Psychological Skills Service

• A trauma informed formulation that helps make sense of difficulties in the context of what happened to you, how you made sense.

• Different types/ level of group and individual interventions. These aim to offer different intensities and different therapeutic approaches (phased approach/ rebuilding the brain from the bottom up)

• Transdiagnostic therapies. We provide therapy that helps you with the difficulty you have rather than categorise/ exclude by diagnosis.

• Supervision, training and teaching to staff in and outside CPFT on request

What is a formulation?

When you are referred to our service you will initially get an email asking you to opt in to a formulation appointment. 

A psychological formulation attempts to make sense of your present difficulties in the context of your life history, recent events, and understandable survival strategies you have adopted that may help in the short-term but maintain your difficulties in the long term. It also acknowledges your strengths that can help you to address your difficulties.

Before your formulation you will be sent a link with two questionnaires. These questionnaires have been chosen to think about the wider stressors and your quality of life and help us plan interventions that will be most helpful.

A psychological formulation tries to make some sense of why you are struggling and inform the specific approach/ intervention that is going to be most beneficial to you right now.  We spend some time really trying to understand your difficulties and how they affect you.  This means asking you what these difficulties look like day to day and when they are manageable or at their worst.

We will try and understand why these difficulties developed.  What has happened to you and how might this have affected you (taking into account your own temperament, cognitive and emotional style and age).  We think about how you have coped/ survived until now and how these strategies have helped you but may have limited you. 
We also think about recent events/ pressures that may have meant that the resources you had are not enough for what you are trying to cope with right now. 

It also acknowledges your strengths that can help you to address your difficulties.  We also ask you to think about where you want to get to (your goals) and what you have tried before. Knowing your goals tells us where you want to get to which helps us choose the right intervention. Knowing what hasn’t worked stops us from recommending something unhelpful.  We might recommend an intervention from our service or from another service that offers a different approach that we think could be helpful. Depending on the service we can make a referral or explain how you might do this.

The interventions we offer

1. Support work sessions

Therapeutic Support Workers provide support and assistance to individuals with complex trauma related mental health challenges. The role involves working closely with patients to help improve their well-being and quality of life.

Key aspects of a Therapeutic Support Worker's role:

• Support people in building skills when lack of skill is a contributing factor to their current difficulties e.g. support people who struggle to struggle to establish a manageable routine.

• Using therapeutic techniques and interventions to encourage positive behaviour and reduce negative behaviours.

• Supporting clients in developing social and life skills.

• Encouraging participation in activities that promote mental and physical health.

• Educating patients about coping strategies and available resources.

• Promoting available resources for additional support e.g., housing/financial 

The support work sessions are often the most important first step in your recovery.  Both the current guidelines recommending a phase based approach to the treatment of complex trauma (Herman, 1992) and the Neurosequential model (see resources) talk about the importance of helping you to regulate yourself and the environment before trying to make sense of what has happened.

2 . Structured psychological skills teaching

In this intervention you will work with one of our team on a one to one basis and receive 8 sessions that based on your formulation we think would be most helpful for what you are struggling with. There are 8 sessions in total.

Your therapist will work through one of seven manuals (see descriptions below and leaflets in the resource section).

These manuals focus on: anxiety management, managing low mood, how graded exposure can help you face fears; acceptance and commitment therapy, compassion focused therapy, coping with voices and understanding and coping with complex trauma.

We have developed these manuals within the service after researching the different ways in which trauma can effect people and different approaches that can help. You will get a copy of the manual. The person working with you will explain how strategies apply to specific situations you struggle with on a daily or weekly basis. For these strategies to be effective there will be work to do between sessions so that you can practice skills and test some of your fears. The person working with you might help you to try out some of these strategies in the sessions either in or outside of the office- depending on what your goals are.

Breakdown of psychological skills taught in the service

• Managing low mood - helping people to reduce the vicious cycle of depression by increasing activity levels.

• Graded exposure - helping people who are unable to leave their homes due high anxiety, to be able to overcome and manage anxiety and get to places they have previously been avoiding.

• Anxiety management - helping people learn strategies to cope with anxiety that interferes with daily life.

• Coping with hearing voices - helping people to learn how to make experiences of voices feel less distressing and interfering in everyday life.  We draw upon cognitive behavioural therapy and compassion focused therapy in these interventions. The clinician will use the model that best helps make sense of why you find your voices distressing

3. Up to 10 sessions of psychological therapy

For many people who come to our service the thing that causes the most distress is not being able to make sense of why they are struggling with their current difficulties.  Some people know that they have experienced considerable trauma in childhood and adulthood and are aware that this is having an impact on them but don’t know why or how.  This causes confusion and shame. 

Spending time making sense of these links can be important if this is something that we think would help a person be able to have a better quality of life. Often people are more confused when what they have experienced in their childhood doesn’t include things that are commonly described as traumatic e.g. physical and sexual abuse.  The making sense sessions help people to understand how their experiences might have included some smaller and persistent trauma every day. Perhaps this was because other people did not understand or empathise with how or how intensely they experienced emotions. Or perhaps your caregivers focused on their careers, or another ill sibling or their own illnesses which meant it wasn’t ok or safe for you to not be ok. 

