Prescott and Sanderson

FAMILY COURT OF AUSTRALIA

PRESCOTT & SANDERSON

[2016] FamCA 926

FAMILY LAW – CHILDREN – FINAL PARENTING — mental illness — lack of co-ordination of medical and allied health professionals — injunction preventing continued treatment by named psychologist of one child refused.
APPLICANT:	Mr Prescott

RESPONDENT:

Ms Sanderson

INDEPENDENT CHILDREN’S LAWYER:

Victoria Legal Aid

FILE NUMBER:

MLC

1306

2012

DATE DELIVERED:

3 November 2016

PLACE DELIVERED:

Melbourne

PLACE HEARD:

Melbourne

JUDGMENT OF:

Bennett J

HEARING DATE:

7–11 December 2015, 2–5 February 2016

REPRESENTATION

COUNSEL FOR THE APPLICANT:

In person

SOLICITOR FOR THE APPLICANT:

Self-Represented

COUNSEL FOR THE RESPONDENT:

Ms Bowen

SOLICITOR FOR THE RESPONDENT:

Hoban Lawyers

COUNSEL FOR THE INDEPENDENT CHILDREN’S LAWYER:

Ms Boymal

SOLICITOR FOR THE INDEPENDENT CHILDREN’S LAWYER:

Victoria Legal Aid

Orders

All previous parenting orders be discharged.
The mother and father have equal shared parental responsibility for the children C born … 2000 (“C”), D born … 2001 (“D”) and E born … 2004 (“E”) (collectively “the children”).
The children live with the mother.
D spend time with the father as agreed between the mother and father, and upon the advice and recommendations of the medical care team led by Professor S.
The mother and father facilitate any view expressed by C in relation to his living arrangements and/or spend time arrangements with the father and unless C expresses any other view C spend time with the father as follows:
(a)every Wednesday from 4.30pm to 7.30pm;
(b)every alternate weekend from 4.30pm Friday to 7.30pm Sunday, commencing on Friday 11 November 2016;
(c)each 24 December from 10.00am to 8.00pm save that upon the father providing written notice to the mother by 30 November in each even numbered year that he wishes to exercise time on 25 December from 10.30am to 8.00pm then his time on 24 December is suspended and time shall take place between 10.30am and 8.00pm on 25 December;
(d)during school term holidays and long summer school vacations as agreed between the father, mother and C and, in default of agreement for each alternate week of the school holidays; and
(e)at such other times as agreed in writing between the parents.
And for the purpose of changeovers:
(i)the father shall collect C at the conclusion of soccer on Friday if C continues to engage in soccer otherwise the mother will deliver C to the father’s home on Friday and the father will return C to the mother’s home at the conclusion of time;
(ii)the mother ensure that C’s overnight bag for time be delivered to, or be with, C at the commencement of soccer training;
(iii)for all other spend time arrangements the mother will deliver C to the father’s home at the commencement of time and the father will return C to the mother’s home at the conclusion of time; and
(iv)such other arrangements as may be agreed in writing between the parents.
E spend time with the father as follows:
(a)every Wednesday from 4.30pm to 7.30pm;
(b)every alternate weekend on each of Saturday and Sunday from 10.00am to 7.30pm, commencing on Saturday 12 November 2016;
(c)for an extra 2 days in every two week holiday period with the effect that there be time for a minimum of 4 days within each 2 week holiday period being the Tuesday and Wednesday immediately following E’s alternate weekend time and such time commence at 10.00am on each of Saturday, Sunday, Tuesday and Wednesday and conclude at 8.00pm on each of those days;
(d)for overnight time at the request of E and/or as otherwise recommended by E’s treating health practitioners;
(e)each 24 December from 10.00am to 8.00pm save that upon the father providing written notice to the mother by 30 November in each even numbered year that he wishes to exercise time on 25 December from 10.30am to 8.00pm then his time on 24 December is suspended and time shall take place between 10.30am and 8.00pm on 25 December; and
(f)at such other times as agreed in writing between the parents.
And for the purpose of changeovers the mother deliver E to the father’s home at the commencement of time and the father return E to the mother’s home at the conclusion of time unless otherwise agreed in writing between the parents.
For the avoidance of doubt, paragraphs 6(a) and (b) of this Order continues in full force and effect during school term holidays and the long summer school vacation.
The mother facilitate reasonable telephone and other electronic communication between the father and the children (or any of them) and the delivery of any gifts from the father to the children (or any of them).
The mother and father do all things necessary to:
(a)enable D to continue to attend upon Professor S as directed and recommended by Professor S.
(b)follow Professor S’s reasonable requests for D to attend further appointments with him;
(c)personally attend any appointment with Professor S either alone or with D as reasonably directed by Professor S and
(d)follow all reasonable directions to each of them by Professor S that may assist with D’s psychiatric progress.
The mother and father do all things necessary to:
(a)enable D to continue to attend upon F for ongoing counselling as recommended and directed by Ms F and Professor S.
(b)follow Ms F’s reasonable requests for D to attend further appointments with her;
(c)personally attend any appointment with Ms F either alone or with D as reasonably directed by Ms F and agreed to by Professor S, or approved by him.
(d)follow all reasonable directions to each of them by Ms F that may assist with D’s therapeutic progress including the child’s participation in distance education.
Save that each of the mother and father are restrained from:
(i)requesting from Ms F any further information that is communicated to her by D other than that which Ms F discloses to each of them in her discretion and
(ii)from being in the room, other than at the request of Ms F (or within hearing) during any therapeutic sessions or conversations between D and Ms F about therapeutic matters,
The parents and Ms F copy to each other any correspondence from him/her to the distance education provider for D contemporaneously with such communication being made.
The mother and father do all things necessary to enable E continue to attend upon Dr Z and Dr L as directed and recommended by those practitioners.
The mother and father do all things necessary to:
(a)enable E to continue to attend upon Ms AA for ongoing counselling as recommended and directed by Ms AA;
(b)follow Ms AA’s reasonable requests for E to attend further appointments with her;
(c)personally attend any appointment with Ms AA either alone or with E as reasonably directed by Ms AA and
(d)follow all reasonable directions to each of them by Ms AA that may assist with E’s therapeutic progress
Save that each of the mother and father are restrained from:
(i)requesting from Ms AA any further information that is communicated to her by E other than that which Ms AA discloses to each of them in her discretion and
(ii)from being in the room, other than at the request of Ms AA (or within hearing) during any therapeutic sessions or conversations between E and Ms AA about therapeutic matters.
The mother and father do all things necessary to enable the children to continue to attend upon Dr K in relation to their medical treatment and if Dr K is not available then such other medical practitioner that is available at the BB Town Medical Centre, BB Town.
The mother and father be equally responsible for the cost of out-of-pocket expenses for D and either of them attending upon Professor S and Ms F and E attending upon Dr L and Ms AA and the mother and father cooperate with each other as to the manner of invoicing to minimise out-of-pocket expenses. Nothing in this Order prevents the father from reliance upon these expenditures in relation to his liability for child support.
IT IS REQUESTED that Professor S undertake a coordinating role in relation to the treatment of D and E and if that occurs with the concurrence of all practitioners concerned the parents each do all acts and things necessary to facilitate the girls’ treating medical and mental health practitioners engaging with Professor S to enable a coordinated approach to the mental health treatment of D and E and, if Professor S considers it would be beneficial to the girls (or either of them) to do so, the mother’s treating mental health professional.
Each of the mother, Ms Sanderson, born … 1965, and the father, Mr Prescott, born … 1973, and their servants and agents be and are restrained from removing or attempting to remove or causing or permitting the removal of C, MALE, born … 2000, D, FEMALE, born … 2001, AND E, FEMALE, born … 2004 (“the children’) from the Commonwealth of Australia.
The children, C, D AND E be and are hereby restrained from leaving the Commonwealth of Australia.
IT IS REQUESTED that the Australian Federal Police give effect to the preceding order by placing the names of the said children on the Airport Watch List in force at all points of arrival and departure in the Commonwealth of Australia and maintain the children’s names on the Watch List until further order.
The mother and father each be and are hereby restrained from causing, permitting or suffering an application to be made in respect of all or any of the children for a new United Kingdom or Australian passport to issue pending further order or order of the Court.
The mother be at liberty to provide a copy of these Orders and Reasons for Judgment to any mental health practitioner she attends.
The Independent Children’s Lawyer provide a copy of these Orders and Reasons for Judgment to:
(a)       Professor S,
(b)       Dr L,
(c)       Ms F,
(d)       Ms AA,
(e)       Dr K,
(f)        Dr Z,
(g)       Mr CC, and
(h)       J Town Primary School and J Town Secondary College.
The appointment of the Independent Children’s Lawyer be discharged.
All extant applications be and are hereby dismissed and this matter be removed from the docket of the Honourable Justice Bennett.
That pursuant to sections 65DA(2) and 62B of the Family Law Act 1975 (Cth) the particulars and the obligations these orders create and the particulars of the consequences that may follow if a person contravenes these orders and details of who can assist parties adjust to and comply with an order are set out in the Fact Sheet attached hereto and those particulars are included in these orders.

IT IS DIRECTED

That all material produced under subpoena be returned to the party or entity producing same at the expiration of the appeal period and if no appeal has been lodged with the Court.

AND IT IS NOTED that the mother and father agree to acknowledge or facilitate C’s wishes in relation to a change in his living arrangements.

IT IS NOTED that publication of this judgment by this Court under the pseudonym Prescott & Sanderson has been approved by the Chief Justice pursuant to s 121(9)(g) of the Family Law Act 1975 (Cth)

Note: This copy of the Court’s Reasons for Judgment may be subject to review to remedy minor typographical or grammatical errors (r 17.02A(b) of the Family Law Rules 2004 (Cth)), or to record a variation to the order pursuant to r 17.02 Family Law Rules 2004 (Cth)..

FAMILY COURT OF AUSTRALIA AT MELBOURNE

FILE NUMBER: MLC 1306 of 2012

Mr Prescott

Applicant

And

Ms Sanderson

Respondent

And

Independent Children’s Lawyer

REASONS FOR JUDGMENT

Introduction

Conduct of the Proceedings

The Children

C
D
E

Evidence

Proof and findings of fact

Background to the Family and Procedural History

Credit & Impression of Witnesses

Father
Mother
Ms H
The expert witnesses

Relevant Law – Parenting Issues

Determining the child’s best interests

Discussion

Relevant additional considerations

The child’s views
The nature of the children’s relationships
Capacity of the parents to meet the children’s needs and the attitude to the children and to the responsibilities of parenthood demonstrated by each of the children’s parents
The children’s maturity, sex, background and other characteristics
The extent to which each of the child’s parents has taken or failed to take the opportunity to participate in making decisions about major long-term issues in relation to the child, to spend time with the child and to communicate with the child
The extent to which each of the parents have fulfilled or failed to fulfil his/her obligations to maintain the child
The likely effect of any changes in the children’s circumstances
Practical difficulty and expense associated with face to face time and/or communication with the other parent
Any family violence involving the children or any member of the children’s family and family violence orders
Whether it would be preferable to make an order that will be least likely to lead to the institution of further proceedings in relation to the children

Parental responsibility

Consideration of equal time or substantial and significant time with both parents

Conclusion

Annexure A: Summary of Medical Practitioners’ Reports

The Mother

Dr U, Consultant Psychiatrist
Dr Y, Consultant Psychiatrist
Mr CC, Consulting Psychologist
Ms F, Consultant Psychologist

Ms F, Consultant Psychologist

Dr FF, General Practitioner
Ms EE, Psychologist
Dr DD, Consultant Paediatrician
Ms F, Consultant Psychologist
A/Professor Q, Consultant Child and Adolescent Psychiatrist
Dr GG, Paediatrician
Ms B, Psychologist
Dr K, General Practitioner
Prof S, Consultant Child and Adolescent Psychiatrist

Ms EE, Psychologist
Dr DD, Consultant Paediatrician
F, Consultant Psychologist
Dr L, Paediatrician
Dr Z, BB Town Medical Clinic
Ms AA, Psychologist

