The Psychotherapy and Personality Disorder Hub is made up of a core team of therapists and clinicians with training in a range of psychotherapy modalities. Some therapists are referred to as trainees or honorary therapists meaning that although they are experienced mental health professionals, they are receiving specific further training in psychotherapy. All clinical work is carried out under the supervision of senior psychotherapists in the service.
What is Psychotherapy?
Psychotherapy includes a range of different approaches to solving some of the problems which people experience in their lives. The way we see ourselves and others and the way we think, feel and act are coloured by what has happened to us throughout our lives. Many of the problems which occur are psychological in nature and may not have responded to medication.
All interventions in this service begin by talking about the problems with an experienced therapist. This can lead to working together to understand the patterns of thinking, acting and emotional responses which are the sources of problems. With insight and understanding, it is possible to make changes and gain more control in our lives. This sometimes takes a long time and can be challenging.
The aim of therapy is to encourage people to talk about their difficulties in order to increase their understanding of themselves and manage their lives more effectively. In therapy, you are encouraged to explore your thoughts, feelings and behaviours in order to find new ways of coping with your life. Therapy often evokes strong feelings that may be uncomfortable. Periods of frustration and disappointment are a normal part of therapy and should be discussed with the therapist. Some types of therapy involve tasks between sessions such as keeping a diary. It’s important that time is allowed to commit to carrying out all tasks in order to benefit from therapy.
What sorts of problems can be helped by psychotherapy?
Difficulties in our lives can sometimes be manifest in confusing and surprising ways, and people report different ways of suffering their problems. Problems of emotional responses, or with thinking and acting may be explored in therapy; long-standing difficulties in coping with life events or relationships; recurring patterns in damaging relationships or behaviours; anxiety, depression, phobias, obsessions and excessive distress brought on by trauma, abuse or bereavement. Complex difficulties in families can be examined and understood, and problems in establishing attachment bonds can be helped and supported through psychotherapy.
We provide psychotherapy assessment, consultation, psychological formulation of services users’ difficulties and deliver a broad range of therapy modalities, which are delivered according to individual needs. As a staff group, we have specialist training in a number of psychotherapeutic models and provide a variety of modalities of therapy.
Psychotherapies offered include:
- Behavioural Psychotherapy
- Cognitive Behavioural Psychotherapy (CBT)
- Compassionate Mind Training informed (CBT)
- EMDR treatment for Post Traumatic Stress Disorder
- Cognitive Analytical Psychotherapy (CAT)
- Brief Psychodynamic Psychotherapy
- Systemic Family Therapy
- Brief parent infant work for parents with young children
- Group Analytic Psychotherapy (long term)
- Dialectical Behavioural Therapy (DBT)
- Mentalisation Based Therapy (MBT)
- Personality Disorder Psycho-Education Group
- The Rotunda Democratic Therapeutic Community
- Transition Group
- Structured Clinical Management
- Crisis Service
- Therapeutic Day Service
This team of four nurses provides intensive case management, based on the psychological model of Structured Clinical Management (SCM) when clinically possible, to those service users with personality disorder who present with the most complexity and who use local resources most intensively. This has allowed most of those service users, formerly out of area, to be repatriated and has also prevented other service users going out of area.
Each case manager has a reduced caseload of 10 service users and offers 100 weeks of intensive case management to each service user in their care. The team provides care co-ordination taking responsibility for care programme approach (CPA), with regular reviews with the community psychiatrist (Responsible Clinician) in the original CMHT. At the end of 100 weeks of care, service users will either be discharged from services or referred back to their original CMHT (most hopefully to be maintained at a non-CPA level). At the point of discharge, service users will continue to have access to the personality disorder day and crisis service for ongoing support.
The team works to its clinical capacity, taking on new referrals when spaces are available. When requests are made but no spaces are available, the personality disorder hub offers support to CMHTs by offering consultations to staff in other teams, to support their ongoing work with service users. Additionally the PD case managers offer a monthly practitioner support group for practitioners from other CMHTs to support with their work (this includes writing extended care plans).
The combined personality disorder day and crisis service provide a physical base for service users to form an attachment. These are based on therapeutic community principles, with service users heavily involved in running them through combined service user/staff meetings each Friday. The need for safe boundaries is ensured by the use of an acceptable behaviour procedure and democratic community meetings to help members reflect if rules are infringed. This helps maximise the promotion of autonomy and responsibility for service users. The PD day and crisis service are currently operational daily until 10.00pm each week night and will soon open at weekends.
The day service is specifically designed for those with a personality disorder and looks to address common issues that those with this diagnosis may experience. This may include a lack of motivation, difficulty engaging in a structured and balanced routine, problems with social interaction, having trouble developing positive relationships, and the ineffective regulation of emotions. The service consists of a structured weekly programme of therapeutic activities that aim to promote health, wellbeing and recovery. This has been developed and managed alongside service users in order to ensure the provision of a service that involves those central to it. Activities and groups on offer focus on providing a balance of occupations that enable skill development and encourage independence in relation to managing distress, engaging in positive roles and a balanced lifestyle, and forming healthy relationships with others. Examples of interventions include creative therapies, wellbeing groups, informal social groups, community based groups and sensory strategies.
Through engaging in activity, service users can develop a sense of identity, understand themselves and their abilities, develop interests and a sense of purpose, and learn new skills and coping strategies to deal effectively with everyday life. The ultimate aim of the service is to provide an environment where service users feel safe and supported, so that they feel able to overcome challenges that may await them on the road to recovery.
