1. 1
Presentation
on
HSE National Counselling Service
for Adults who Have Experienced Abuse in Childhood
To A Life that Shines – Reflecting on 10 Years of the NCS
from
Fiona Ward, Director of Counselling
to
Regional Health Forum – Dublin North East
22nd
November, 2010

2. 2
The National Counselling Service exists to listen to, value
and understand those who have been abused in
Childhood, in particular those abused in institutional
care.
The National Counselling Service aims to assist clients to
live more satisfying lives and in learning from their
experiences, strives to prevent further abuse in Ireland

3. 3
Overview
NCS Established 10 years ago in September 2000, following:-
 Media attention to issue of institutional abuse: “ Dear Daughter”; “States of Fear”
programmes;
 An Taoiseach’s public apology in response to the recognition of abuse children
suffered whilst in State care in institutions;
 The establishment of the Commission to Inquire into Child Abuse.
NCS Established to provide:-
 A professional, confidential, counselling and psychotherapy service;
 National service delivered locally (DNE - Rian and Laragh);
 Service available to any adult who experienced childhood neglect, emotional,
physical or sexual abuse in childhood.
 Priority given to adults who experienced abuse in institutions as children.

4. 4
National Model of Service
 Accessible:-
 Free phone access;
 Self referral by telephone, non-stigmatising;
 Available free of charge in all regions of the HSE.
 Available from more than 60 locations nationwide
 Eight locations in DNE area:- Dublin 9, Dublin 7 and Dublin 3, Navan,
Cavan, Monaghan, Drogheda and Dundalk.
 Professional:- confidential, counselling and psychotherapy Service.
 High Quality:-
 National policies and standards guide practice;
 Comprehensive model of supervision;
 Shared learning across areas.

5. 5
Cont/d…
 Counselling and psychotherapy tailored to meet client needs
 No dominant therapeutic model;
 Counsellor/therapists hold different therapeutic trainings.
 NCS Counsellor/Therapists, highly qualified and experienced in the area of
developmental trauma:-
 Primary health qualification in nursing, social work, medicine or
psychology;
 Post-graduate qualification in counselling and psychotherapy;
 Minimum of two years post-graduate experience.
 28 counsellor/therapists working across the DNE area - 18 WTE.

6. 6
Accessing Counselling
 Easy access:-
 Free-phone number;
 Self referral encouraged: 65% of referrals in DNE are self referrals.
 Contact details taken by Administrator
 Follow up call by counsellor/therapist to Client prior to appointment if
necessary or if requested.
 Initial appointment within 4 - 6 weeks;
 If counselling appropriate client’s name placed on waiting list for ongoing place in
counselling/psychotherapy;
 Clients may be prioritised for counselling [clients who experienced abuse in
institutions, clients who identify risk issues];
 Client provided with information and details of other support services while
awaiting ongoing counselling.

7. 7
Referral Profile
 20,000+ referrals since 2000 (more than 5,500 in DNE)
 Nationally 1,000 adult men and women in counselling at any one time.
 15% report a history of abuse in institutions;
 During 2009 approximately 35,000 appointments were offered to clients
nationally
 75% of appointments were attended.
 Majority of clients self refer [65%] i.e. make contact directly themselves
 Main sources of third party referrals: Mental Health Services and GPs.
 35% of clients referred are male;
 Majority of clients aged 26-54 years
 Significant proportion of clients are older adults 4% are aged 69 or older.

8. 8
Nature and Context of Abuse
 NCS offers counselling and psychotherapy for all forms of child abuse, physical,
emotional, sexual abuse or neglect;
 Sexual abuse most commonly reported:-
 71% of NCS clients report experiences of sexual abuse alone or in combination
with other forms of childhood abuse (similar rate for males and females).
 47% of clients reported that they had experienced emotional abuse;
 Men more likely to report experiences of physical abuse;
 Women more likely to report abuse by a family member;
 Men more likely to have experienced abuse in an institution;
 31% of clients report experiencing multiple forms of childhood abuse.

9. 9
Context of Abuse
Multiple
Perpetrators and
Settings
Extra-Familial
Institutional
Familial
Institutional (15%) Familial (47%) Extra-familial (26%) Multiple (12%)
(NCS 2009)

10. 10
Reasons people seek counselling
Emotional
Difficulties (21%)
Relationship
Problems (8%)
Coping difficulties
(32%)
Mental Health
Difficulties (12%)
Legal Issues (4%)
Readiness (18%)
Disclosure Issues
(2%)
Sexuality issues
(2%)
Other (8%)
Emotional Difficulties (21%) Relationship Problems (8%)
Coping difficulties (32%) Sexuality issues (2%)
Mental Health Difficulties (12%) Legal Issues (4%)
Readiness (18%) Disclosure Issues (2%)
Other (8%)
(NCS 2009)

11. 11
Waiting times
 Time waiting for a counselling place varies depending on client needs and choices
e.g. location, gender of therapist, time of appointment, etc.;
 Clients are prioritised based on clinical need;
 Waiting time varies:-
 Average wait is 6 months with prioritised clients seen within 2 months or less.
 56% clients are offered counselling within 6 months;
 Waiting time may be longer depending on clients particular needs or requirements;
 216 clients currently awaiting ongoing counselling in DNE.

