Assessment & Treatment
We are a national service and work with people from all over the country.
We have a network of psychotherapists working in various locations across the UK and Ireland, and wherever possible we offer treatment close to a client’s home, though this is dependent on the availability of specialist practitioners at the time that treatment is due to start. We also see a number of people at our main premises in north London, as well as at other London locations easily accessible by public transport.
Occasionally and in exceptional circumstances, for example where patients are so disabled by symptoms that accessing services is extremely difficult for them, we can offer clinical supervision and even treatment via telephone or webcam.
Assessments are usually carried out in London, although if somebody is unable to travel it is often possible for our staff to travel to them. Where there are particular privacy concerns, we can offer meetings at places which offer a very high level of anonymity and security.
Unfortunately, it is not always straightforward to access treatment for dissociative disorders from a specialist service such as ours. At the present time decisions about whether patients can receive treatment from the Clinic are made by NHS commissioners (those responsible for allocating funds) in the area local to each patient. Decisions may be made differently in different areas.
As an independent provider, we are funded separately from most NHS mental health hospitals and clinics, and we require special funding authorisation to be made by the NHS on behalf of each patient we see either for an assessment or treatment.
In order for the NHS to fund treatment, a referral needs to come to us formally from an NHS professional, usually a GP or a psychiatrist, NHS care co-ordinator or other NHS mental health professional. It is not possible for someone to refer themselves to the Clinic nor for their friends or family to do so.
It is usually best to begin by talking to your GP to see whether they feel a referral here would be helpful. We can provide more information about what we do either to you or directly to your GP or mental health professional.
Decisions regarding funding for assessments and/or treatment packages are made at local level by the patient’s local NHS commissioning body. This is typically a Clinical Commissioning Group (CCG), but may be a commissioning Mental Health Trust or, in some cases, a Local Authority.
We encourage all professionals who wish to make a referral, or think they might wish to, to contact us in the first instance and speak to a member of the senior clinical team, who can talk through the referral process and explore with you how this works in your local area, as this can differ slightly by region.
In some localities, NHS CCGs require the funding application to come directly from the local NHS providers/referrers, sometimes using a specialist form. In most areas currently, however, the Clinic is able to make the funding application direct to the CCG with supporting letters from the relevant local professionals. This not only saves busy local professionals time, but the Clinic is aware of the questions NHS commissioners typically need answering in relation to our client group and a tailored application jointly between the Clinic and local services can then often save time and the need for additional clarifying questions to be answered which can delay the funding process, causing more anxiety to patients.
NHS commissioners have a duty to spend their budget as wisely as possible, and to help people get support closer to home wherever they can. Therefore it is not unusual for them to recommend that someone tries to access help from their local NHS mental health team before they will consider a specialist onward referral to a service like ours.
Some local mental health teams are well-equipped to provide help with dissociative disorders, but others are not. In some cases, it is possible for treatment to be carried out by a local team under the specialist supervision of someone from the Clinic or for the Clinic to provide consultation and/or training to local staff teams. We usually need to consider these issues on a case-by-case basis. Please call us to discuss available packages.
Dissociative disorders, including the most severe form, Dissociative Identity Disorder (D.I.D.) are highly complex and generally not well understood conditions in the UK due to a current lack of specialist training in this country. We therefore provide a very thorough, multi-disciplinary and evidence-based assessment. This takes place over a half-day and includes a detailed SCID-D diagnostic interview with a SCID-D National Assessor and a psychotherapeutic consultation with a Consultant Clinic Psychotherapist. We always use assessors with considerable experience and training in the dissociative disorders field
The would-be client/patient is involved in the stages of finalising the detailed report to enable patient involvement and ownership of the final document. It can take a couple of months to arrange all meetings and agree a final report. We hope that this process in itself is a therapeutic one.
Clinic treatment packages vary, from specialist psychotherapy only packages held jointly with local Community Mental Health Teams and other local providers and full care packages, again working in liaison with local services but holding overall clinical responsibility and including:
- Up to four sessions of specialist therapy per week, delivered at a level considered clinically appropriate and discussed with the patient, but usually comprising one double session (100 minutes) of intensive specialist psychotherapy supported by a further double session of support therapy. Support therapy may be traditional ‘talking therapy’ or where indicated may include an alternative treatment modality, such as Art or Music Psychotherapy.
- Access to a reasonable level of out-of-hours and emergency support for the client – which can be provided via e-mail, telephone or text message if required.
- Access to the Clinic’s support and administration team, including the Clinic Manager.
- Fortnightly specialist clinical supervision for the lead therapist to identify potential risk areas, ensure best practice and minimise secondary traumatisation.
- Weekly case review amongst the Clinic’s senior management team.
- Six-monthly clinical progress reports (or more frequent if required).
- An excellent level of liaison with local NHS health and social care services, including attending CPA and other professionals’ meetings, regular telephone liaison and the provision of an annual training session if required. Consultation and supervision packages for local professionals and teams can also be provided on request.
100-minute therapy sessions are recommended for this client group by the International Society for the Study of Trauma & Dissociation (The ISSTD):
- To enable sufficient time for processing of painful traumatic memories, to enable dissociated parts of the patient to all have sufficient time in therapy sessions and;
- To have time to work through dissociative states in treatment so as the patient can leave safely at the end of sessions.
The Clinic observes NHS Caldicott Principles governing patient confidentiality and User Involvement in Clinic services is at the heart of our clinical practice, with patients being involved in the process of their reporting to NHS Commissioners and being encouraged to feed back to the Clinic team and local services/commissioners regularly on their treatment experience.
We have no ‘party line’ on D.I.D. as to whether ‘integration’ or ‘co-existence’ should be the final outcome. We follow the wishes of those who come to us. However, we would expect everyone coming to treatment to gain a fuller understanding of their condition and to develop improved ways of living with it, which usually leads to a reduction in suicide attempts, a reduced need for hospitalisation and a greater sense of hope for the future. For many the process of having someone bear witness to their story can in itself be therapeutic.
Some people are able to find or maintain work, bring up their child more lovingly, be more able to maintain a friendship or a partnership. For some, the outcome is realising that the years of trauma they have gone through has affected all their life patterns to an extent that they might always feel in pain and fear, but they know what their reality is and are able to work with it.