Introduction

These proceedings concern the parenting arrangements for C born in 2000 (“C”), D born in 2001 (“D”) and E born in 2004 (“E”) collectively (“the children”).
This family is afflicted by mental health issues. Having heard the parents extensively and from some of the expert witnesses revealingly, I am satisfied that these proceedings must be finalised on the basis that there is no good solution for the family in the short to medium term and that the principal benefit of these proceedings is confined to a realisation amongst treating health professionals that there is an urgent need for oversight and cohesion between them in his or her treatment of the daughters and a greater scrutiny of the role that the mother’s anxieties play in the promotion of the daughters’ conditions.
The applicant father was unrepresented for the final hearing. He was last represented by Ms Jenkins on 20 April 2015. The mother was represented by Ms Bowen, of counsel. Ms Boymal was counsel for the independent children’s lawyer.
By his application, the father is seeking to have shared parental responsibility for the children; that C and E live and spend time equally between the father and the mother on an alternate weekly basis; that D continue to live with the mother for as long as her treating medical professionals determine this to be in her best interests; and that there be a particular focus on D re-establishing regular contact with the father, preferably by telephone as a priority. With respect to E, the father is seeking consideration of a staged implementation of the living arrangements without prolonging the process. The father also seeks orders to be made that prevent the mother from making unilateral decisions for the children without consulting him and that she keep him informed and seek his permission before any major decisions are made about the children.
The respondent mother seeks shared parental responsibility for the children and that the children live with her; that D spend time with the father as agreed by the medical team lead by Professor S; that E spend daytime only access visits; that C spend every second weekend with the father; that there be unrestricted communication between the children when living or spending time with the other parent; that D continue to attend upon Professor S and Ms F; that E continue to attend upon Dr Z and Dr L; and the children continue to attend upon Dr K.
The parties each sought orders in relation to the children’s passports and the ability to travel interstate (the father) and to the United Kingdom (the mother).
Pursuant to an order made on 1 August 2013, Mary Lonergan, solicitor, was appointed as the independent children’s lawyer for the children within the meaning of Division 10 of Part VII of the Family Law Act1975 (Cth) (“the Act”). Her role is to form an independent view, based on available evidence, of what is in the best interests of the children and then act in these proceedings in what she believes those best interests to be.[1] Ms Lonergan is not a legal representative retained by the children and she is not bound by any instructions from them.[2] The role of the independent children’s lawyer is to deal impartially with the parties, ensure that any views expressed by the children are fully put before the court, to analyse documentary, expert evidence and reports and to distil from that evidence significant matters for the purpose of properly drawing them to the court’s attention. The independent children's lawyer is also under a specific duty to take steps to minimise for each of the children the trauma associated with proceedings[3] and to facilitate an agreed resolution of matters at issue in the proceedings to the extent that it is in the best interests of the children to do so.[4]
[1] Family Law Act 1975 (Cth) s 68LA(2).
[2] Family Law Act 1975 (Cth) s 68LA(4).
[3] Family Law Act 1975 (Cth) s 68LA(5)(d).
[4] Family Law Act 1975 (Cth) s 68LA(5)(e).
The independent children’s lawyer met with the children in April 2016 for approximately an hour at T Town Community Health.
The family has had contact with a range of medical professionals. The history of treatment is long and diverse. It is too long to incorporate into these reasons but too revealing to omit or cherry pick. Accordingly, I have summarised the attendances as an annexure (see Annexure “A”)[5] to these reasons and will refer to the content in the course of these reasons. These include reports by twelve different clinicians. Annexure “A” would reward being read it its entirety. I have regard to this evidence in my determination.
[5] Annexure “A”

Conduct of the Proceedings

These parenting applications are proceedings to which the Less Adversarial Trial provisions of Division 12A of Part VII of the Act apply.
The principles for conducting child related proceeding, which I observed, require the court:[6] to consider the needs of the child concerned and the impact that the conduct of the proceedings may have on the child in determining the conduct of the proceedings, to actively direct, control and manage the conduct of the proceedings and ensure that the proceedings are to be conducted in a way that will safeguard the child concerned against family violence, child abuse and child neglect and the parties to the proceedings against family violence. These principles found expression in excluding some of the children’s therapeutic practitioners from professionals required to give evidence. To the greatest extent possible, the proceedings were conducted in a way that would promote cooperative and child-focused parenting by the parties. The proceedings first came before me in July 2014. The matter reached final hearing stage on at least two occasions and the hearing was postponed in favour of trialling some clinical intervention for D and E. Case management considerations were subordinate to the needs of the family. Eventually, the final hearing was of nine days’ duration.
[6] Family Law Act 1975 (Cth) s 69ZN.

The general duties[7] and powers relating to evidence[8] expand the court’s role in the regulation of child related proceedings. I am satisfied that the case was conducted in such a way as to promote an outcome which is, to the greatest extent possible, in the children’s best interests. However, it was not until all the evidence was adduced that it became clear that little can be done and that, in my determination, whilst the father’s application is well intentioned it is not well founded.
[7] Family Law Act 1975 (Cth) s 69ZQ.
[8] Family Law Act 1975 (Cth) s 69ZX.
The proceedings were dominated by D’s mental health issues and E’s health and mental health issues and the mother’s capacity to provide care for the girls. I will provide detail about the girls later in these reasons (see [23]–[38]). At this point it is sufficient to say that D is socially incapacitated, unable to function normally, cannot mix freely within the community or attend school. D may never lead a normal life. E is able to attend school and to spend limited time with the father. She is mentally unwell and suffers some physical ailments which fortify her reluctance to leave home, her mother and sister or to spend extended time with the father. The overwhelming concern of the father, and the court, is that E is heading in the same direction as D and, therefore, that there needs to be more sharing of information between professionals about their treatment of the girls.
C is psychologically sound but is impacted by the conditions of his sisters and his mother’s behaviours.
The father is of normal functioning.

The Children

I will describe my impression of the children in the context of s 60CC(3)(g) of the Act. They have no particular traditional or familial cultural issues.

C first, as he is the least complicated child.
C is the eldest child and has a good relationship with both parents. In his relationship with his mother, C acknowledged some tensions and that they get angry with each other. Ms V reports that “[t]his appeared to relate to normal teenage/parent conflict around C’s increasing desire for independence”.[9]
[9] Family Report, 9 November 2015, [46].
In contrast, C expressed his father’s home as a “friendlier environment, although did note that there were some tensions in his relationship with his father around school work and the father’s home environment was stricter in requiring him to do his homework.[10]
[10] Family Report, 9 November 2015, [46].
In the mother’s household he is treated differently to his sisters and the mother often during cross examination would dismiss his behaviour saying “he is a boy”. The lack of enmeshment in his relationship with the mother is its greatest strength. In his interviews with Ms V, family consultant, C expressed a desire for finality in these proceedings.
C is progressing quite well at school with the exception of maths. He will be undertaking cognitive and educational assessments at school to determine the degree of support that is required. He has established good peer relationships and has invited some of his friends around to his father’s house when he is staying there.
Given C’s age and mental health, both parents are content for C to choose where he lives and the schedule he would like for his living arrangements. The parents are currently negotiating changes to C’s living arrangements, trialling a week about schedule. C expressed some concerns with the practicalities of spending more time with his father, concerns about how he would get to school, and his annoyance about the changeover process prior to his soccer games which he amounted to be the miscommunication between his parents.[11].
[11] Family Report, 9 November 2015, [45], [47].

D was 14 years of age at the hearing. Since she was a little girl she has shown signs of separation anxiety and irrational fears in relation to the broader outside world. She has had a disruptive childhood and experiences some adjustment difficulties not assisted by having had seven changes of schools.[12] She has also seen an inordinate number and range of medical and health professionals. Based on affidavit material, she has already attended on nine professionals in relation to her well-being following the parent’s separation in 2011.
[12] Report Professor S, 9/9/2014.
According to Dr DD, Consulting Paediatrician, since her mother was unexpectedly hospitalised in 2011 D’s fears of the outside world and separation from her mother have increased.[13] When the parents first separated D would go regularly to access visits with her father, although not in accordance with the agreement between the parties as she did not stay overnight. She expressed anxieties about the intimate relationship between her father and his new partner, now wife, Ms H. Now she refuses to visit him, speak to him on the telephone or get out of the car.
[13] Dr DD, Letter to Dr K, 21 December 2012.
As the expert evidence resoundingly affirms, D has developed a very serious mental health problem. She suffers from a psychiatric illness which consists of complicated anxiety disorder, including general anxiety, separation anxiety, phobias and obsessive compulsive anxiety (also referred to as obsessive compulsive disorder). Her separation anxiety takes the form of social phobia and drives her extreme social avoidance. D will not leave the house, refuses to attend school and does not attend to matters of personal hygiene in an adequate or appropriate way. She has a range of gender dysmorphic responses due to her anxieties; she does not want to grow up and has fear of embarrassment by her peers regarding her appearance of physically becoming a woman.
Following an Initial Assessment Session, Associate Professor Q reported:[14]
[14] A/Professor Q, Gender Clinic RCH, Confidential Mental Health Note, Initial Assessment Session, 27 April 2014.
Cognitive functioning:
… [D] is reported to be very concrete in her thinking at times and resolutely resistant to some conversations or lines of thought connected with physical aspects of gender. She will not discuss “babies”, presumably because this reminds her of her own female body identity and potential? …
Suicidal ideation: her mother reports at the end of November 2013 [D] drew pictures indicating a wish to suicide. A mother’s (sic) anxious living at home particularly during a time when she has her periods. This needs further assessment: mother says however she can get extremely distressed and angry at home if the issue of her female body development is raised or challenged. She gets very depressed when her periods are present and her mother fears for her safety. [D] did not discuss this directly.
Experience of gender:
When asked about this [D’s] reply on a number of occasions “I don’t like talking about it”. She sees her younger sister as a girly girl who “makes a sick she silly” (sic)…
Insight:
Needs further assessment, but [D] came willingly to the clinic and participated in the assessment except when it came to discussion of things to do with details of gender identity, puberty and possible treatment.
She is apparently desperate to not have periods, but refuses to discuss them. She says to her mother she will not take medication that is specifically female such as the oral contraceptive pill, even though it could lead to the cessation of the distressing periods.
Her mother describes a series of rigid behaviours:
Since the age of five years she is (sic) the word ‘baby’ or more recently the word “woman”. If these were mentioned she used to get hysterical, aggressive and take off her pants and underpants.
She would not wear girls’ clothing. She wears leggings, T-shirt and sneakers.
Her menstrual periods began in November 2013 she is always refused (sic) to wear any sanitary protection.
…
At five years of age she had an episode of thrush and can nest (sic) cream had been applied. She now continues to insist this needs to be applied daily when she wears underwear.
She refuses to wear a bra, she cuts her underarm hair with scissors. And will not acknowledge her secondary female physical sex characteristics.
At home ... [e]ven if she is having a heavy period she will insist on only wearing pyjama bottoms and she pays no attention to her sanitary needs.
In 2014, D experienced episodes of suicidal ideation and Professor S, her treating psychiatrist at the time expressed serious concerns as to her survival. During cross examination, Professor S reported D’s suicidal ideation has now subsided and that she has shown marked improvement in relation to this. Nevertheless, in other areas of her mental health he attests, she has deteriorated and her mental health situation remains complex. In an email sent on 25 August 2015 to Dr K about D, Professor S reports:
On the one hand [D] has made some significant progress, with her education … Unfortunately, however, she has also become increasingly anxious to the point of being overwhelmed with intrusive obsessional and anxious thoughts or a formless and pervasive sense of anxiety and panic. Some of her thoughts involve a fear of her “family breaking up” or her mother dying. These intrusive thoughts lead to a compulsive behaviour which takes the form of her need to “mutter’. She needs to mutter by herself and therefore was having difficulty coming to see me … she is not able to mutter in the presence of another person.
Professor S later reported (24 November 2015) to Dr K:
[D] was relatively talkative about her school work, trips in the car and about her siblings and daily life but through the interview, she made no eye contact with her face being fully covered by her hair. She was reluctant to talk about her muttering but did indicate that she to do it to “drive it away”. She was distressed telling me this and I think she may have been crying although I could not see her eyes. She told me that it was “a voice” that was intruding on her thinking and also interrupting her school work. It was not possible for me to determine if this was simply her imagination rather than a hallucination although she did indicate that the voice had a command type quality.
D requires a multi-disciplinary approach to her treatment and health management. With oversight from Professor S, she sees a treatment team comprising Ms F, A/Professor Q and Dr K thereby benefitting from both psychotherapy and psychological support.
There is mixed agreement about the efficacy of Ms F’s treatment of D in particular from the father who has expressed grave concerns about Ms F and does not want her to be involved in D’s treatment. I have significant concerns about Ms F’s interaction with the family, her marginalisation of the father and her support of the mother. However, D has clearly indicated that she wants to talk to Ms F and only Ms F. Through her treatment with Ms F, D has been undertaking and developing strategies in cognitive behaviour therapy including development of stress management and relaxation techniques. Part of this process includes re-orienting D to learning, and actively helping her accept distance education, to which D was initially very resistant. D has shown significant improvement, taking up year nine work and regularly completing her workbooks and assignments. Nevertheless, D is not in a school situation, conducting her learning by distance education.
D’s social engagements are tentative and very limited. She has begun going out in the car on some visits with her mother, although D does not get out of the car unless she is going to see Ms F, Professor S or Dr K. She has resumed some physical exercise, using an exercise bicycle at home.

