Rotunda Psychotherapy, Consultation and Complexity Service

Who is the service for?

The Rotunda day programme is a unique specialist service based within Liverpool for people with severe and enduring complex interpersonal, emotional and behavioural problems. These problems are often referred to as personality disorders and people so described often adopt unhealthy and self harming behaviours. The service may benefit those looking for an alternative to traditional psychiatric services.

How does the community work?

The group programme helps members to discuss how they relate to one another individually as well as to the group. Group sessions provide an opportunity to discuss and explore the types of relationship difficulties which occur and to make links to help people understand where their problems may have originated. All aspects of a member’s behaviour, relationships, and difficulties within the group are open to feedback and discussion, and this is considered to be part of the therapeutic work.

The group is run by the group and is not primarily staff led. This involves members taking on a variety of roles to enable the group to run. The emphasis of the programme is on assisting members to understand their difficulties, the meaning of their behaviours, and the impact these have on their relationships. This is done with the help and support of the group.

Group members are actively encouraged to help and support each other in addressing their difficulties, in the group setting. One-to-ones are not encouraged in the group, and all relationships and interactions are held at the whole group level.

A key group principle is the “culture of enquiry”. This means that all aspects of the running of the group from individual behaviour to structures of the group and roles of staff are open to enquiry from any group member.

• The group consists of up to 15 group members and 3 to 4 group facilitator
• Involvement in the group lasts for 12 months and there is an ongoing transition group once per month for members who have completed the programm
• The day programme is a highly structured combination of group based psychotherapeutic work and social therapy
• It runs in accordance with democratic therapeutic community principle
• A key aspect in the way the group runs is that group members have an equal say in the day-to-day running of the group - working together in an atmosphere of tolerance and understandin
• Group members engage as active participants in the programme, helping themselves and others, and taking responsibility for the task of making positive changes or challenging unhealthy ways of bein
• The day programme is run by the group members and there are no one- to-one therapeutic interaction
• Responsibility for the wellbeing of the group and its members is not confined to the group facilitators, but is a shared concern for the group as a whole
• The Rotunda is not a crisis service and each group member must have an agreed “crisis plan” to meet group member’s needs should this become necessar
• The democratic therapeutic community approach empowers group members by raising self esteem, confidence and improving social functionin
• The running of the group provides the members with an experience of holding responsibilities which encourage members to think about their actions and how they impact on others
• Through the group programme people gain greater awareness of the consequences of their behaviour and take responsibility for the changes they need to make to their live
• An important part of the day programme relates to group members looking at unhealthy and destructive behaviours and therefore managing risk within the group settin
• The group helps its members think about the possible repercussions of unhealthy and damaging behaviour which people may not have been previously aware of.

Managing behaviours

Relationship problems and behaviours often repeat themselves whatever the environment or situation. There is an emphasis in the group on helping people to increasingly recognise and discuss those repeat patterns and destructive behaviours and to look at practical ways of managing difficulties or making changes.

The group comprises service users and staff, the users being in the majority. Decisions are made by consensus or voting, and members therefore have the power to decide on important aspects of the functioning of the group. Behaviours that arouse the concern of the group, such as angry outbursts or self-injury, are discussed and managed by the group as a whole. As all members struggle with similar difficulties, there is an emphasis on making the group a safe and supportive place to work with one another. The group works best when people feel safe enough to be honest with one another.

Members uphold group rules by using the group’s structures.

If someone is a risk to themselves or others, the group decides how to communicate relevant information to relevant authorities. The group as a whole, including the staff, have this responsibility. Confidentiality is a major group rule. In some extreme instances the group may breach confidentiality in the event of someone considered being a major risk to themselves or others.

How can it feel to be in the group?

Groups are fundamentally human environments, and are complex; different individuals can experience the same group in differing ways, and these experiences can be different at different times. The environment can at times be a stressful place because past experiences can feel as if they are being replayed in the group. Such experiences are important, as engaging with these kinds of feelings can help to develop understanding and the process of overcoming repeating patterns or cycles of behaviour.

Because the group is made up of individuals of different backgrounds, there are inevitable differences between people, and sometimes people are faced with the challenge of having to see things differently. Some members, for example, may believe that their behaviours are not problematic; others may disagree and this kind of situation is dealt with by challenge, feedback, group discussion and support. Engaging in the group in this way is valuable in helping people to think about their own behaviours and their responses to other people’s needs. Although the group is challenging, this happens with an ethos of understanding and respect, and in an environment in which people feel safe and confident.

The group works best when difficult feelings and behaviours are brought out into the open and discussed and explored by the group. Group members need to have enough information about each other to help one another understand their behaviours and so support each other so people are expected to be honest about their experiences and behaviours.

Some people feel quite exposed by the notion of being in a group, but despite this go on to form important relationships. Thus people begin to feel safe enough to work in the group and become more involved in the support of others.

