Objective: Most rural and remote regions face chronic health workforce shortages. Strategies designed to redress this problem include Fly-In Fly-Out (FIFO) and Drive-In Drive-Out (DIDO) health services. The aim of this paper is to examine the opportunities and challenges involved in these forms of service delivery. Design: Detailed review of recent literature relating to FIFO and DIDO services in rural & remote Australia. Results: FIFO and DIDO have obvious short-term benefits for rural Australians seeking health care services in terms of increasing equity and accessibility to services and reducing the need to travel long distances. However, there are significant long-term disadvantages such as the potential for burnout among FIFO and DIDO health professionals who travel long distances and work long hours, often without adequate peer support or supervision. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary health care system in small rural communities.Conclusions: Given the potential negative consequences for both health professionals and rural Australians, this paper cautions against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary health care services in rural and remote communities.

One of PACJA's stated aims is to stimulate research in this field, by providing an online journal in which the findings of effectiveness and other research studies can be published. In this online journal, we intend to publish articles that contribute to the evidence base of psychotherapy and counselling in the form of theoretical essays, experiential reports, and empirical studies featuring quantitative, qualitative, or mixed-method approaches. PACJA encourages practitioners, researchers, students and educators (even if you have never published before) to submit articles for publication. The process is intended to be a supportive in order to mentor aspiring authors to contribute to the dissemination of knowledge in the counselling and psychotherapy field. The first edition lives up to PACJA's aims, with six differing articles of merit, a commentary relating theory to practice, and two book reviews.

This qualitative study explored the factors that help counsellors exposed to indirect trauma thrive personally and professionally, and sustain their engagement in trauma counselling work. The existing literature details the challenges of indirect trauma exposure in trauma work. However, the ways in which counsellors are able to derive rewards and maintain their engagement in trauma counselling work are less well recognised. The study used a grounded theory approach, with semistructured interviews conducted with 18 therapists. The study found four main interrelating themes: thriving in trauma work; navigating the empathic journey; empathic stamina and engaging in self-reflexivity; and sustaining interest and commitment. Important factors included attending to both the adverse and rewarding aspects of trauma work, having access to appropriate support structures, and incorporating variability and diversity in the work. This study extends the current understanding of the processes, practices, and strategies that promote the rewarding and sustaining aspects of trauma counselling work.

One of the aims of this research was to develop an understanding of the role mothers were perceived to play during the process of disclosure of child sexual abuse. Using narrative inquiry methodology, face-to-face in-depth interviews were conducted with 22 men and women who had an early sexual experience. Even though a mother's support and protection is known to be important, this study showed that many mothers were seen as unable to offer such support, which had an important influence on nondisclosure. The heterogeneity of perceptions of mothers among adults who experienced child sexual abuse and gender differences are described. Health professionals need to manage complex relational dynamics between adult survivors and their mothers.

Working with children is challenging in many ways, not least of all ethically. When health professionals work with children or young people they are, to a greater or lesser extent, also working with at least one parent or guardian. A child rarely presents for therapy without an adult deciding it is necessary for some reason (Koocher, 2008). Sometimes it is a parent or a teacher who wants the child to attend therapy, and sometimes it is a family therapist (Lowe, 2004). Given that young children are not always in a position to give informed consent to treatment such as counselling or psychotherapy, the adults involved are required to act in such a way as to protect the 'best interests of the child'.