From about 5 years of age E has been prone to bowel issues and some evidence suggests she was lactose intolerant. She also suffers from urinary tract infections and has been diagnosed with irritable bladder syndrome which is also known as detrusor instability. The detrusor being the muscle of the bladder which causes the bladder to contract. An overactive bladder muscle causes the bladder to contract, and incontinence to occur. This leads to anxieties for children about being near to a toilet. The evidence presented is that this is a physical not psychological condition.[15] The anxiety or stress that E might feel about locating a lavatory is not connected to the anxiety that Dr L, paediatrician, and Ms AA, psychologist, refer to as being more serious than they initially thought.
[15] Transcript of Proceedings, 9 December 2015, 158.
The father in cross-examination attests that E has had blockage of the bowel twice since the parties separated requiring large doses of laxatives, a situation he blames as a result of a poor diet. Dr L affirmed that E is a little overweight for her age and height, but this matter was secondary in terms of E’s well-being.
E’s anxieties are generalised. As Dr L describes it, E has “free-floating anxiety”. She has expressed anxiety about having renal ultrasounds to address her bladder issues and in having a breath hydrogen test. She also is anxious about the toileting issues and needing to be close to a toilet.
Since the parental separation in February 2011, E has only spent one and a half nights with the father.[16] E has a strained relationship with the father, although it is the father’s evidence their relationship has become stronger in recent years. E has clearly stated that she is happy to continue with day visits to her father, but she does not want overnight stays. She has not changed her position although she remains unable to clearly articulate her reasons for not wanting to stay overnight. E has told Dr L, that she does not trust her father but was unable to elaborate further as to what she meant by this.[17] As Dr L said during cross examination:
We don’t really understand the nature of [E’s] concerns about overnight stays. She has not been able to put into words or disclose it either to myself or to [Ms AA]. But I respect the fact that [E] is very clear in her desires, has not wavered and doesn’t present as a histrionic or manipulative child at all. She presents as intelligent and articulate.[18]
[16] Transcript of Proceedings, 7 December 2015, 14.
[17] Transcript of Proceedings, 9 December 2015, 157.
[18] Transcript of Proceedings, 9 December 2015, 157.
In a telephone conversation with Dr L, Ms AA reportedly said that “[E] is quite vulnerable and has a way of coping that might give you the impression that she is coping better than she really is".[19] E is “well-defended” in other words, meaning that she can present well and appear to be holding it all together but underneath she has “entrenched and debilitating anxiety”.[20] As a result of this “well-defended” presentation it seems that the practitioners have found that E’s anxieties are more marked than they initially thought them to be.
[19] Transcript of Proceedings, 9 December 2015, 172.
[20] Transcript of Proceedings, 9 December 2015, 157 and 171.
Ms AA also categorically expressed that, given her current condition and anxieties, E should not be placed under any more pressure, including having to have overnights with the father. During cross examination, Dr L recounted her conversation with Ms AA as follows:[21]
She [Ms AA] expressed a concern that [E’s] anxiety was evolving into concerns about puberty and growing up and that has resonances, as I understand it, with her older sister, [D] … [D] is not my patient so I don’t know the ins and outs of that, but that was something [Ms AA] had expressed some concerns about. So the gist of it was that the situation was maybe more complex that I had originally thought.
[21] Transcript of Proceedings, 9 December 2015, 171.
Dr L is of the view that E’s views should be listened to, stating:[22]
I think in in a situation like this where [E] has so clearly entrusted us with her thoughts and is so articulate and is so intelligent, I think it would be potentially devastating, really, for her not to feel that the people she has entrusted with this information were to actually listen or to report it to appropriate authorities in a responsible way.
[22] Transcript of Proceedings, 9 December 2015, 173.

Evidence

There were no significant objections taken to the admissibility or fairness of the evidence relied upon.
At the trial the applicant father relied upon the following evidence:
a)His Further Amended Initiating Application, filed 26 November 2015;
b)His Affidavit, affirmed 26 November 2015;
c)Family Report by Ms V, Family Consultant, dated 9 November 2015;
d)His Affidavit, affirmed 19 March 2015;
e)Affidavit of Ms H, affirmed 19 March 2015;
f)His Affidavit, affirmed 13 April 2015;
g)Affidavit of Ms H, affirmed 13 April 2015;
h)Family Report by Ms V, Family Consultant, dated 19 December 2014;
i)Affidavit of Dr U, sworn 27 November 2013 including Annexure “A”, Psychiatric Assessment Report by Dr U, Consultant Psychiatrist, dated 1 November 2013.
j)Child and Parents Issues Assessment Memorandum by Ms V, dated 4 June 2013.
At the trial the respondent mother relied upon the following evidence:
a)Her Outline of Case, dated 15 April 2015, including the Supplementary Outline of Case for the Respondent Mother, dated 1 December 2015;
a)Response to the Further Amended Initiating Application, 2 April 2015;
b)Her Affidavit sworn 1 April 2015 including annexures; and
c)Reports by Ms F, Consultant Psychologist, annexed at “LS1” and “LS2” of the mother’s Affidavit, sworn 26 July 2013.
The materials and evidence arranged by the independent children’s lawyer were as follows:
a)Family Report by Ms V, Family Consultant, dated 9 November 2015;
b)Family Report by Ms V, Family Consultant, dated 19 December 2014;
c)Child and Family Meeting Memorandum by Dr X, Family Consultant, dated 5 August 2014;
d)Psychiatric Assessment Report by Dr U, Consultant Psychiatrist, dated 1 November 2013;
e)Child and Parents Issues Assessment Memorandum by Ms V, Family Consultant, dated 4 June 2013;
f)Evidence of Professor S, Consultant Child and Adolescent Psychiatrist;
g)Evidence of Dr L, Paediatrician; and
h)Reports and Exhibits of other medical and mental health professionals in the affidavits of the parents.
Section 69ZT operates to exclude various divisions and chapters of the Evidence Act1995 (Cth) which deal with general rules about giving evidence,[23] cross examination,[24] documents, hearsay, opinion, admissions, evidence of judgments and convictions, tendency and coincidence, credibility and character. However, neither s 55 nor s 135 of the Evidence Act are excluded. Therefore it remains the case that only relevant[25] evidence is admissible the and court retains a discretion to exclude even relevant evidence. The court may exclude or limit the use of evidence which is relevant and thus admissible if the court is satisfied that the probative value of the evidence is substantially outweighed by the danger that the evidence might be unfairly prejudicial to a party (Evidence Act1995 (Cth) s 135(a)); or be misleading or confusing (Evidence Act1995 (Cth) s 135(b)); or cause or result in undue waste of time (Evidence Act1995 (Cth) s 135(c)).
[23] With the exception of ss 26, 30, 36 (s 69ZT(1)(a) of the Act refers).
[24] With the exception of s 41 relating to improper questions.
[25] . Section 55 provides that relevant evidence is evidence which if it were accepted, could rationally affect (either directly or indirectly) the assessment of the probability of the existence of a fact in issue in the proceedings
It has not been possible to include all aspects on which I heard, or on which there was, evidence. Nonetheless I have taken the totality of the evidence into account. Just because I have not mentioned something in these reasons, it does not follow that I did not have regard to it.

Proof and findings of fact

Section 140 of the Evidence Act 1995 (Cth) provides the relevant test for the Court’s assessment of evidence in this matter: the facts in issue are to be proved by the party with the persuasive onus on the balance of probabilities.
A statement of fact is a finding of fact.