Joining the group

Following referral (usually by a psychiatrist or by a GP), Rotunda staff will offer an assessment to develop an understanding of the individual’s difficulties and make a joint decision about whether the group would be a useful approach. In order to process the referral, all known child protection issues must have been addressed prior to the referral. Following assessment, the person needs to join a preparatory group which will help the person further understand the model, the way the group operates and to make a decision whether to continue with their referral to the group.

If someone decides they want to join the Rotunda day therapeutic community they will be invited to attend an introductory group where prospective day therapeutic community members have an opportunity to meet the current day therapeutic community group. If the person wishes to continue with their referral they will then be invited to a selection meeting.

In the selection meeting, applicants are usually invited in twos, and each applicant is asked to discuss with the group for 15 minutes why they would like to join the group. This is anxiety provoking and often a very daunting prospect but one which everyone in the group has been through, so are aware of what it feels like. The members in the selection group are assessing whether an applicant is likely to benefit from joining the group and how it will feel to work with them. Decisions are taken by a democratic vote after the applicants have left. Applicants risk feeling and possibly being rejected by peers, which may feel worse than rejection by professionals. It is helpful to remember that the members in the selection group will have similar histories and difficulties to the applicants and are assessing the applicants and the groups’ ability to work with one another.

Conclusion

This information is intended to act as a guide to inform you about the spirit that underlies the Rotunda group. It is not a definitive guide and information is best discovered by discussion with other members. We encourage a “culture of enquiry” whereby people are encouraged to ask for guidance or explanation if they don’t understand what is happening and this is expected especially as new people join the group. Successful therapy within the group is helped by entering into the spirit of the treatment. This can only be known by discussing it with other group members.

The Rotunda group aims to provide an environment that is safe and supportive and where relationship difficulties are discussed. This can lead to painful feelings but ultimately may help people have a better quality of life, including forming close and safe relationships. This is done by the group helping one another to cope with their histories and their feelings. The group is not appropriate for everyone and some people do not like this way of working. However, this cannot always be found out until it is experienced.

Referral process

The process of joining the group can be elongated, thus giving potential group members time to reflect on whether they feel ready to engage and commit to the group

• Referrals can either come from a primary service (GP) or a secondary service (CPN, social worker, probation worker, psychiatrist, psychologist etc).
• People are not able to self refe
• Referrals must be accompanied by additional supporting information outlining all current or past risk issues and this needs to be accompanied by a robust “crisis plan” agreed between the referrer and the potential group membe
• A referral pack can be requested from the admin team at the servic
• Once the referral and crisis plan have been received, prospective group members are asked to attend an assessment meeting in the first phase of the referral process
• Following this, in phase two of the referral process, more formal prep-group meetings are arrange
• Following the preparatory phase of the day therapeutic programme, an individual is asked to attend an introductory grou
• Should the person wish to proceed to join the day therapeutic community, a selection meeting is arrange
• The referral process involves the whole group and is structured to ensure that the group can assess whether or not the day programme will be of benefit to the potential member and to the group as a whole.

General Information

• The day programme meets at the Psychotherapy Service, Spring House, 12 Haigh Road, Waterloo, Liverpool, L22 3XP every Tuesday between 10.00am and 3.00p
• Refreshments and lunch are provided as part of the whole experience of the da
• All interactions in the day programme happen in groups, there are no individual meeting
• Problems on the day are all addressed in the group and in this way individuals find ways their issues can be managed.

Training Placement

• The project can offer a 6 or 12 month training experience to interested Mersey Care staff who can be seconded to work in the grou
• Training placements aim to give the trainee a learning experience in group working using democratic therapeutic community principle
• The training placement offers trainees the opportunity to work positively with service users in a unique therapeutic environmen
• The Rotunda group welcomes those with an interest in learning more about the day therapeutic community model of working and invites you to apply for a place in the training programme if you can demonstrate the following:
  1. A positive attitude toward working in a group with a flattened hierarchy which aims to promote group member’s empowerment
  2. Relevant experience of working in a mental health setting such as psychiatry, nursing, counselling, probation, and social work
  3. A self reflective, approachable and calm interpersonal capacity
  4. An ability to contain heightened levels of anxiety
  5. A capacity to work psychologically and to be able to maintain strict professional boundaries
  6. An interest in group process.

Consultation and Education

• A consultation service is also offered within the model to other professionals working with challenging behaviours with this client grou
• Current and follow up group members have an interest in giving information to both professionals and prospective group members about the day programme.

If you require any further information about the Rotunda day programme, the training placement or the referral process please contact the service.

Psychotherapy, Consultation and Complexity Service
Mersey Care NHS Foundation Trust
12 Haigh Road,
Waterloo
Liverpool,
L22 3XP

Tel: 0151 250 6128