I am delighted to be the person to launch the inaugural edition of the Psychotherapy and Counselling Journal of Australia (PACJA), which is the official on-line e-journal of the Psychotherapy and Counselling Federation of Australia (PACFA). Without the financial and administrative support of PACFA, and the voluntary academic support offered members of PACFA and its Member Associations, this journal would not exist. In June 2012 I examined how much research is currently being conducted in the field of counselling and psychotherapy in Australia. You might be surprised to know that between 2001 and 2012, TROVE online thesis database published 9924 theses about psychology, 4952 about social work, 619 about counselling and 260 about psychotherapy. Of course, many of the psychology theses relate to particular modalities and there is considerable overlap within these figures. In the same period, 935 theses were published about mindfulness, 259 about family therapy, 209 about art therapy, 196 about CBT, and 91 about narrative therapy. There were 1266 theses published about depression, 254 about anxiety disorder, 217 about drug and alcohol issues, 162 about child sexual abuse and 122 about domestic violence. It is not surprising that the figures for psychotherapy and counselling are lower than for psychology and social work, since psychotherapy and counselling courses generally do not offer Bachelor Honours programs or fully embrace research as a culture. However, much of the research conducted by psychologists and other mental health professionals informs our work and an increasing number of psychotherapists and counsellors are becoming research active.

One of the aims of this research project was to develop a fuller understanding of the process of disclosure of child sexual abuse. Face-to-face in-depth interviews were conducted with 22 men and women aged 25 to 70 years old, who had an early sexual experience at the age of 15 or under with someone of 18 or over. Narrative inquiry methodology was used and data was analysed using Rosenthal and Fischer-Rosenthal's (2004) process of data analysis. Disclosure can be conceptualised as a complex and life-long process, and most participants did not make a selective disclosure until adulthood. The findings extend Alaggia's (2004) model of disclosure to include the life stage and the person to whom the disclosure is being made. The main barriers to disclosure and possible gender differences are discussed. Family therapists need to manage the challenges inherent in disclosure of child sexual abuse at any age.

The issue of Childhood Sexual Experiences (CSEs) is highly controversial, and has generated considerable disagreement and conflict. Such experiences are often framed as child sexual abuse (CSA) within a discourse of child maltreatment. Sexual activity between adults and young children is indeed abuse, and fully merits the moral stance taken by therapists, health professionals and society. However, Childhood Sexual Experiences presents evidence that viewing all CSEs through the same prism of abuse, victimhood and commonly-held perceptions of gender socialisation may not always allow those affected to tell the whole story. Not all those who experienced sexual activity as children view themselves as victims, believe that their experiences had a profoundly or irrevocably negative impact on their lives, or view their experiences as ‘abusive’. Others do not want their identities to be linked to specific events in childhood. Applying a positive psychology approach, Childhood Sexual Experiences recounts and explores the stories of those who have shown an ability to come to terms with or overcome the difficulties that they have faced, exploring the insights these narratives of resilience present to therapists and health and social care professionals. I would encourage you to read this book with an open mind and to look for the strength and determination to be found in these narratives, remembering that those who are resilient may teach us how better to help those who are less fortunate.

The aim of this research project was to explore how men and women constructed a sense of self through narrative following an early sexual experience with an adult. Using narrative inquiry methodology, 22 in-depth interviews were conducted in New South Wales, Australia, with 13 women and 9 men ages between 25 and 70. All participants had an early sexual experience at the age of 15 or younger with someone 18 or older. Narrative analysis was used to examine the co-constructed stories that emerged. Participants told four evolving narratives about their experiences: narratives of silence, of ongoing suffering, of transformation, and of transcendence. The gender differences between these narratives have been examined in the light of the literature relating to childhood sexual abuse, the victim and survivor discourses, and the social construction of gender.

This research study was designed to evaluate the use of creative arts classes as an adjunct to therapy, to enhance recovery for children for whom there had been an allegation of child sexual assault. Children who were attending therapy in a rural Australian town were invited to free after-school classes in clay modelling, African dance and drumming, mosaics, and Aikido. Twenty-two interviews were conducted with non-offending parents and teachers. The teachers and the therapist observed the children's behaviour during every class. Data was analysed using a thematic approach. The program proved very popular with children, parents, and teachers alike. There were many benefits for the children, who grew in self-confidence, demonstrated improved social skills, formed trusting relationships, and experienced a reduced sense of isolation. The possibility of increased disclosures and the impact of external events on recovery are discussed.