Background to the Family and Procedural History

The mother was born in the UK, discontinued tertiary education and worked on a farm before coming to Australia. The mother is not employed outside the home. At the time of hearing she was 50 years old. She receives a Centrelink Newstart Allowance and child support from the father. The mother has not re-partnered.
The father works full-time as a technician. At the time of hearing he was 42 years old. He has re-partnered.
The parents began living together in June 1999, and married later in that year. C was born in 2000, D was born in 2001 and E was born in 2004. The family lived in Queensland until the end of 2008 when they moved to J Town in Victoria.
In February 2009 the family was in the vicinity of the Black Saturday fires and more recently another passing close to J Town both of which have left a detrimental impression and subsequent significant fear of fires upon D (who was then 7 years old).
On February 2011 the parties separated. The children began to spend time with the father as agreed by the parties. The father’s post-separation residence was in the same community as the wife and children. C and D spent overnight time with the father and E spent day time only with him.
The parents attended Relationship Australia and agreed to see Dr K, general medical practitioner, to discuss arrangements with the girls.
In about April 2011, the father re-partnered with Ms H.
In about September/October 2011 D stopped spending overnight time with her father.
The parents divorced in April 2012.
D attended upon Ms HH, psychologist for two to three sessions in September and October 2011 and again in February 2012. This was arranged by the mother following consultation with the father.
In February 2012 the parents agreed that the children spend alternate weekends with the father from 5.00 pm Friday to 8.00 pm Sunday, and two evenings for dinner each week. C spent time in accordance with this 2012 agreement whereas D and E spent only day time with the father from 5.00pm to 8.00pm on Friday and 11.00 am to 8.00 pm on Saturday and Sunday, generally each alternate weekend.
In July 2012 the father corresponded via email with the mother, seeking to formalise an agreement through a mediator for time with the children.
On 7 July 2012 during a changeover and with C in the car, the mother stood in the way of the car and shouted at the father, saying words to the effect that he was on drugs. During cross examination the mother denied this incident but did acknowledge that it was inappropriate for the couple to have heated arguments in front of the children. I am satisfied that the father was not affected by drugs and that the mother’s actions were unreasonable.
In September/October 2012, Dr K referred D and E to Ms EE, psychologist. The mother took the children to see Ms EE in late 2012 without the father’s consent. Ms EE proposed Gradual Exposure Therapy in relation to the girls’ perceived aversion to overnight stays with the father. This is described more fully at pages 62 and 72 of Annexure “A” but, essentially, required the girls be exposed safely and in steps to staying overnight. Ms EE recommended that the girls stay with their father a little later on weekends, shower, put on their pyjamas and dressing gowns and watch a movie together before going home to their mother’s for the night. The father deposes that the mother refused to act on this advice and she ceased further counselling for the girls with Ms EE.[26]
[26] Affidavit of the father, affirmed 19 March 2015, [66]–[67].
In November 2012, Dr K referred E and D to Dr DD, paediatrician for counselling. The father did not consent to the children seeing Dr DD.
In early 2013, the children attended upon Ms F, psychologist for the first time. This was arranged by the mother without the father’s knowledge or consent.
In early February 2013 the father notified the mother that he would retain E’s passports and that she could retain C and D’s. The mother kept E home from school, notifying the father by text that E would not return to school until he returned her passport.
In February 2013 the father sought an undertaking that the mother cease taking the children to Dr DD or any other practitioner without his consent. The mother agreed to give the undertaking. Then the mother began communicating though her lawyers to the father about actions taken by her and the father with the children.
On 28 February 2013, the father filed an Initiating Application in this Court seeking orders to regularise the arrangements for the children to see and spend time with him. The mother’s response was filed 25 March 2013. The mother agreed to most of the orders sought by the father, making slight alterations to times suggested. She also sought that the children be allowed to have psychological support and counselling as recommended by Dr DD, paediatrician, and Dr K, general practitioner.
On 3 April 2013 orders were sought, and made, by consent by Registrar Marrone including an order for the children to attend counselling with F; for the children to spend time with their father as agreed; and a family report to be prepared by the court.
In about April/May 2013 D and E spent progressively less time with the father. C spent 3 nights, 5 days and 12 weeknight dinners, D spent 6 days and 9 weeknight dinners and E spent 4 days and 2 weeknight dinners with the father.
In May 2013, the parties attended an intake meeting with Ms V, family consultant of this court. Ms V met subsequently with the both parties and the children on 27 May 2013. In her report which was published on 4 June 2013, Ms V recommended that C spend time with the father each alternate weekend from Friday to Sunday and the girls spend time with father on at least one occasion each week. In her report, Ms V made the following observations:[27]
[Mr Prescott’s] reported experience of being undermined by [Ms Sanderson] has led him to assert himself on relatively minor issues (such as refusing to allow [C] to have a light on at night). This has directly impacted on the children and his relationships with them. Whilst [Mr Prescott’s] reluctance to accede to, what he views as, unreasonable demands by [Ms Sanderson] is understandable, given the significant impediments to the children spending time with him at present, [Mr Prescott] is encourage (sic) to consider the prioritisation of more significant issues. [C’s] time with his father could resume quite readily should he be allowed a light at night.
[Ms Sanderson] (sic) presentation and her narrative about the children’s relationships with their father was concerning. It became clear that [Ms Sanderson] has shared a significant degree of information with the children regarding their father and this dispute. [Ms Sanderson] has either demonstrated poor judgement in these communications with the children or she has done so in an attempt to interrupt the children’s relationships with their father. The narrative the children present around their relationships with their father are indicative of the early signs of alignment with their mother. [Ms Sanderson’s] capacity to support the children in their relationship with their father currently appears to be compromised and may require further assessment.
There is little dispute that all the children, but particularly [D] and [E], have underlying anxiety symptoms which have and continue to impact on their functioning across various environments. Certainly the reported anxiety is not isolated to the children’s relationship with [Mr Prescott] nor to issues arising from this dispute. However, it seems apparent that their anxiety is compounded by [Ms Sanderson’s] inability to separate these issues and to shield the children from her own views and anxieties.
…
Both parents stated their willingness to engage in a therapeutic process to assist them in how to manage the children’s anxieties, particularly as they relate to the time they spend with their father. The children will also benefit from their parents developing a more cooperative parenting relationship which minimises areas of conflict. The parents may wish to discuss with [Ms F] whether she would be well placed to work directly with them in this regard …
[27] Ms V, Children and Parents Issues Assessment Report, 4 June 2013, 9-11.
In about June/July 2013 C spent 3 nights, 3 days and 6 weeknight dinners, D has 2 weeknight dinners, and E spent no time with the father.
Ms F, psychologist, wrote a series of reports on 10 May 2013. She then produced a supplementary report dated 25 July 2013 (Thursday) which I am satisfied was published to the mother and the independent children’s lawyer prior to being published to the father. She wrote:-
[D] is at present exhibiting symptoms of acute trauma, and this, coupled with her significant anxiety and unusual behaviours, has led me to a serious concern that she has been the victim of sexual abuse.
Ms F did not send the supplementary report to the father until 9:53p.m. on Monday 29 July 2013 in anticipation of a hearing on Thursday 1 August 2013. This left the father without an adequate opportunity to respond by evidence or to obtain clarification from her prior to the hearing. It was an incendiary step in the relationship between the father and Ms F and one from which that relationship has, quite understandably, never recovered. The father felt ambushed and aggrieved by Ms F’s failure to publish the supplementary report promptly and to all persons at the same time nor provided him with an opportunity to discuss her “serious concern” before writing the report. It is difficult not to conclude, as the father alleges, that he was the victim of unprofessional conduct by Ms F, vis-à-vis the timing of her supplementary report and that the those actions disadvantaged him and, I am satisfied, ultimately D.
On 1 August 2013 Senior Registrar FitzGibbon made consent orders which provided for C to spend alternate weekends with the father from 4.30 pm Friday to 8.00 pm Sunday, D and E to spend the same weekend but from 4.30 pm to 8.00 pm Friday and 10.00 am until 8.00 pm on each of the Saturday and Sunday. Orders were made, by consent, restraining the attendance of the children on Ms F; requiring the parents to engage with Child and Adolescent Mental Health Services (“CAMHS”); and for the mother to attend on Dr U, consultant psychiatrist, for a psychiatric assessment to be used as evidence in these proceedings.
C spent time with the father in accordance with the Order made on 1 August 2013. D spent no time with the father and E spent time on 7 occasions, each for a maximum of a few hours.
In August 2013 the mother consulted Ms F in her own right. At this stage, the mother was enjoined from permitting the children, or any of them, to attend upon Ms F for treatment. That restriction should have been a powerful message to the mother not to consult Ms F herself and for Ms F to be professionally circumspect about taking the mother on as a patient. I can only assume that Ms F failed to consider how her therapeutic treatment of the mother could compromise her ability to treat the children (of any of them) in the future.
During August 2013 and early December 2013 there were a number of events which follow a somewhat similar daily pattern: the mother arrives at the father’s home with the children. Text messages are passed between the parties. The mother leaves with D and E and C remains with his father.
In November 2013 D commenced menstruating and, for reasons set out in A/Professor Q’s report in Annexure “A” this was very distressing to D who at the time drew pictures indicating she wished to suicide. She continues to experience high levels of anxiety when she has her periods, refusing to discuss them or address her personal hygiene needs. Nor will she take medication such as the contraceptive pill to stop her periods.
The father and Ms H become engaged to marry in 2013.
On 3 December 2013, Senior Registrar FitzGibbon varied the existing orders so that the three children spend time with the father each Wednesday from 4.30 pm to 7.30 pm; C spends each alternate weekend from 4.30 pm Friday to 7.30 pm Sunday; and D and E from 11.00 am to 7.30 pm on each of Saturday and Sunday with the father. A further order was made for all three children to attend on Ms B, the school psychologist.
On 7 December 2013, there was a significant incident between the children and the father. The mother dropped the three children at the father’s home. C entered the father’s home and remained there while the girls remained outside refusing to enter the father’s home. The girls eventually walked off down the street. The father followed the girls on foot and in due course all three are collected in the car by Ms H. Once back at the father’s home, D refused to get out of the car. There was a struggle in which the father alleges D was violent towards him and D alleges the father physically abused her. The father physically lifted D from the car. Both girls were delivered back to their mother later that day after spending some time in the home with the father and Ms H. This was the last time that D spent time with the father.
E increasingly spent time with her father in accordance with Senior Registrar FitzGibbon’s Order of 3 December 2014. D telephoned the father on 2 March 2014 and said she was not ready to speak to him. She hung up abruptly.
In February 2014 D saw Associate Professor Q and Dr GG of the P Hospital in relation to gender issues.
Unbeknownst to the father, D ceased attending school on 21 March 2014. D’s non-attendance at school was significantly enabled by a series of medical certificates issued by Dr K, general practitioner.
The father and Ms H relocated in March 2014 from J Town to a town 25 minutes away by car. Both gave evidence, which I accept, that the mother acted aggressively to them in public and they thought it prudent and found it necessary to move away from the area of the mother’s residence.
The father became aware on 23 May 2014 that the children had a low attendance rate at school, of below 80 per cent. The father met with the Principal to discuss C and D’s attendance and progress, and was informed, for the first time, that D had not attended school since March 2014.
In June 2014 D was referred to CAMHS for further intensive treatment and saw Ms II, psychologist. On 6 November 2014, during a case conference CAMHS advised that they will no longer work with the family in relation to D other than to provide a crisis response and services. It was confirmed that clinical care and treatment would remain with Professor S, psychiatrist, and Dr K.
The matter was first listed before me on 21 July 2014 for a first day hearing having been adjourned into the list of cases awaiting final hearing by Senior Registrar FitzGibbon on 3 December 2013. I made orders including that a Child and Parents Issues Assessment be conducted. The Assessment was published by Dr X on 5 August 2014.
Dr X notes as follows:
[15]. [Ms Sanderson] repeatedly advised the writer that [D] has made it clear to multiple professionals and herself that she will only speak with [Ms F], but that [Mr Prescott] refuses to allow this. [Ms Sanderson] reported that, though the order for the children to cease treatment with [Ms F] was made with her consent, she was blaming of [Mr Prescott] and the legal representatives for having “bullied” her into agreement. She was adamant [Ms F] was the only psychologist with whom [D] had formed a true therapeutic relationship. Interestingly, [Ms Sanderson] presented a picture of [D] refusing to engage with CAMHS or [Ms B], however, these professionals did not share this view and appeared to have garnered significant information from [D] during their limited time with her. It is of note that [Ms F] is now [Ms Sanderson’s] own therapist.
[16]. Many of the professionals who have met [D] to date ([Ms F], [Ms B], CAMHS, [Dr K]) have noted that [D’s] thought processes and responses to the issue of sexuality and other issues bear hallmarks of obsessive-compulsive disorder (OCD) and occur within the context of more generalised anxiety. It is [Ms F’s] formulation that [D’s difficulties] with sexuality and her father are better understood as a response to some unresolved trauma, possibly sexual abuse, as opposed to a complex anxiety and OCD response, and thus her treatment recommendations follow. It appears to be this professional opinion that [Ms Sanderson] holds in highest regard. She was minimising of any general anxiety issues and denied OCD behaviours for [D], acknowledging only worry related to bushfires and the current issue regarding sexuality, while [Mr Prescott] listed a number of anxieties for [D] dating back to childhood. It is expected that the assessments of CAMHS and [Professor S] will provide further clarity regarding formulation, diagnosis and appropriate treatment for [D].
Dr X recommended that focus should be placed on D’s recovery and be guided by the mental health professionals already treating her, to wit, A/Professor Q, Professor S and Ms II (CAMHS). She noted that “it is essential that both parents are included in the assessments and treatment decision making”.[28] It was also recommended that D see Ms F only to the extent necessary for Ms F to conclude her association with D and explain that she was referring her on to another professional for psychiatric assessment. Dr X opined that D “may benefit from seeing Ms F for this process rather than D holding the unrealistic expectation that Ms F would continue to working with her if she were permitted”.[29]
[28] Dr X, Children and Parents Issues Assessment, 5 August, [26].
[29] Dr X, Children and Parents Issues Assessment, 5 August, [28].
On 28 August 2014 I set the matter for final hearing and made further orders including requesting the preparation of a Family Report, provision of documents to Professor S and for the parents to authorise and request F to provide a letter to D communicating the closure of their relationship as described in the preceding paragraph.
ON 25 September 2014, Ms F wrote to the Court expressing her significant concern about writing this letter to D. She wrote:
I have given serious consideration to this request but do have a significant concern as to whether such a letter would have an adverse effect on [D]. A letter explaining why I will not see [D], however carefully worded, would be seen as a rejection instead of as a positive encouragement to move forward. As a professional I am committed to the safety and wellbeing of my patients and I hesitate to take action that could lead to a marked deterioration in the mental health status of a fragile young girl.
Recently I have been shown a copy of [Professor S’s] letter to the GP and parents and note that a recommendation is made for [D] to return to therapy with myself. I am willing to concur with [Professor S’s] treatment model where I would work with [D] together with [Professor S] and her GP [Dr K]; [Professor S] would work with her parents; and CAMHS would case manage. I would discuss termination with my client [Ms Sanderson] prior to any sessions with [D].
I would prefer to await the resolution of [Professor S’s] recommendations before a final decision is made on my letter to [D]. [D’s] interests must be paramount and may not have been fully or properly presented to the court.
On another matter, I have noted with concern over the past twelve months a number of derogatory comments and references to my professionalism and expertise which appear to be based solely on innuendo, or upon what [Mr Prescott] believes or has told others.
For the Court’s information there was a notification made by [Mr Prescott] last year which the Australian Health Practitioners Regulation Agency completely dismissed on 26 September 2013 stating there was no case to answer.

On 13 December 2014, Professor S reported to Dr K that D had asked to see F again. On 15 December 2014 the independent children’s lawyer advised that, following Professor S’s recommendations, she supported D’s attendance upon F. The father resisted this proposal.
It is common ground that in about December 2014 C expressed an interest in living with his father.
Ms F wrote to Professor S and the parties on 12 January 2015 advising that she supported continuing to see D in collaboration with Professor S and Dr K.
On 30 January 2015 I made orders including lifting the restraint on D attending on F; providing for E to spend time with her father from 11.00 am Saturday to 11.00 am Sunday on the weekends; for C to spend time with the father; and for the father, E and Ms H to attend upon Dr L prior to E’s overnight time commencing. My reasons for decision on 30 January 2015 are reported at case neutral citation [2015] FamCA 162 and I incorporate those reasons into these reasons. The mother commenced to consult another psychologist in the same consulting suite where Ms F’s rooms are situated. The mother’s evidence is that D would have appreciated that the mother’s therapeutic relationship with Ms F ceased at this point. I cannot accept that is so. It is more likely than not that D perceives Ms F to be sympathetic to the mother.
On the 26 February 2015 I made further orders for E to be collected by the father from school in order to see Dr L. This was necessary because the mother sought to impose herself by insisting that she, not the father, collect E from school for the appointment with Dr L. It had been my expressed intention that E be collected by Ms H and the father. That was known to the mother. Ultimately, the mother conveyed E.
On 11 March 2015, following evidence from Dr L that E was “intensely anxious” about the commencement of overnight time with the father and that she also presented as intensely anxious about the prospect of being separated from her mother, I suspended the orders made on 30 January 2015 for E to have overnight time with the father. I requested intervention by the Department of Health and Human Services (“DHHS”). My reasons for decision on 11 March 2015 are reported at case neutral citation [2015] FamCA 167 and I incorporate those reasons into these reasons.
The matter was listed for final hearing before me on the 20 April 2015, however it was determined that a final hearing would be premature given that E had been recommended for treatment by Ms AA, psychologist, and that the treatment had not yet commenced. I ordered, by consent, that the parents facilitate the attendance of E upon Ms AA and referred the matter for mention before me in July 2015 for the purpose of checking on the readiness of the matter for a trial which was tentatively listed for October 2015 estimated to take 5 days.
I made interim orders on 13 July 2015 providing for the alteration to weekend arrangements to facilitate attendance by C and E at the father’s wedding to Ms H; for the parents to do all things necessary to complete the enrolment of D in the Distance Education Program; and the appointment of F to finalise the enrolment and act as a liaison point between the Distance Education provider and the parents. Orders were also made for a further full family report with Ms V, family consultant, and for the father to make a contribution towards the costs of Ms F’s services. The final hearing which was tentatively fixed for October 2015 was vacated and the matter fixed for final hearing on 7 December 2015.
The father and Ms H married in 2015.
In his affidavit affirmed 26 November 2015 the father deposes that he “sought extra holiday time with [his] children on every school holidays and on nearly all occasions [the mother] has agreed to this with respect to [C] but not [E]”.[30] He goes on to say:[31]
[18]. Prior to the September 2015 school holidays, [C] expressed that he was keen to spend the first week of the school holidays with me. I had taken extra holiday leave from work beyond my [holidays] in early September for that purpose. I expressed to the mother via SMS message that I would like to spend some extra time with [E] during this time and proposed Monday, Wednesday and Friday from 9.30am until 8pm in addition to the following weekend as normal.
[19]. Although several SMS messages were exchanged between the mother and me, there was not reply regarding extra time for over 24 hours. When the mother did reply, she stated that she had no problem with [C] spending the week but said that [E] “had plans” and offered no solution as to alternate days. I insisted that I would like to spend extra time with [E], but, although several messages were exchanged, I received no further reply from the mother on the topic of extra time …
[30] Affidavit of the father, affirmed 26 November 2015.
[31] Affidavit of the father, affirmed 26 November 2015, [18]–[19].
On 22 September 2015 the father sent an email to Ms Sanderson’s solicitor, Mr Hoban, requesting extra holiday time with C and E.[32] In response the mother advised that E would spend time with the father on the afternoon of the 23 September 2015 and from 11.00am to 8.00pm on Friday (25 September 2015). The father deposed as follows:[33]
[22] On Friday 25 September 2015, when [E] arrived for her one day of extra time, she was quiet and it became evident through discussions with her that she was upset at me for having to give up her plan of going to the pool. We discussed the importance of us spending extra time together when we get the opportunity and I asked her if she thought that her mother and I should coordinate extra time together on the school holidays. [E] said that she did think this should be organised. [E] was much happier and relaxed after this and we enjoyed the rest of our day together.
[32] Affidavit of the father, affirmed 26 November 2015, Annexure AJP 1.
[33] Affidavit of the father, affirmed 26 November 2015, [22].
On 20 November 2015 I made orders, including procedural orders for preparation of the final hearing, commencing 7 December 2015.