Psychological therapy typically involves a few sessions of “sense making”. During these sessions the therapist will work with you to draw out an explanation of how your past experiences may have led to current difficulties, and how your survival strategies/ best efforts have helped you to survive but now might be over used/ over sensitive.  The idea would be that at the end of these sessions you have a shared understanding that makes sense to you. Your therapist will bring in knowledge and experience that have of the effects of complex trauma and a range of psychological models. 

After this period of sense making your therapist will work collaboratively with you to think about where you want to focus and what therapeutic models are going to be most helpful to you. You will have up to 10 sessions focusing on your priorities.  At the end of this they will review your progress towards your goals and discuss what other interventions/ services could be helpful for you

4. Understanding and Coping with Trauma group. 

This is an online group programme for people who meet the criteria for CPTSD.  It covers the following topics:

•   What is “complex trauma”?

•   Some of the ways that complex trauma effects our brain development, beliefs, and reaction to others

• How complex trauma leads to CPTSD and what CPTSD is

• Strategies and resources for coping with intrusive symptoms of PTSD including flashbacks, nightmares and dissociation.

• This group draws upon some ideas from Compassionate-Focused Therapy, helping group members to develop more compassionate ways of relating to themselves and the difficulties they face.

Psychoeducation and resource building are part of all evidence based therapies for PTSD.  If your complex PTSD originates from multiple/ prolonged trauma starting in childhood, it is likely that your threat system is over active and areas of your brain needed to soothe yourself or feel a sense of safety are underdeveloped.  Growing up feeling unsafe (emotionally and physically) around people means that you have negative templates of yourself and how other people will respond to you.  You will struggle to feel safe around people and haven’t had the opportunity to develop resources.  Being around people often triggers a dissociative response because your brain continues to feel like you are unsafe and cannot escape.

We offer these resource and skills building in an online group.  The group format means that people get the chance to realise that they are not alone in what they experience. Many people feel a lot of shame about having complex PTSD and believe they should have “got over it” by now. 

The group helps challenge this shame. The group also provides a gradual way of being around people. Many people try and avoid their fear of being abandoned or abused by others by avoiding people altogether. Being a group means that you start getting used to being around people again helping to challenge that fear. It also gives you a chance to learn from others. A group can be more manageable and less anxiety provoking for people with CPTSD than one to one therapy. 

As everyone in the group will have experienced interpersonal trauma they will have experienced either rejection, abandonment, neglect or abuse from other people. This means that any new relationship triggers considerable fear of the same reaction. This will be the same in one to one therapy and this fear can make it hard to focus or think.In a group this is less activated and can be managed. 

The group has 2-3 facilitators who are there to support, notice and ensure people can be heard.  It is a skills group designed to provide skills to help provide resources. We advise that people don’t provide details of traumatic events during this therapy and the facilitators will talk through this at the beginning and focus on creating safety.

5. Individual Occupational therapy

In PSS, the primary role of OT is to work with individuals to identify, learn and develop skills in relation to their own sensory processing patterns 

including modulation and praxis challenges and how these link to self-regulation.  This will help individuals to understand how these can influence participation in daily activities and contribute to their overall health and wellbeing.  

Further to this primary role in PSS, OTs can work with a person to restore productive and meaningful roles including work, relationships, self-care, hobbies and interests. This may be (but not limited to) when the person is transitioning from PSS, to enhance and further develop independence, confidence and participation.  

What is sensory modulation? In basic terms, sensory modulation is about too much, or not enough, in relation to incoming sensory information. We modulate our responses in various ways all the time, to support self-regulation. We often refer to this as being over or under responsive to sensory input, both from our environment but also from within our body.  

What is praxis? The neurological process by which we think about what we need to do, plan this and then action it. This might be things like planning a meal, getting the ingredients, following the recipe. So, praxis involves the process of having an idea, being able to plan the idea and then being able to execute the plan)  

Group schema therapy

Group Schema Therapy (GST) is a group therapy programme for people with experiences of childhood or attachment trauma.

The programme supports people who recognise that their current difficulties are connected to adverse experiences in childhood (see adverse childhood experiences) and/or adolescence. The key emphasis in schema therapy is that we understand that for a variety of reasons your core needs were not met as a child (these include; feeling loved, feeling like you belong, being able to express your emotions, being able to be your own person, having safe attachments, having limits and being allowed to have fun).  It may be that your caregiver was doing their best at the time or you can explain this happened as an adult, but ultimately these needs were not met and this has effected your templates of the world

GST is designed to help address longstanding patterns of feeling, thinking and behaviour that are causing distress. These patterns may contribute to difficulties such as recurring  depression , anxiety , eating disorders , substance misuse , emotional dysregulation, poor self-image or relationship difficulties. 

GST helps you to recognise how your earlier life influences the way you feel about yourself and your relationships, and shapes how you go about coping with life now.

