
- the professional staff there are often not members of relevant professional associations (like the NZ Psychotherapists Association - NZAP) -- why should they be? well, then they might be professionally accountable to their peers -- but Ashburn don't want that do they, and as a result, their assessments are often devoid of ciients' life contexts, being heavily medical-model instead (I was "assessed" - I should have been receiving counselling, but no counselling was ever received -- by pysychotherapist "Richard" there, and ended up feeling he'd make a very good entomologist -- I felt stuck like on an insect on the end of a pin by his "counselling" and report of his assessment, but it did me no good whatsoever, as it didn't review me in the context of my life history -- something directly contrary to the guidelines of the NZAP and the NZ Counsellors Association.
- there's a severely restricted range of research-validated therapies -- even though Ashburn says it functions according to a psychodynamic model, there's a restricted range of psychodynamic therapies -- there's nothing like Spermon's therapy for complex trauma (Spermon, Darlington, and Gibney, 2010); there's nothing like Fonagy's Mentalization Therapy (Bateman & Fonagy, 2003) -- despite having a speaker about it at a conference held at Ashburn -- Mentalization's an essential element of research-supported psychodynamic therapy for those with histories of disturbed attachment -- the majority of Ashburn clients. There are no contextual therapies like Dialectical Behavior Therapy or Acceptance and Commitment Therapy -- which extensive clinical research supports. There's a lack of respect for men's particular needs, like gender respecting therapy for adult male survivors of chilhdood sexual abuse -- MSSAT is particularly shunned by Ashburn staff. Treatment for those with subtance abuse problems bears no relation to motivational interviewing (MI) -- both AA and MI are well accepted approaches in the substance abuse counselling field; instead, Ashburn's approach is heavily confrontational -- which is DEFINITELY NOT supported by the clinical treatment literature, but likely counter-productive.
- there's no respect for Client-Directed, Outcome-Informed (CDOI) approaches and patients' perspectives (see Fluckiger, et al, 2012) -- Ashburn expects patients to act in accordance with a strict expert-subject role relationship -- but who's the real expert in what's going on for patients? You, the patient suffering, or someone else without your life experience?? Thus, Ashburn staff clearly stigmatize patients and patients' therapy suffers due to patients not being respected and not being able to take part properly in therapy as a result.
- sadly, those in NZ are devoid of many of the rights available elsewhere -- you do NOT have a right to your clinical records -- that's for those at places like Ashburn to decide -- in Australia, your records must be made available to your clinical representative if an agency like Ashburn decides it's not in your best interests to receive those records directly -- thus such agencies evade even any sense of accountability
- Ashburn staff exercise shame-based approaches (instead of validation-based approaches, see Linehan, et al, 2002) to manage clinical milieu, with damaged patients exacting damaging influences on others, or are just "neglected" -- I had difficulty with one patient's negative transference with me due to my reminding her of her father -- I advised psychiatrist Stephanie as soon as I became aware of this, but when I left, eight months later, the problem still had not been addressed, and this patient's, and my own, therapy was all the while being damaged in the process.
- Ashburn is primarily profit-driven, as soon as you look as if you're leaving you're quickly dismissed and your ongoing care is not assured; further aggravated by Ashburn staff repeatedly saying, in effect, "we're the best", and repeatedly criticising and deriding other services -- quite unjustifiabily -- I've always had excellent care (by the nursing staff) in Psychiatric Services in Dunedin -- far better than I ever had at Ashburn, just the psychiatrists in public services here have been lousy, in MY experience, especially the "intellectual leader" of Psychiatric Services in Dunedin, Paul Glue, who once said "they're the best there is", referring to staff at Ashburn -- well, compared to you, Paul, ANY other psychiatrist is good, that's true, but certainly Ashburn staff psychiatrists are very far from being good, or competent. Certainly, we need to, and can, largely, rely on the nursing services in the public system, rather than being afraid of those services as a result of the derision they receive from Ashburn staff.
So, so far as "finding a place of safety", the first and most important thing is to not put yourself in a more difficult position than you were in originally -- Ashburn IS a far worse place than you're in, if you're in recovery, and no longer being sexually or physically abused. Many nursing staff go there, rather than local services, in a wish to avoid the stigma rife in the system if you're a working professional (Adams, et al 2010), but quickly (like overnight!) leave as soon as they have their first experience of Ashburn. But, if you've suffered complex trauma, or emotional abuse, going to Ashburn will be yet a continuation of your history of abuse.
Come on Ashburn -- and you psychiatrists there! Challenge me and my "allegations" above in a court of law, but respect my right to my records so I can fight my case! No challenge means no contest.
Not surprisingly, the guts have been ripped out of Ashburn in recent years -- the lion's share of its income used to come from ACC due to clients with sensitive claims receiving counselling there -- this doesn't happen anymore, due to "financial" reasons -- Ashburn couldn't justify its treatments for ACC clients. Ashburn -- a lovely location, a great, much needed, potential service, but currently going to waste in the hands of its psychiatrist / administrators.
As my website users will know, this post, and its more positive recommendations, have been delayed by a more thorough review of meta-analytic studies looking at treatment outcome studies for trauma and complex trauma -- more on the results of that in my next post!
Adams, E. F. M., Lee, A. J., Pritchard, C. W., & White, R. J. E. (2010). What stops us from healing the healers: a survey of help-seeking behaviour, stigmatisation and depression within the medical profession. The International journal of social psychiatry, 56(4), 359–370. doi:10.1177/0020764008099123
Bateman, A. W., & Fonagy, P. (2003). The development of an attachment-based treatment program for borderline personality disorder. Bulletin of the Menninger Clinic, 67(3), 187–211.
Flückiger, C., Del Re, A., Wampold, B. E., Znoj, H., Caspar, F., & Jörg, U. (2012). Valuing clients’ perspective and the effects on the therapeutic alliance: A randomized controlled study of an adjunctive instruction. Journal of Counseling Psychology, 59(1), 18–26. doi:10.1037/a0023648
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., & Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and alcohol dependence, 67(1), 13–26.
Spermon, D., Darlington, Y., & Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes. Psychology Research and Behavior Management, 3, 119–127.