Credit & Impression of Witnesses

Father

The father presents as a credible and sincere witness. He has an air of soft authority. He has an intuitive sense of the anxieties in the mother’s home and the impact these anxieties have upon the psychological make-up of the children, particularly the girls. He appears to be reflective of his actions and expresses a deep and genuine concern for the plight of his children.
As a self-represented litigant, he came prepared with many notes and questions for each of the witnesses. He addressed the issues in a thorough and steady way having placed a lot of thought and consideration into how he wanted to run his case.
The father is a calm and thoughtful person who is not easily, or at least outwardly, responsive to the range of negative and often spurious allegations which were made about him in the running of these proceedings. However, he is naïve in his aspirations to assist his daughters and can be close-minded to the potential support and medical treatment they need. His intentions and actions are often misconceived however, they are for the most part based on what he considers to be in the best interests of the children.

Mother

The mother presents a simplistic view of the world. She has a blinkered view of the evidence presented to her about the state of her daughters’ mental health, and the seriousness of the matters and breadth of issues they are facing. In the face of catastrophic evidence about the mental health of her daughter, she does not accept any evidence which is critical of her and dismisses the role which she plays in the well-being and mental stability (and lack thereof) of the girls.
With a self-righteous air, the mother is quick to blame the father for all failings in the children’s mental and physical well-being. She has twisted the realities of situations making incidents more significant than they need be and giving the father’s actions an unwarranted negative slant.
The mother does not recognise her own anxieties or mental health state and the impact that they may have on the children. She is impervious to the idea that her anxieties flow directly to the children, particularly the girls; creating what Dr U describes as a “leakage of her anxieties to the children”.[34] Dr U identified a loop of anxiety passed from one female to another within the mother’s home that entrenches the girls within the mother’s environment and widens the gap in their relationship with their father.[35]
[34] Affidavit of Dr U, sworn 27 November 2013 including Annexure “A”, Psychiatric Assessment Report by Dr U, Consultant Psychiatrist, dated 1 November 2013, 8 [4].
[35] Affidavit of Dr U, sworn 27 November 2013 including Annexure “A”, Psychiatric Assessment Report by Dr U, Consultant Psychiatrist, dated 1 November 2013, 8 [4]–[6];
The mother lacks insight into Dr L’s evidence particularly in relation to Dr L’s compelling evidence that E’s anxiety was more serious than just because she suffers from irritable bladder. The mother was not able to acknowledge that E experienced “free-floating” anxieties as Dr L reported.[36]
[36] Transcript of Proceedings, 9 December 2015, 162.
There was inconsistency in some of the mother’s evidence, particularly in relation to her having multiple sclerosis and being diagnosed with obsessive compulsive disorder. She became defensive, rushed her answers and was often caught having to revisit her responses. She used phrases like “I know my children” frequently, and would dismiss C’s behaviour or issues, suggesting “he is just a boy”. In contrast to the father, not a lot of thought went into the mother’s answers. My impression is that she had not reflected on any of these past four years of proceedings for the purpose of assessing how matters may have turned out differently. The mother exhibits no sign of personal responsibility. She is impervious to criticism and she is self-validating.

Ms H

Ms H is the father’s wife. She was a fair and credible witness. She gave clear and concise evidence. As to be expected, she was supportive of the father and presented no evidence inconsistent with his.
Ms H has a steady, self-assured demeanour. She appears to genuinely care for the children and expressed anecdotes of positive relationship-building interactions with the children, for instance baking a cake for D’s birthday when she was not seeing her father and going with the children to buy Mother’s Day and birthday cards and presents for Ms Sanderson. She attested to playing games with C, encouraging the children to eat healthy food, as well as playing basketball in the park and exercising together (particularly the latter with E).
Her level of insight given her personal history, which she readily shared, is significant. She spoke about how when her parents separated they frequently denigrated each other in front of her, playing one parent off with the other and which she found distressing. Ms H shared parallels in her own history to that of the children; she had similar bladder problems as a child and she also had a severely mentally ill brother who suffered from severe depression. Her brother stopped going to school, ran away from home and at 15 years of age became a drug addict. It was not until he suffered a stroke from an overdose at 18 years old that his life turned around. Still suffering from bouts of depression he has rebuilt his life, established his own family and runs his own business.[37] Ms H was diagnosed in 2014 with Delayed Sleep Phase Disorder which requires her to catch up on sleep on the weekend. She has undertaken treatment for the condition and manages it through diet and exercise. She has not been diagnosed with any mental health issues.[38]
[37] Transcript of Proceedings, 10 December 2015, 218–19.
[38] Transcript of Proceedings, 10 December 2015, 219.
Ms H demonstrates an ability to empathise with the issues confronting the children. She identifies some difficulties faced by the children and impressed as having an intuitive sense of what the children are going through and of the psychological make-up of the mother. Nevertheless, Ms H shares the father’s naive view of his daughters’ needs.

The expert witnesses

Expert evidence was provided by Dr L, Professor S, Dr U, and Ms V. As indicated, certain therapeutic professionals were not required to give evidence directly and nor were they cross-examined. All four witnesses provided helpful and insightful advice and opinion into the needs of the family and the mother’s psychological impact upon the children. Ms V and Dr U were in court when Professor S gave evidence by telephone and had the benefit of hearing it first-hand. Professor S was invited to listen to theirs.
The expertise of these witnesses is of high calibre but benefit to be derived from them is diluted by virtue of Dr U and Ms V having a forensic role as court appointed experts whilst Professor S and Dr L are on the ground as therapeutic professionals. Within the domain of the therapeutic professionals, being Professor S, Dr L, Ms F, A/Professor Q, Dr Z, Ms AA and Dr K, there is obvious expertise but in my observation the insufficient co-ordination of their respective talents leaves the children at some risk. The family is indeed fortunate to have the attention of Professor S but the Professor only sees D. Likewise, Dr L sees only E. The marked and concerning lack of coordination of the expert assistance available to this family has permitted a lack of scrutiny of the mother’s behaviour, over and above her transporting the children to various appointments and her compliance with treatment. Very importantly there has been lack of any attention to the mother’s mental state and the extent to which the mental health deficits of both D and E feed into the mother’s personality make up and vice versa.
Dr L is a qualified specialist paediatrician and sees E approximately every three months. She was able to also provide input from a telephone discussion she had with Ms AA, psychologist, prior to giving evidence in court.
Dr L’s evidence was clear and coherent in terms of outlining E’s views and the detriment to E of spending overnight time at her father’s. Dr L articulated several reasons why E’s views should be respected and why there should not be overnight time with her father. These included: firstly, that E would feel let down and that she had not been heard. E had expressly said to Dr L that “she felt people were not listening to what she was saying”; secondly, that this would considerably exacerbate E’s anxiety and be detrimental to her mental health; and thirdly, that if E felt unhappy about the arrangement then it would significantly impact and “sadly” interfere with her relationship with her father.[39] Dr L also noted that not listening to E may damage the established relationship with her mental health care professionals and would set her “slow and gentle progress” back.[40] Dr L was of the view that E was an intelligent and articulate child as evidenced by her school reports and was capable of providing her own opinion.[41]
[39] Transcript of Proceedings, 9 December 2015, 172.
[40] Transcript of Proceedings, 9 December 2015, 173.
[41] Transcript of Proceedings, 9 December 2015, 158.
I found Dr L to be a clear and helpful witness. Dr L has little exposure to the mother.
Professor S is a consultant child and adolescent psychiatrist who has had a coordinating role in the treatment of D with A/Professor Q, CAMHS, and, much more recently, with Ms F and Dr K.
Professor S’s evidence was by telephone and extensive and is discussed later in these reasons (particularly at [147]–[150]). I accept Professor S’s evidence. I am particularly relieved that, by the time his evidence concluded, he accepted that the family needed some overarching coordination of mental health and specialist services and that he is prepared to assume that role.
Dr U provided a psychiatric assessment of the mother in 2013 in his capacity as a single expert witness. He was in court to hear the evidence of Professor S. There was a slight difference of perspective between Professor S and Dr U. For instance, Dr U said, “I’m picking up a view from Professor S that the mother is reacting to the children’s anxieties. I saw the children reacting to the mother’s anxieties”. Dr U was of the view that it was the anxiety of the mother rather than her obsessive compulsive disorder that was more of a factor in the impact upon the children.
Dr U supported the view that there needs to be more co-ordination of treating professionals. In cross examination by the father there was the following interchange:[42]
[MR PRESCOTT]: [Dr U], you said before that you feel that the treatment team has become aligned and split, and you mentioned CAMHS earlier, and you mentioned existing relationships that have been built, but given that alignment and that split, what would be your recommendation to — where to go from here?—
[DR U]: Well, you heard the discussion between Her Honour and [Professor S], and I think that that’s probably the place to start. He’s a very, very experienced child psychiatrist, used to working with — you know, child — child psychiatry is different because children have parents, and — and aunties, and uncles, and so on, so we’re used to working in systems. So that’s a very good start, I think. What I would be hoping for, as a result of the discussion, would — that there would be more of an overview whereby everyone is — gets included in one way or — one — one way or another, and I think the thing that’s missing therapeutically is — is— is some family work ‑ ‑ ‑
[42] Transcript of Proceedings, 4 February 2016, 606.
Dr U is an assessing expert psychiatrist and not a therapist. He has not seen the children nor the father. I accept all of his evidence in relation to the mother. To the extent that he expressed opinions in relation to the mother’s capacity to parent these children, his evidence made a great deal of sense but must be weighed in light of him having read relevant reports and having heard Professor S’s evidence but not having assessed the children independently nor having observed them with the mother. That said, Dr U’s assessment that the mother is in need of mental health treatment and that there are some strong connecting factors between her anxieties and the anxieties and mental health conditions of the girls, resonates strongly with me. I found his evidence to be credible and valuable.
Ms V, Family Consultant, has seen the family and prepared reports on three separate occasions, in July 2013 (Child and Parents Issues Assessment), December 2014 (Family Report) and November 2015 (Family Report). In 2015 she did not meet with D as she was unwell on the day of the interviews. She has an excellent understanding of the family and their psychological and social issues. Her recommendations, supported by her testimony, have not altered significantly since she first interviewed the family.
I accept Ms V’s evidence and accord it considerable weight.

Relevant Law – Parenting Issues

These proceedings are brought under Part VII of the Act. Pursuant to s 60CA of the Act, in deciding to make any parenting order in relation to the children, I must regard the children’s best interests as the paramount consideration.
The core values of the legislation are to ensure that children have the benefit of both of their parents having a meaningful involvement in their lives, to the maximum extent consistent with the best interests of the child; to protect children from physical or psychological harm from being subjected to, or exposed to, abuse, neglect or family violence; to ensure that children receive adequate and proper parenting to help them achieve their full potential; and to ensure that parents fulfil their duties, and meet their responsibilities, concerning the care, welfare and development of their children.[43]
[43] Family Law Act 1975 (Cth) s 60B.