The crisis service offers one to one support to those experiencing any form of emotional or mental health crisis, and who are looking for a space where they can talk openly in a supportive and therapeutic environment. The service offers one to one drop in support, appointments, and telephone support and is run by trained mental health practitioners and support workers.The longer term plan for the crisis service is to provide four to five crisis beds, offering respite for days up to three weeks. Between the services we aim to offer a compassionate and understanding environment that promotes recovery and personal development.
Referral is open to those service users currently using the PD hub (ie. under the PD case management team or receiving one of the therapies for PD [MBT and DBT], including the Rotunda) with additional capacity for a small number of regular external referrals from CMHTs.
- Our requirements of you
- How does the service operate?
- What is a clinical consultation?
- What is an individual psychotherapy assessment?
- What happens at a family assessment clinic?
- How long will my appointment take?
- How long will I wait to be seen at my appointment?
- What to do in an emergency or crisis?
- Can I have access to my own records?
- Can I complain if things are not correct?
Our requirements of you
Regular attendance is an important requirement in order to benefit from psychotherapy. Therefore, patients are expected to attend their appointments as a priority and should contact the department if unable to attend for any reason. Notice should be given in advance for any planned absences from therapy.
The use of drugs or alcohol before or during sessions is unhelpful to therapy. If you are intoxicated you will be asked to leave if your therapist feels you cannot utilise the session. Please refrain from eating and drinking during your appointment and keep mobile phones switched off. In keeping with the Care Plan Approach, your therapist will write a short letter about your progress to your referrer at appropriate intervals. If your GP or psychiatrist is prescribing medication, this is perfectly acceptable in psychotherapy. However, it is important that you mention any significant changes in your medication during the therapy sessions.
How does the service operate?
When a referral’s received, the Psychotherapy team will arrange an assessment appointment. Alternatively, we may feel that your needs would best be served by another service, in which case your referrer will be notified.
It’s not usual to have more than one type of therapy at the same time as this can be confusing and can reduce the benefits. Any thoughts of wishing to seek additional help are best discussed with your therapist. There are of course situations where a number of professionals need to be involved with a person’s care such as community psychiatric nurses and social workers, it would be helpful for you to make your therapist aware of the support that you receive.
The questionnaires you are asked to complete as part of your referral, give some information about your life history and any problems or difficulties that you may be experiencing, and help us to decide who may be the best person to see you. They are confidential. These questionnaires are a tool to help you and the therapist understand the particular difficulties you are going through and should be looked upon as possibly being very beneficial to the outcome.
What is a clinical consultation?
Consultation is when a member of our team meets with your care team to assist them in planning the appropriate care you need, which may or may not include having therapy within our service.
What is an individual psychotherapy assessment?
The purpose of the initial assessment is to go through some of your ‘story’ and discuss your current difficulties in order to decide if therapy would be beneficial for you and if so, which type of therapy.
What happens at a family assessment clinic?
Some patients are invited to attend with their families and are seen by the Family team. This is made clear in the invitation letter.
The family team commonly work by having one or more team members meet with the family, whilst the other members of the team observe and provide suggestions. The details of these arrangements are agreed at the first meeting.
How long will my appointment take?
The usual time is between 50 to 60 minutes for an individual appointment and 90 minutes for a team or family appointment.
However, exact timing is always agreed between you and your therapist.
How long will I wait to be seen at my appointment?
Each person is given a personally appointed and agreed time and we aim to see you at your appointed time. Please report to our reception desk at every appointment. If you find yourself waiting more than five minutes and you have not been attended to, please remind our office staff that you are still waiting.
What to do in an emergency or crisis?
As psychotherapy is not an emergency service, you will need to use your normal network of support. This could include family and friends in the first instance, but also other agencies such as your GP, A&E mental health team (Liverpool Royal: 0151 706 0624, Aintree: 0151 529 8858) or the Samaritans, depending on what you need at the time. It is important to bring the difficulties you experienced to the attention of your therapist at the next session.
Our staff are very sensitive to the nature of the information you provide, both written and verbal, and your confidentiality is protected at all times. However we communicate by letter with other staff involved in your care and you can opt to receive copies of any letters written regarding your care. If you have difficulties around this, you can discuss these with our staff before your assessment commences or thereafter with your appointed therapist. Our service policy is that all information is strictly personal to you and should you be involved in a family clinic, this material will not be shared unless you give prior permission.
All therapists discuss their clinical work in supervision with experienced therapists, who abide by the same rules of confidentiality.
Can I have access to my own records?
On the questionnaires you complete at the time of referral, you will be invited to state whether or not you would like to receive copies of any letters to your referrer or GP. If you later change your mind this is not a problem, just let your therapist know.
The Access to Health Records Act 1990, allows you to have sight of your records at a mutually agreed appointment with your therapist. If you have not been seen for six months prior to this appointment, you may have to pay an administrative fee. Any information we have is protected by the Data Protection Act and General Data Protection Regulation (GDPR) compliant.
Can I complain if things are not correct?
If you have any dissatisfaction with your psychotherapy, please discuss this with your therapist in the first instance. In the event of the matter not being resolved, the Trust has a formal complaints procedure. If your unhappiness with our service has not been possible to solve with your therapist, you can contact our PALS and Complaints team here.
We offer initial assessment appointments within six weeks of receipt of your completed questionnaire. Following the initial assessment, which may take one or more sessions, if it has been agreed that therapy should go ahead, patients are placed on the waiting list of one of the types of psychotherapy available. We are continually working to minimise the wait for psychotherapy and your wait will depend on the type of therapy you have agreed to. However, waits for therapy can be long due to the high demand on our service, and we acknowledge that this is frustrating for those waiting.