GST consists of 24 weekly  2 hours group sessions (online), with some specific individual sessions to review your experiences and check that the group is meeting your goals (in person).

To learn more about schema therapy please see the attachment in the resources section (What is group schema therapy)

Trauma processing therapy

This is individual therapy focused on the reprocessing of trauma memories.  This therapy is specifically for people who meet the criteria for complex PTSD and who experience flashbacks, intrusive nightmares and avoidance that significantly effects all areas of functioning.  Trauma processing is not recommended for people who are not experiencing these difficulties.

You and your therapist will identify specific memories that you think are stuck and need to be reprocessed.  These will be the memories related to the flashbacks, nightmares or problems you have which are understood as the past feeling like it is in the present.  You will not be processing all your trauma memories- just the ones that appear to be stuck and impacting on you now.  You and your therapist will initially contract for 12 sessions. 

Using questionnaires and monitoring between and before sessions you and your therapist will continue to measure how helpful the therapy is in targeting your difficulties. These measures are really important to understand anything that is getting in the way and what is working. 

Trauma processing requires you to relive memories using different techniques. To ensure that you can benefit from the therapy and be able to flexibly visit the past and return to the present you will have needed to have completed the trauma stabilization group before starting this therapy (see above). The group provides you with psychoeducation and resources that essential for looking at memories of developmental trauma.

How do I refer?

All referrals from outside of CPFT come via the GP and our primary care mental health service

See information on how to refer below: 
Information for referrers.docx [docx] 69KB 
Guidelines for referrers for referrals for CPTSD.docx [docx] 868KB

Referrals from within CPFT (see table attached here) 

Most referrals are received electronically through S1. We do not take referrals by emails. We are aware that some of our referrers do not have S1. If this is the case please contact pssadmin@cpft.nhs.uk

Please see below document on how to make a referral on System 1. PSS - Making an Electronic Referral on SystmOne.docx [docx] 329KB

Assessment and monitoring

Watch an introduction to the CPTSD Guidelines here.
Overview of guidelines on CPTSD 2024 3 (1).pptx [pptx] 3MB
Differentiating between ALT TT and PSS 2.docx [docx] 964KB

Watch a film about differentiating between ACT, CFT, DBT and Schema : 
Differentiating between ACT, CFT, CBT, schema and DBT 1 (1).pptx [pptx] 2MB

Assessing a client’s suitability for CT-PTSD: Assessment video
 

 

 

Will I be seen online or in person?

Please note: PSS is both an online and face to face service. For some therapies there will be an option, for others it will only be available either online or face to face.

Where to park and are there parking charges?

Limited free parking at Chesterton Medical Centre. Peterborough clients should use the public car parks, or phone ahead for parking advice.

Is there access and support for patients and visitors with a disability?

Please ring the team before your appointment to discuss any requirements.

How to cancel your appointment

Please call and leave a message 01733 746811.

 

 

The effects of developmental trauma PSS poster.pdf [pdf] 1MB
PSS simplified powerpoint.pptx [pptx] 1MB
Occupational therapy and Sensory approaches in PSS.pptx [pptx] 4MB

Trauma body workshop part 1- What do we mean by trauma and how does it effect us.pptx [pptx] 8MB
Trauma body workshop part 2 - Understanding the link between trauma and chronic pain.pptx [pptx] 20MB
Trauma body workshop part 3 - Understanding the link between trauma and chronic fatigue.pptx [pptx] 10MB
Trauma body workshop part 4- Understanding the relationship between trauma and FND.pdf [pdf] 2MB
Trauma body workshop part 5- Other physical problems linked to trauma.pdf [pdf] 847KB
Trauma body workshop part 6 Top down approaches to treatment and where to find them.pptx [pptx] 17MB
Trauma body workshop part 7- Bottom up approaches and references.pdf [pdf] 4MB

Trauma Body workshop - film 1
Trauma Body workshop - film 2
Trauma Body workshop - film 3
Trauma Body workshop - film 4

Schema Group.pdf [pdf] 446KB
The effects of developmental trauma PSS poster.pdf [pdf] 1MB
Understanding and Coping with Trauma Group (1).pdf [pdf] 1003KB
Support Work.pdf [pdf] 1MB
Trauma Body Workshop.pdf [pdf] 288KB
Psychological Therapy - Complex Trauma.pdf [pdf] 998KB
Psychological Skills - Low Mood.pdf [pdf] 1MB
Trauma processing leaflet[pdf] 569KB
Psychological Skills - Anxiety.pdf [pdf] 266KB
Psychological Skills - Graded Exposure.pdf [pdf] 306KB
PSS simplified powerpoint.pptx [pptx] 1MB
The effects of developmental trauma PSS poster.pdf [pdf] 1MB
CFT for Voices.pdf [pdf] 631KB

 

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At Cambridgeshire and Peterborough NHS Foundation Trust, we value the often life-long support carers provide and recognise them as equal care partners. We want to offer as much guidance and reassurance as possible, to help you in your caring role. You can find general information and support for adult carers, young carers and parent carers by following this link.