Dr K, General Practitioner

Date	Issues and Findings	Recommendations
22/07/2014 Summary Report	· D is suffering with mood and gender disorders. These issues have been ongoing since the age of 5 and have increased following the onset of periods. · Current issues which exacerbate the conditions include: periods, sexual changes associated with puberty (doesn’t want to become a woman), relationship with father, family court proceedings, & anxiety related events such as recent bush fires. · As a child would rub cream on her vagina whenever she left the house or went to the toilet. · On the mention of the word “baby”, she would remover her pants and underwear. · Manifesting with poor mood, crying, anxiety, poor sleep, reduced motivation and suicidal ideation. She has threated self harm if she is forced to attend her father’s home. She has indicated this with drawing and direct statements. It is clear she is suffering with a depressive illness. · D has not attended school since March 2014. This relates to her periods and unwillingness to wear pads. As time has gone on, she has been concerned that other students are aware she has her period and accordingly has refused to attend school. · At times when she has had an appointment at the medical centre, she refused to enter. This is often related to her having her period. In this situation, she remains in the car, on a towel, bleeding through her clothes. When she does attend, she often will not speak and has her head down. This is the case with other care providers. · She is currently seeing Dr Q, Professor S, Dr GG, CAMHS.	· Rapport is difficult to establish with D and it is important she continue to see carers she will speak to. · Very concerned that D is suffering with anxiety and a major depressive disorder with associated thoughts of self harm. She requires appropriate treatment from relevant carers.
10/08/2015 Summary Report	· D has been diagnosed with severe depression and anxiety. · In effect she has had a “mental breakdown” and is not coping with usual activities of daily living. · She is reluctant to leave the house and does not interact with strangers and rarely with friends.	· She does not have the capacity to engage with court appointed family counsellor. Such a meeting would be practically impossible, harmful and lead to further mental decline.
23/02/2015 Summary Report	· D continues to suffer with significant mental health issues, particularly anxiety and depressive symptoms. · There has been improvement in her mental state. This includes the ability to maintain eye contact, smile intermittently and converse. · Much of her improvement is due to counselling provided by Ms F and the rapport that has been established.	· Further improvement is required before D is able to return to school. · Other gender issues need to be addressed before this is possible. · Cessation of treatment (with Ms F) would be harmful.

Date

Issues and Findings

Recommendations

22/07/2014

Summary Report

· D is suffering with mood and gender disorders. These issues have been ongoing since the age of 5 and have increased following the onset of periods.

· Current issues which exacerbate the conditions include: periods, sexual changes associated with puberty (doesn’t want to become a woman), relationship with father, family court proceedings, & anxiety related events such as recent bush fires.

· As a child would rub cream on her vagina whenever she left the house or went to the toilet.

· On the mention of the word “baby”, she would remover her pants and underwear.

· Manifesting with poor mood, crying, anxiety, poor sleep, reduced motivation and suicidal ideation. She has threated self harm if she is forced to attend her father’s home. She has indicated this with drawing and direct statements. It is clear she is suffering with a depressive illness.

· D has not attended school since March 2014. This relates to her periods and unwillingness to wear pads. As time has gone on, she has been concerned that other students are aware she has her period and accordingly has refused to attend school.

· At times when she has had an appointment at the medical centre, she refused to enter. This is often related to her having her period. In this situation, she remains in the car, on a towel, bleeding through her clothes. When she does attend, she often will not speak and has her head down. This is the case with other care providers.

· She is currently seeing Dr Q, Professor S, Dr GG, CAMHS.

· Rapport is difficult to establish with D and it is important she continue to see carers she will speak to.

· Very concerned that D is suffering with anxiety and a major depressive disorder with associated thoughts of self harm. She requires appropriate treatment from relevant carers.

10/08/2015

Summary Report

· D has been diagnosed with severe depression and anxiety.

· In effect she has had a “mental breakdown” and is not coping with usual activities of daily living.

· She is reluctant to leave the house and does not interact with strangers and rarely with friends.

· She does not have the capacity to engage with court appointed family counsellor. Such a meeting would be practically impossible, harmful and lead to further mental decline.

23/02/2015

Summary Report

· D continues to suffer with significant mental health issues, particularly anxiety and depressive symptoms.

· There has been improvement in her mental state. This includes the ability to maintain eye contact, smile intermittently and converse.

· Much of her improvement is due to counselling provided by Ms F and the rapport that has been established.

· Further improvement is required before D is able to return to school.

· Other gender issues need to be addressed before this is possible.

· Cessation of treatment (with Ms F) would be harmful.

Prof S, Consultant Child and Adolescent Psychiatrist

Date	Issues and Findings	Recommendations
9/09/2014 Letter to Dr K in follow up to referral.	· Met with D and mother, separate meeting with the mother and a separate meeting with the father. · A presents with a complex and deteriorating anxiety disorder, complicated by fluctuating depression and compulsive behaviour. · Has separation anxiety – the anxiety takes form of social phobia. Fear of embarrassment by her peers of her appearance and that she is physically becoming a woman. · Range of body dysmorphic responses as a result of her anxiety e.g. does not want to grow up and would rather be a boy. · D has had seven changes of school and had some difficulties adjusting. · Parent’s separation – she is reluctant to stay at the father’s house because he physically hurt her. He says he lifted her out of the car when she refused to get out — D says he put a headlock on her and dragged her from the car. This incident has led to a conviction in her mind that she does not want to have contact with her father. · Issues of mother’s MS. That mother might have shared her health concerns with D. · Fear of the word “baby” in the context of having an itchy vagina when she was 5-6 years old. · On meeting D Prof S found her hostile and relatively uncommunicative. Hid her eyes behind her hair.	· Requires a multidisciplinary and coordinated approach to her treatment and management. · Would benefit for psychotherapy and psychological support (D makes it clear she will only talk to Ms F) · There is a private adolescent inpatient unit at the MM Clinic which has a program that might be more suitable for the mental health problems experienced by D – not sure if the parents have private health cover. · Might be a role for medication (e.g. SSRI Fluoxetine) · Hopes that the Father might reconsider his rejection about the involvement of Ms F
13/12/2014 Letter to Dr K following teleconference with Ms II (CAHMS) and A/Professor Q	· CAHMS not playing active case mgmt. role. Will continue to chair occasional case conferences in order to coordinate professional care of D. · A reluctant to see Prof S and refuses to get out of car. · Only talks about ordinary daily events will not talk about more emotionally charged issues e.g. Attendance at school, or mgmt. of her periods. · Generally D isolates herself and remains in PJs and dressing gown. · Some activities w her mother (crosswords and puzzle books). · Refuses to take medication and will not contemplate antioxidant food substance or Vitamin D which might help improve her mood. · Some internet contact with a friend · Refused to do schoolwork forwarded to her by her maths teacher. · Reluctant to leave the house and expressing increased anxiety about potential bushfires. · Mother no longer consults Ms F but is receiving independent counselling support. · Suggestion that Child First provide further support to the mother. · D refusing to acknowledge she was menstruating. · Without prompting D has asked on a number of occasions that she would like to see Ms F.	· Dr K to discuss Child First with mother and to make referral. · Prof S has spoken to Ms F and Ms F has agreed to see D again · Ms F has agreed to regularly discuss her treatment sessions of D with Ms F and consult him about treatment for D.
23/12/2014 Email to Mr Prescott	· Spent time talking with D in the car (as she had her period and wouldn’t get out). · Same as above in terms of general findings. · A again indicated that she wanted to see Ms F. · A knows that father doesn’t want her to see Ms F and that the Court has refused to allow her to see Ms F. · Agree with father that D is “calling the shots” but this is a manifestation of her anxiety disorder and mental illness.	· Only realistic way forward which offers some hope of therapeutic improvement is to allow D to see Ms F again. · Prof S will work with Ms F to support her in the difficult task in providing psychological treatment to D. · Prof S will continue to see D to monitor her progress.
18/03/2015 Notes on case conference	· In attendance: Ms II, Dr K, A/Professor Q, Ms F, Professor S. · Prof S contacted by Regional Child Protection Unit as it had been reported D was not attending school. Suggested contacting the ICL. · ICL planning on meeting with the children. · Prof S requested the mother to determine D’s current status at the school, and who to speak to about A’s return to education. Ms NN, student well-being leader) advised that when D was ready to start doing schoolwork it would be arranged on a part-time basis by the Distance Education School in collaboration with the current school. · Prof S reported father is happy to pay for D to resume keyboard lessons. · Ms F reported D is happily attending fortnightly therapy sessions with her. D has indicated that her primary goal is to try and get back into education. D has discussed various word and number puzzles she completes every day. Ms F is working to introduce a more school like structure into her day time activities. D is not yet able to concentrate on reading but is going to try and do some calligraphy and cooking activities. Also working to encourage D to dress for the day rather than stay in her dressing-gown. She makes eye contact with Ms F and has become more animated. She has begun to eat three meals a day. She becomes anxious in discussion about taking on outside activities such as feeding the birds. · Dr K reported D is more chatty and engaged but has indicated that she is anxious and unable to contemplate doing some distance education subjects yet although is now able to concentrate on her number and word puzzles. D will not talk about, and denies, her periods and will not take care of herself when this occurs. She is now washing and grooming her hair but her facial naevus is becoming more prominent even though tried to hide it with her hair. There was some discussion about the impact this might have on her socialisation due to embarrassment. It is difficult to treat and would require plastic surgery. D is not able to talk about this matter. She continues to refuse to take anti-depressant, anxiolytic or vitamin D. She still reacts adversely to some issues and will refuse to speak. · Ms II reported that CAMHS will be withdrawing their involvement and teleconferences will no longer be held. · All members indicated that since D has commenced psychological treatment with Ms F she was demonstrating some early signs of improvement.	· BT agreed to continue arranging teleconference with Dr K, Ms F and Dr Q every 4-6 weeks to coordinate clinical care.
26/03/2015 Letter to Mark K	· Clear improvement in D’s mental health. · She said she was a lot happier. · Still not going outside · Not getting dressed in day clothes at home · She said she is trying to work with Ms F towards some form of education · Thinking about the possibility of doing some form of distance education (a subject or two) – maths is her favourite. · She said she was worried about having to speak to the ICL but Ms F had encouraged her to do it and she said she ‘can do it now’ · Had a note from a friend and was smiling when telling the story. · Still not able to discuss other issues which worry her such as her periods · Still socially avoidant but has been able to willingly dress and leave the home for visits to Dr K, Ms F and to Prof S’s clinic.
24/06/2015 Email to Mary Lonergan, ICL	· Say D with her mother for a short period of time and then some time by herself. · A continues to make slow but clear progress in response to her treatment with Ms F and some improvement in her mental health. · She is more outgoing and better able to hold a conversation and now makes good eye contact although still mostly has her fact covered with her long hair. · She had recently spent 7 hours at the birthday party of a girlfriend from primary school in the company of three other friends of hers. · She enjoyed the social activity. She felt somewhat exhausted after the first major social contact in many months but was pleased and encouraged by the experience. · She has also been out in the motor car when her mother visits places such as the shopping centre in BB Town although still remains in the car. · She spends five to six hours a day doing puzzles or maths assignments. Ms F has helped her to increase this amount of activity and to feel more positive about the future. · D is still somewhat apprehensive about Distance Education next school term but indicated Ms F has helped her feel confident and that she had agreed to allow Ms F to contact the Distance Education school to facilitate enrolment. · She was able to speak positively about memories of growing up in Queensland as a young child and family activities with her brother and sister. · She indicated she is no longer worried or anxious about her sister E. · She is able to talk to Ms F about anxious thoughts and is beginning to manage to gain control over these anxieties. · It is clearly evident that D is beginning to respond positively to the psychological treatment provided by Ms F.	· That the unhelpful prohibition placed on Ms F to facilitate D’s enrolment in Distance Education school and to the first point of clinical contact with teachers at the school be reconsidered.
25/08/2015 Email to Dr K Update on D’s progress following discussion with Ms F.	· A has made significant progress in her treatment, including with her education. She has enrolled in distance education and starts semester 1 subjects today. · Enthusiastic about returning to school · Has become increasingly anxious – feeling overwhelmed with intrusive obsessional and anxious thoughts – fear of her family breaking up or her mother dying. Leads her to mutter. · A expressed to Ms F that she wants to take medication to overcome the problem of anxious thoughts and muttering.	· Dr K to prescribe Fluoxetine capsules 20mg.
24/11/2015 Email to Dr K	· Prof S viewed some of D’s work sheets in her Distance Education maths subject; she is achieving top marks and positive comments from her teacher. · D was relatively talkative about her school work, trips in the car and her siblings and daily life. She made no eye contact with her face being fully covered by her hair. · She was reluctant to talk about her muttering. · She said it was “a voice” that was intruding her thinking and also interrupting her school work. · Prof S unable to determine if it was a hallucination or part of her imagination. She indicated that the voice had a command type quality. This perception had become worse since she had received a long email from her father which “used that word”. When asked if it was one of the words from the past she could not say e.g. baby, she became distressed, lowered her head even more and started muttering. · She indicated she would think about taking medication to assist in relieving her distress.	· Suggest a trial of Sertraline (instead of Fluoxetine) for its effectiveness in the treatment of anxiety and obsessive compulsive phenomena. · Prescribed half a tablet (25mg) in the morning.

