Psychological Skills Service (PSS)

The Psychological Skills Service (PSS) is a new service for people who experience significant difficulties with their mental health, whilst also managing to keep themselves safe and relatively well without significant support from services.

Historically, the people who the PSS is designed for might have found that their difficulties were too complex to be supported in primary care, whilst also not considered serious enough to be supported in secondary care and so fell through the gaps. The service also helps people may have had some CBT or other therapy in the past and found it to not be as helpful as they had hoped.

Background: How did the service develop?

PSS was developed as part of the Exemplar project in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to address gaps in psychological service provision between primary and secondary care, support the development of a more seamless pathway and promote joint working.

For more details about the service watch a film here and a second film here. You can also click on the drop downs below.

What does the PSS offer?

  • A trauma informed formulation that helps make sense of difficulties in the contect 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?

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.Please see resources section for an example template of what a formulation might look like from our service

The different types of therapy we provide:

  • Support work sessions (see leaflet in the resources section)
  • Support work is aimed at helping you to manage some things in your environment that are:
  • Destabilizing you/ keeping you feeling unsafe/ unsettled or in high alert/ making it harder to focus on anything in the present AND/OR
  • Can help you to be able to find out about and access other services that could help you/provide you with more information and support.
  • Your support worker will also teach you some skills to regulate or manage different emotions so that you can focus on how to solve problems and help you to practice these strategies as part of your sessions.
  • If you struggle with reading, writing or processing information you might also get additional sessions with a support worker to help you to be able to do homework or go over material from other interventions

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.

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 (see leaflets)

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

2. 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.

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

4. Coping with hearing voices - helping people to learn how to make experiences of voices feel less distressing and interfering in everyday life.

5. Acceptance and commitment therapy - helping people to live life more fully informed by their values, learning how to feel in control of their lives and even when feeling the inevitable difficult feelings that come with being alive

6. Understanding and coping with complex trauma - we also offer this as a group and a lot of people find the group is more helpful because it is reassuring and challenging to their sense of shame that other people experience similar difficulties

7. Compassion focused therapy (CFT) - learning ways to be more self-compassionate (kind, gentle, empathic, courageous), overcome shame, increase self-soothing skills and find ways of tackling an internal critic (a critical voice/bully that puts down everything that you do). CFT also helps people learn how to self soothe/ develop a soothing system that may be underdeveloped due to early experiences

8. Psychological therapy (10 sessions) - sometimes learning skills can be enough for a person to tackle problems and reach their goals. For other people we know that it is important to try and understand in more depth how these problems relate to earlier experiences and how or why certain difficulties link to together e.g. why do my early experiences mean I feel alert all the time, hate myself and hear voices that tell me I worthless. For some people making sense of and linking things together is needed for them to work towards goals. If this is the case we offer psychological therapy. If you are assigned to this type of therapy you will meet with a therapist who will review and breakdown you initial formulation, talk through what this means and how it links to your past and make a plan for therapy.

They will use this to make a plan with you about what difficulties to tackle and in what order. They will base this on a psychological model which they will talk through with you so that you can understand why certain strategies are being recommended. This therapy involves homework between sessions to be effective. In sessions because links between past and present are made this can be more painful or triggering of past memories and emotions than the skills sessions. Although you won’t be asked to go into detail about any past traumas even the process of understanding that something traumatic that happened may link to now is often hard.

The therapy will draw on the models described in the section on skills

9. The sense-ability group (see leaflet in resources section) - we understand that there may be a variety of reasons why people have sensory problems (either being over or under sensitive to certain sensory cues) (see resources Developmental-Trauma-Close-Up-Revised-Jan-2020.pdf (beaconhouse.org.uk). This can be due to developmental trauma, natural temperament or neurodivergence.

We understand that if you struggle with the management or processing or sensory information life is more overwhelming. In light of this we have developed a face to face group that aims to help you build sensory awareness of yourself, others, and the environment, increase self control. You will learn to understand your senses and which of those might be hypersensitive or hypo sensitive. You will learn how to use this awareness to increase energy or help you feel calmer and more focused (depending on what you need at the time). This will help you improve your ability to pay attention to activities you want to, complete activities and mean you are better able to problem solve.

10. Trauma stabilisation group (12 sessions) - this is an online group programme providing information about what complex trauma is, how and why exposure to complex trauma impacts on many areas of development, strategies for how to cope and develop of more compassionate perspective on the difficulties you face.

11. Individual Occupational therapy - for people who are struggling more with understanding their sensory problems you will meet with one of our occupational therapists who will help you complete an assessment of your sensory profile and develop an understanding of your specific sensory processing difficulties. You will then learn some strategies of how to manage and adjust your home and working environment so that you can focus on what is important to you.

12. Schema therapy group - this group is 24 sessions in total and helps you to understand how and why your early experiences linked to negative beliefs about yourself, the critical beliefs and standards you set yourself and how the way you have learnt to cope helped protect your from feeling vulnerable but has also meant that your needs keep not being met (see attached leaflet)

13. Advanced individual therapy - this is individual therapy helping you to process trauma memories and support you in being able to examine the memories and the beliefs you have about yourself and what happened to you. Up to 30 sessions are offered. Your therapist will draw on models that have an evidence base in the treatment of complex PTSD.

Referral information for professionals

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 here:  Information for referrers.docx [docx] 69KB

 

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

 

Frequently Asked Questions (FAQs)

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.

 

 

Information for carers

A carer is anyone, including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid.

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

As a patient

As a patient, relative or carer using our services, sometimes you may need to turn to someone for help, advice, and support. 

Patient Advice and Liaison service  Contact the Trust