Psychotherapy and Personality Disorder Hub
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.
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.
Which models of psychotherapy are available?
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:
Personality Disorder Case Management Team
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).
Personality Disorder Day and Crisis Service
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.
Service user testimonials
Please read what some of our service users have said about the service here.
Our teams are made up of a range of professionals, read about them here.
Answers to all of the above can be found 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.
Our services, including the Rotunda Day Therapeutic Community Service are based at Spring House, 12 Haigh Road, Waterloo, Liverpool L22 3XP. Phone 0151 250 6128/6130.