Date

Issues and Findings

Recommendations

9/09/2014

Letter to Dr K in follow up to referral.

· Met with D and mother, separate meeting with the mother and a separate meeting with the father.

· A presents with a complex and deteriorating anxiety disorder, complicated by fluctuating depression and compulsive behaviour.

· Has separation anxiety – the anxiety takes form of social phobia. Fear of embarrassment by her peers of her appearance and that she is physically becoming a woman.

· Range of body dysmorphic responses as a result of her anxiety e.g. does not want to grow up and would rather be a boy.

· D has had seven changes of school and had some difficulties adjusting.

· Parent’s separation – she is reluctant to stay at the father’s house because he physically hurt her. He says he lifted her out of the car when she refused to get out — D says he put a headlock on her and dragged her from the car. This incident has led to a conviction in her mind that she does not want to have contact with her father.

· Issues of mother’s MS. That mother might have shared her health concerns with D.

· Fear of the word “baby” in the context of having an itchy vagina when she was 5-6 years old.

· On meeting D Prof S found her hostile and relatively uncommunicative. Hid her eyes behind her hair.

· Requires a multidisciplinary and coordinated approach to her treatment and management.

· Would benefit for psychotherapy and psychological support (D makes it clear she will only talk to Ms F)

· There is a private adolescent inpatient unit at the MM Clinic which has a program that might be more suitable for the mental health problems experienced by D – not sure if the parents have private health cover.

· Might be a role for medication (e.g. SSRI Fluoxetine)

· Hopes that the Father might reconsider his rejection about the involvement of Ms F

13/12/2014

Letter to Dr K following teleconference with Ms II (CAHMS) and A/Professor Q

· CAHMS not playing active case mgmt. role. Will continue to chair occasional case conferences in order to coordinate professional care of D.

· A reluctant to see Prof S and refuses to get out of car.

· Only talks about ordinary daily events will not talk about more emotionally charged issues e.g. Attendance at school, or mgmt. of her periods.

· Generally D isolates herself and remains in PJs and dressing gown.

· Some activities w her mother (crosswords and puzzle books).

· Refuses to take medication and will not contemplate antioxidant food substance or Vitamin D which might help improve her mood.

· Some internet contact with a friend

· Refused to do schoolwork forwarded to her by her maths teacher.

· Reluctant to leave the house and expressing increased anxiety about potential bushfires.

· Mother no longer consults Ms F but is receiving independent counselling support.

· Suggestion that Child First provide further support to the mother.

· D refusing to acknowledge she was menstruating.

· Without prompting D has asked on a number of occasions that she would like to see Ms F.

· Dr K to discuss Child First with mother and to make referral.

· Prof S has spoken to Ms F and Ms F has agreed to see D again

· Ms F has agreed to regularly discuss her treatment sessions of D with Ms F and consult him about treatment for D.

23/12/2014

Email to Mr Prescott

· Spent time talking with D in the car (as she had her period and wouldn’t get out).

· Same as above in terms of general findings.

· A again indicated that she wanted to see Ms F.

· A knows that father doesn’t want her to see Ms F and that the Court has refused to allow her to see Ms F.

· Agree with father that D is “calling the shots” but this is a manifestation of her anxiety disorder and mental illness.

· Only realistic way forward which offers some hope of therapeutic improvement is to allow D to see Ms F again.

· Prof S will work with Ms F to support her in the difficult task in providing psychological treatment to D.

· Prof S will continue to see D to monitor her progress.

18/03/2015

Notes on case conference

· In attendance: Ms II, Dr K, A/Professor Q, Ms F, Professor S.

· Prof S contacted by Regional Child Protection Unit as it had been reported D was not attending school. Suggested contacting the ICL.

· ICL planning on meeting with the children.

· Prof S requested the mother to determine D’s current status at the school, and who to speak to about A’s return to education. Ms NN, student well-being leader) advised that when D was ready to start doing schoolwork it would be arranged on a part-time basis by the Distance Education School in collaboration with the current school.

· Prof S reported father is happy to pay for D to resume keyboard lessons.

· Ms F reported D is happily attending fortnightly therapy sessions with her. D has indicated that her primary goal is to try and get back into education. D has discussed various word and number puzzles she completes every day. Ms F is working to introduce a more school like structure into her day time activities. D is not yet able to concentrate on reading but is going to try and do some calligraphy and cooking activities. Also working to encourage D to dress for the day rather than stay in her dressing-gown. She makes eye contact with Ms F and has become more animated. She has begun to eat three meals a day. She becomes anxious in discussion about taking on outside activities such as feeding the birds.

· Dr K reported D is more chatty and engaged but has indicated that she is anxious and unable to contemplate doing some distance education subjects yet although is now able to concentrate on her number and word puzzles. D will not talk about, and denies, her periods and will not take care of herself when this occurs. She is now washing and grooming her hair but her facial naevus is becoming more prominent even though tried to hide it with her hair. There was some discussion about the impact this might have on her socialisation due to embarrassment. It is difficult to treat and would require plastic surgery. D is not able to talk about this matter. She continues to refuse to take anti-depressant, anxiolytic or vitamin D. She still reacts adversely to some issues and will refuse to speak.

· Ms II reported that CAMHS will be withdrawing their involvement and teleconferences will no longer be held.

· All members indicated that since D has commenced psychological treatment with Ms F she was demonstrating some early signs of improvement.

· BT agreed to continue arranging teleconference with Dr K, Ms F and Dr Q every 4-6 weeks to coordinate clinical care.

26/03/2015

Letter to Mark K

· Clear improvement in D’s mental health.

· She said she was a lot happier.

· Still not going outside

· Not getting dressed in day clothes at home

· She said she is trying to work with Ms F towards some form of education

· Thinking about the possibility of doing some form of distance education (a subject or two) – maths is her favourite.

· She said she was worried about having to speak to the ICL but Ms F had encouraged her to do it and she said she ‘can do it now’

· Had a note from a friend and was smiling when telling the story.

· Still not able to discuss other issues which worry her such as her periods

· Still socially avoidant but has been able to willingly dress and leave the home for visits to Dr K, Ms F and to Prof S’s clinic.

24/06/2015

Email to Mary Lonergan, ICL

· Say D with her mother for a short period of time and then some time by herself.

· A continues to make slow but clear progress in response to her treatment with Ms F and some improvement in her mental health.

· She is more outgoing and better able to hold a conversation and now makes good eye contact although still mostly has her fact covered with her long hair.

· She had recently spent 7 hours at the birthday party of a girlfriend from primary school in the company of three other friends of hers.

· She enjoyed the social activity. She felt somewhat exhausted after the first major social contact in many months but was pleased and encouraged by the experience.

· She has also been out in the motor car when her mother visits places such as the shopping centre in BB Town although still remains in the car.

· She spends five to six hours a day doing puzzles or maths assignments. Ms F has helped her to increase this amount of activity and to feel more positive about the future.

· D is still somewhat apprehensive about Distance Education next school term but indicated Ms F has helped her feel confident and that she had agreed to allow Ms F to contact the Distance Education school to facilitate enrolment.

· She was able to speak positively about memories of growing up in Queensland as a young child and family activities with her brother and sister.

· She indicated she is no longer worried or anxious about her sister E.

· She is able to talk to Ms F about anxious thoughts and is beginning to manage to gain control over these anxieties.

· It is clearly evident that D is beginning to respond positively to the psychological treatment provided by Ms F.

· That the unhelpful prohibition placed on Ms F to facilitate D’s enrolment in Distance Education school and to the first point of clinical contact with teachers at the school be reconsidered.

25/08/2015

Email to Dr K
Update on D’s progress following discussion with Ms F.

· A has made significant progress in her treatment, including with her education. She has enrolled in distance education and starts semester 1 subjects today.

· Enthusiastic about returning to school

· Has become increasingly anxious – feeling overwhelmed with intrusive obsessional and anxious thoughts – fear of her family breaking up or her mother dying. Leads her to mutter.

· A expressed to Ms F that she wants to take medication to overcome the problem of anxious thoughts and muttering.

· Dr K to prescribe Fluoxetine capsules 20mg.

24/11/2015

Email to Dr K

· Prof S viewed some of D’s work sheets in her Distance Education maths subject; she is achieving top marks and positive comments from her teacher.

· D was relatively talkative about her school work, trips in the car and her siblings and daily life. She made no eye contact with her face being fully covered by her hair.

· She was reluctant to talk about her muttering.

· She said it was “a voice” that was intruding her thinking and also interrupting her school work.

· Prof S unable to determine if it was a hallucination or part of her imagination. She indicated that the voice had a command type quality. This perception had become worse since she had received a long email from her father which “used that word”. When asked if it was one of the words from the past she could not say e.g. baby, she became distressed, lowered her head even more and started muttering.

· She indicated she would think about taking medication to assist in relieving her distress.

· Suggest a trial of Sertraline (instead of Fluoxetine) for its effectiveness in the treatment of anxiety and obsessive compulsive phenomena.

· Prescribed half a tablet (25mg) in the morning.

Ms EE, Psychologist

Date	Issues and Findings	Recommendations
17/09/2012 Handwritten note to the mother	· In regard to overnight time · Gradual exposure is based on the theory of gradually exposing a client, safely and in steps to the thing they fear e.g. staying overnight.	· Gradual Exposure Theory – that the girls stay at their father’s a little later on weekends, have showers, put on pyjamas and dressing gown, watch a movie and then come home somewhat later.

Date

Issues and Findings

Recommendations

17/09/2012

Handwritten note to the mother

· In regard to overnight time

· Gradual exposure is based on the theory of gradually exposing a client, safely and in steps to the thing they fear e.g. staying overnight.

· Gradual Exposure Theory – that the girls stay at their father’s a little later on weekends, have showers, put on pyjamas and dressing gown, watch a movie and then come home somewhat later.

Dr DD, Consultant Paediatrician

Date	Issues and Findings	Recommendations
21/12/2012 Letter to Dr K following referral	· E has found it difficult to adapt to living in a family of separated parents. · E only wants to go as far as Suburb OO when she accompanies her father on contact visits. She wants to stay close to her mother. · E has symptoms of irritable bladder, does not have urinary incontinence although occasionally complains of urgency of voiding. · She does not want to stay overnight with her father. Her father is understandably quite cross about her attitude regarding his contact. E has periods of refusing to go on contact visits and then softens and accompanies him again. · She related an episode where her father tricked her to go with him to see her paternal aunt. E said that she lost trust in him at this time and is very wary that he will try to “trick them” on subsequent visits and she will be separated from her mother. E also related a time when her father would not let her telephone her mother and she cried and became upset. · She has had time away from school partly because of illness and partly because of emotional upset. · She had slapped cheek infection on two occasions associated with intense itching. · On occasions she has gone to sick bay rather than accompany her father. · Her father was sometimes late to pick the girls up from school and this caused E a great deal of stress and anxiety. Plans have changed more recently. · The father is keen for the girls to stay with him overnight but the girls are very reluctant to do this. · Their brother C seems to cope well with the contact. · E has some anxiety symptoms and separation anxiety.	· Support plans for E to continue to see Ms HH for counselling. · Strongly encouraged the mother to try to keep discussions with her ex-husband well out of earshot.

Date

Issues and Findings

Recommendations

21/12/2012

Letter to Dr K following referral

· E has found it difficult to adapt to living in a family of separated parents.

· E only wants to go as far as Suburb OO when she accompanies her father on contact visits. She wants to stay close to her mother.

· E has symptoms of irritable bladder, does not have urinary incontinence although occasionally complains of urgency of voiding.

· She does not want to stay overnight with her father. Her father is understandably quite cross about her attitude regarding his contact. E has periods of refusing to go on contact visits and then softens and accompanies him again.

· She related an episode where her father tricked her to go with him to see her paternal aunt. E said that she lost trust in him at this time and is very wary that he will try to “trick them” on subsequent visits and she will be separated from her mother. E also related a time when her father would not let her telephone her mother and she cried and became upset.

· She has had time away from school partly because of illness and partly because of emotional upset.

· She had slapped cheek infection on two occasions associated with intense itching.