12. 12
Long term Effects of Child Abuse
 Childhood abuse known to have a significant impact on mental health
(Carr 2009; McGee et al 2002).
 Functioning across a wide range of areas affected:-
 Psychological adjustment;
 Personality functioning;
 Propensity to engage in self harm;
 Intimate relationships;
 Parenting relationships;
 Educational & Occupational functioning;
 Health.

13. 13
NCS Model of Intervention
 Multi-theoretical, complex trauma treatment model of intervention;
 Utilising an integrative approach attachment/relational issues & trauma symptoms
are addressed;
 Therapy involves: processing of traumatic material using therapy as a secure base;
 Key elements include:-
 Therapeutic alliance – trust;
 Psycho-education;
 Symptom alleviation;
 Affect regulation;
 Cognitive intervention;
 Processing of traumatic memory;
 Relational issues;
 self acceptance. (Adapted from Courtois, 2007)

14. 14
Length of Counselling
 Majority of clients attend weekly for one hour;
 Range of counselling contract options offered depending on assessed needs:-
 Short term up to six sessions - to address immediate issues or a current crisis;
 Medium term contracts - up to 20 sessions;
 Long term contracts - more than one year.
 Clients may be offered individual therapy or group therapy;
 Research indicates that clients with pervasive problems require more than 20
sessions to make clinically significant progress (Carr 2008);
 In general clients who experienced abuse in institutional settings attend for
longer contracts than those abused in other settings
 34% of institutional clients availed of 20+ sessions vs 26% of those abused in
non-institutional settings.
 Process of engaging in therapy can be extremely difficult for clients where
there was an absence of normal developmental experience: e.g. one main
caregiver;
 Approximately 15% of clients attend over a period of years due to the
extensive and multiple abuse they experienced.

15. 15
Impact of the Ryan and Murphy Reports
Following the Ryan report referrals increased significantly across the NCS:-
 Total Referrals to the NCS increased by 49% in 2009;
 Notable increase in referrals of clients abused in institutions : 91% increase
noted during the three months following publication of Ryan report;
 Majority of clients made contact for the first time.

16. 16
NCS 10th
Anniversary
 NCS Publication marking ten years of Service;
 A collection of articles by NCS Staff;
 Reflections on practice over the last ten years;
 Voice of the client central to the publication;
 Showcases learning and knowledge gained over the past decade;
 Available online at www.hse-ncs.ie.

17. 17
Developments:
Adaptations of the NCS model
 Primary Care Counselling Project:- HSE North East
 1000+ clients per year avail of short term counselling at their GP practice.
 Asylum and Refugee Counselling Project:- HSE North East
 Trauma Counselling for Residents of Mosney Accommodation Centre.
 Self-Harm Intervention Project:- Wexford
 Therapeutic intervention for those who self-harm or who have attempted suicide.
 Connect National Counselling Helpline Service
 HSE funded Out of hours telephone counselling service.
 Breaking the cycle:-
 Service offered to family members to address intergenerational impact,
 Link with St Clare’s Unit, Temple St Children’s hospital and NIAP.

18. 18
What Clients Say: Client Evaluation of the NCS
(NCS Client Evaluation 2009)
Key Issues Identified by Clients:-
 Trust; Overcoming secrecy; Self-harm; Remembering; Feeling to blame;
Sense of relief; Gaining a new perspective on life.
Outcomes:- Reported Effectiveness of NCS Counselling:-
 84% clients report improved understanding of their difficulties;
 82% report improved ability to manage feelings;
 77% report improved ability to cope;
 73% report improved self-confidence;
 53% reported an improvement in their ability to trust others.
“Attending the NCS means finding a way out of darkness and despair to a life that is
liveable… and beyond that to a life that shines”

19. 19
Additional information
 NCS National Freephone 1800 235 234
 www.HSE-NCS.ie
Afterhours telephone Counselling:-
 Connect 1800 477 477
(Wednesday to Sunday, 6:00pm – 10:00pm)

20. 20
Summary
 NCS: A professional, confidential, counselling and psychotherapy service;
 National service available in all HSE areas, delivered locally;
 Available free of charge to any adult who experienced childhood neglect,
emotional, physical or sexual abuse in childhood;
 Priority given to adults who experienced abuse in institutions as children;
 20,000+ clients referred since 2000;
 Easily accessed: Self referral and Free-phone;
 Majority of clients report positive benefits from counselling.

21. 21
Questions?