· On occasions she has gone to sick bay rather than accompany her father.

· Her father was sometimes late to pick the girls up from school and this caused E a great deal of stress and anxiety. Plans have changed more recently.

· The father is keen for the girls to stay with him overnight but the girls are very reluctant to do this.

· Their brother C seems to cope well with the contact.

· E has some anxiety symptoms and separation anxiety.

· Support plans for E to continue to see Ms HH for counselling.

· Strongly encouraged the mother to try to keep discussions with her ex-husband well out of earshot.

Ms F, Consultant Psychologist

Date	Issues and Findings	Recommendations
10/05/2013 Summary Report	· E presented with behaviours, thought patterns and indicating a significant anxiety issue. · She is particularly attached to her mother and suffers considerable separation anxiety. · E loves school but has acknowledged that there are times during the school day when she misses her mother. She will not go on school excursions without her mother accompanying her, does not go on sleepovers and will only visit a friend’s house if her sister goes as well. · E has an exceptionally close relationship with her sister. · Her connection with her father has been more strained of late and she feels pressure to sleep over during access weekends with her father. · She has significant fears around the dark and trouble relaxing and sleeping which leads to her irritable bladder syndrome and the need to go to the toilet often. · E has only slept at her father’s when her mother was unexpectedly hospitalised. · E’s profile on the Beck Youth Inventories – Second Edition (BYI-II) showed a low level for disruptive behaviour, anger and depression; a reasonable self concept; a more elevated score for anxiety.	· Time needs to be taken to strengthen the relationship with the father and this process can only be initiated if E feels in control in terms of being able to leave her father’s house or contact her mother when she chooses. · The level of her anxiety response should habituate and lessen over time, particularly with the encouragement of her parents. · E experiences a high generalised anxiety state and therapeutic work around anxiety management should be undertaken with the involvement of both parents.

Date

Issues and Findings

Recommendations

10/05/2013

Summary Report

· E presented with behaviours, thought patterns and indicating a significant anxiety issue.

· She is particularly attached to her mother and suffers considerable separation anxiety.

· E loves school but has acknowledged that there are times during the school day when she misses her mother. She will not go on school excursions without her mother accompanying her, does not go on sleepovers and will only visit a friend’s house if her sister goes as well.

· E has an exceptionally close relationship with her sister.

· Her connection with her father has been more strained of late and she feels pressure to sleep over during access weekends with her father.

· She has significant fears around the dark and trouble relaxing and sleeping which leads to her irritable bladder syndrome and the need to go to the toilet often.

· E has only slept at her father’s when her mother was unexpectedly hospitalised.

· E’s profile on the Beck Youth Inventories – Second Edition (BYI-II) showed a low level for disruptive behaviour, anger and depression; a reasonable self concept; a more elevated score for anxiety.

· Time needs to be taken to strengthen the relationship with the father and this process can only be initiated if E feels in control in terms of being able to leave her father’s house or contact her mother when she chooses.

· The level of her anxiety response should habituate and lessen over time, particularly with the encouragement of her parents.

· E experiences a high generalised anxiety state and therapeutic work around anxiety management should be undertaken with the involvement of both parents.

Dr L, Paediatriianc

Date	Issues and Findings	Recommendations
19/09/2014 Report to Dr Z	· E, mother and father in attendance. · Issues included: bladder difficulties since 3-4 yrs old; current irritable bladder - urinary urgency; and intermittent diarrhoea (twice a week) · Irritable bladder – E tends to be “urgent” during the day time and dry at night. · Attending new school – J Town Primary and doing very well. 1.5 years ahead academically. · Missed time at school due to bladder and bowel difficulties. · Nice group of good friends · Developmental milestones – normal. · Anxious about being near a toilet. Children become fearful of incontinence. She is a highly sensitive girl. · Children with this need support and understanding. Lack of ready access to toilets can be extremely stressful. · Intermittent loose bowel movement – possibly lactose intolerance.	· E could be encouraged to go to the toilet every 2 hrs to prevent becoming ‘urgent’. · Condition is one of maturity and likely over time that it will improve. · Sometime medication is required but side-effects and not needed at this time. · Renal testing and breath hydrogen test.
25/11/2014 Report to Dr Z	· E, mother in attendance. The appointment had been rescheduled by Dr L and the father was unable to attend · Issues relating to intermittent diarrhoea, irritable bladder. · Discussion about feelings in regard arrangements from Family Court matter · Doing well at school, reading level at year 7 level. Doing well academically and has many friends · Anxious about long journeys in car because she needs to access the toilet frequently. · When at father’s she misses her sister and mother and likes her brother to be with her when she is at her father’s. She likes to stay at home when she is at her father’s and worries about going out. · Happy to see father during the day but expressed significant anxiety about staying overnight.	· Anxiety does not cause of irritable bladder but is likely to aggravate the situation significantly. · Important to take her condition into account when considering access arrangements.
10/03/2015 Report to Dr Brooke Z	· E, father and Ms H in attendance · The Court ordered the appointment to discuss E’s difficulties. · E did not attend school today and so father and Ms H met with the Dr until she was dropped off by mother. · Discussed nature of urinary tract difficulties. Father and Ms H wanted to know what else they could be doing to help her with her urinary problems and anxiety. · E tends to be having a lactose free diet – still awaiting breath hydrogen test · When E arrived, Dr saw her on her own first. · E said: (verbatim) I’d like the court to go away I’d like not to stay overnight for a few years until I’m ready I don’t trust Dad. He said he would wait until I was ready but he went behind my back to the court. · Daytime visits were ok. She said that it is not just the issue about access to the toilets, “I don’t want to be too far away from Mum and Al”: · E agrees she feels unhappy about being too far away. · “He would prefer me to be unhappy staying overnight than happy going by day” · “I want no more court - it’s getting too much for me” · E said Hi to her father on the way out. In further discussions with father and Ms H they said that she had been anxious when day visits had started and she had got through this. They felt it was better to ‘push through’ the anxiety and that after a few overnight stays E would be comfortable in the same way she was now comfortable with day time visits. They said there is no point in dragging things out.	Suggested it might be most appropriate for E to see a psychiatrist or psychologist in relation to her anxiety. Following considerable thought recommend Professor S, Child Psychiatrist – he already sees her sister and has a good understanding of the family.

Date

Issues and Findings

Recommendations

19/09/2014

Report to Dr Z

· E, mother and father in attendance.

· Issues included: bladder difficulties since 3-4 yrs old; current irritable bladder - urinary urgency; and intermittent diarrhoea (twice a week)

· Irritable bladder – E tends to be “urgent” during the day time and dry at night.

· Attending new school – J Town Primary and doing very well. 1.5 years ahead academically.

· Missed time at school due to bladder and bowel difficulties.

· Nice group of good friends

· Developmental milestones – normal.

· Anxious about being near a toilet. Children become fearful of incontinence. She is a highly sensitive girl.

· Children with this need support and understanding. Lack of ready access to toilets can be extremely stressful.

· Intermittent loose bowel movement – possibly lactose intolerance.

· E could be encouraged to go to the toilet every 2 hrs to prevent becoming ‘urgent’.

· Condition is one of maturity and likely over time that it will improve.

· Sometime medication is required but side-effects and not needed at this time.

· Renal testing and breath hydrogen test.

25/11/2014

Report to Dr Z

· E, mother in attendance. The appointment had been rescheduled by Dr L and the father was unable to attend

· Issues relating to intermittent diarrhoea, irritable bladder.

· Discussion about feelings in regard arrangements from Family Court matter

· Doing well at school, reading level at year 7 level. Doing well academically and has many friends

· Anxious about long journeys in car because she needs to access the toilet frequently.

· When at father’s she misses her sister and mother and likes her brother to be with her when she is at her father’s. She likes to stay at home when she is at her father’s and worries about going out.

· Happy to see father during the day but expressed significant anxiety about staying overnight.

· Anxiety does not cause of irritable bladder but is likely to aggravate the situation significantly.

· Important to take her condition into account when considering access arrangements.

10/03/2015

Report to Dr Brooke Z

· E, father and Ms H in attendance

· The Court ordered the appointment to discuss E’s difficulties.

· E did not attend school today and so father and Ms H met with the Dr until she was dropped off by mother.

· Discussed nature of urinary tract difficulties. Father and Ms H wanted to know what else they could be doing to help her with her urinary problems and anxiety.

· E tends to be having a lactose free diet – still awaiting breath hydrogen test

· When E arrived, Dr saw her on her own first.

· E said: (verbatim)

I’d like the court to go away
I’d like not to stay overnight for a few years until I’m ready
I don’t trust Dad. He said he would wait until I was ready but he went behind my back to the court.

· Daytime visits were ok. She said that it is not just the issue about access to the toilets, “I don’t want to be too far away from Mum and Al”:

· E agrees she feels unhappy about being too far away.

· “He would prefer me to be unhappy staying overnight than happy going by day”

· “I want no more court - it’s getting too much for me”

· E said Hi to her father on the way out. In further discussions with father and Ms H they said that she had been anxious when day visits had started and she had got through this. They felt it was better to ‘push through’ the anxiety and that after a few overnight stays E would be comfortable in the same way she was now comfortable with day time visits. They said there is no point in dragging things out.

Suggested it might be most appropriate for E to see a psychiatrist or psychologist in relation to her anxiety.
Following considerable thought recommend Professor S, Child Psychiatrist – he already sees her sister and has a good understanding of the family.

Dr Z, BB Town Medical Clinic

Date	Issues and Findings	Recommendations
21/01/2015 Report	· E discussed she may be required to have to stay overnight at her fathers. · E concerned about having to go to the toilet at other people’s houses and reason why she doesn’t go to sleepovers. · Expressed having significant anxiety as a result. · Also missed her sisters and her mother when she wasn’t with them.	That overnight stays with the father not commence until E’s medical issues are better under control.
27/03/2015 Report	· No proven urinary tract infections – diagnosis of irritable bladder. · Physical issue that is triggered by anxiety. · Has seen E on multiple occasions and has been told that she does not feel comfortable staying overnight at her father’s and the thought of it makes her feel extremely anxious. · Comfortable to stay with daytime visits for not. · Would be willing to re-address the issue of overnights in a few years’ time.

Date

Issues and Findings

Recommendations

21/01/2015

Report

· E discussed she may be required to have to stay overnight at her fathers.

· E concerned about having to go to the toilet at other people’s houses and reason why she doesn’t go to sleepovers.

· Expressed having significant anxiety as a result.

· Also missed her sisters and her mother when she wasn’t with them.

That overnight stays with the father not commence until E’s medical issues are better under control.

27/03/2015

Report

· No proven urinary tract infections – diagnosis of irritable bladder.

· Physical issue that is triggered by anxiety.

· Has seen E on multiple occasions and has been told that she does not feel comfortable staying overnight at her father’s and the thought of it makes her feel extremely anxious.

· Comfortable to stay with daytime visits for not.

· Would be willing to re-address the issue of overnights in a few years’ time.

Ms AA, Psychologist

Date	Issues and Findings	Recommendations
19/11/2015 Summary Report (after 10 sessions)	· Commenced seeing E 5 May 2015. Met once with the E and the father and once with E and the mother, and had 8 sessions alone with E · Rapport has been tenuously established over time. Required a slow and sensitive approach to lower E’s defence. · Initially E presented as highly functional in her school performance, her social skills and within her friendship group. · She employed a range of distraction and defensive strategies to avoid uncomfortable issues. · She has begun to use these strategies less over time and has been more open about her anxiety and more able to tolerate uncomfortable feelings. · While in some areas E is highly functional, she suffers from a moderate to quite severe level of entrenched and debilitating anxiety in several areas of her life. · Using some Narrative Therapy and some CBT elements to begin to identify her anxiety, her triggers and also the cognitive and behavioural elements of her anxiety.	· In view of E’s high level of anxiety and debility, will need to continue to build trust and rapport to work together for quite some time to come.

Date

Issues and Findings

Recommendations

19/11/2015

Summary Report (after 10 sessions)

· Commenced seeing E 5 May 2015. Met once with the E and the father and once with E and the mother, and had 8 sessions alone with E

· Rapport has been tenuously established over time. Required a slow and sensitive approach to lower E’s defence.

· Initially E presented as highly functional in her school performance, her social skills and within her friendship group.

· She employed a range of distraction and defensive strategies to avoid uncomfortable issues.

· She has begun to use these strategies less over time and has been more open about her anxiety and more able to tolerate uncomfortable feelings.

· While in some areas E is highly functional, she suffers from a moderate to quite severe level of entrenched and debilitating anxiety in several areas of her life.

· Using some Narrative Therapy and some CBT elements to begin to identify her anxiety, her triggers and also the cognitive and behavioural elements of her anxiety.

· In view of E’s high level of anxiety and debility, will need to continue to build trust and rapport to work together for quite some time to come.

[2016] FamCA 926

3 November 2016

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