We provide liaison and consultation on a range of issues, such as Trauma, including but not limited to: Post Traumatic Stress Disorder (PTSD), Complex PTSD, all other types of Trauma (developmental, communal, familial, institutional, and work related), Cognitive processing, Adverse Childhood Experiences, developmental issues including Trauma, and Neuro Diverse development, effects, management. Trauma also presents as mental health issues and we can offer support for including but not limited to personality disorders, psychotic disorders, dissociative disorders and attachment disorders, domestic violence, sexual violence, substance misuse, neuro divergent, suicidal thoughts, idealisation and attempts, self-harm and neglect of self. Consulting is charged on an hourly basis and is supporting any individual or supporting staff working with any of the above. Consultation can be accessed at any stage of client package management, from recruitment of staff to supporting staff as well as assisting to write care plans, risk assessments and other clinical measures needed.
These are used when a client displays difficult behaviours which may impact the staff physically, psychologically or emotionally. Following on from the trauma informed training, staff are given psycho-educational input re the client as well as emotional support. This is to minimise the impact of vicarious or secondary trauma as well as burnout. These sessions allow the team to not only feel supported but to make staff members feel appreciated, heard, and important to the team which in turn creates another facet of job satisfaction.These have clear benefits to client care. These are regularly reviewed also and usually minimise to monthly once a client and team are settled.
This training includes but is not limited to an overview of the neuro scientific approach to trauma and how this impacts triggers, trauma processing, neural associations and reactions/behaviours. During this training there is also an element of process group to allow staff to process the information given and understand the material. The client is also discussed throughout the training to allow staff to understand how trauma affects this individual particularly and to ask questions about specific behaviours and triggers. This is not only to give more succinct and cohesive information about our client but to support staff/client from the outset. Adverse childhood effects are also discussed within the day, and the impact of these on emotional regulation. Training also includes the window of tolerance which staff keep as a guide of what to look for and how to approach the client if they happen to become hyper/hypo vigilant.
The main aim of an initial assessment is to establish capacity, ability and necessity for therapy. Will need any documentation to inform past and present issues, ways of relating and what has already been tried in ways of communicating and therapy. The more information given will support a 360 view in terms of needs, risk and allow for a more thorough assessment. The meeting with the client (and family/peers) will also help to inform me of the client’s phenomenological experience as well as how the client communicates with me, and the suitability of differing types of therapy. These include but are not limited to CBT, Psychotherapy, psychodynamic, existential,Art/music/creative, person centred, and an integrative approach is common.There is also an element of psycho educational discussion depending on whether the client is neurotypical or neurodivergent, the capacity of the client and need for 'logical thinking'. A proposal will be included recommending whether the client is capable of therapy and details of therapy intended if any.
The main aim of a psychoanalytic analysis is to gather all information necessary to consult with managers regarding clients needs, diversities, support, safeguarding, recruitment, as well as for therapeutic and training purposes. In addition, the analysis will also gage cognitive and emotional abilities of the client for prospective therapy and/or interventions.The Psychological analysis includes the initial assessment as above for the first session. The second session includes an assessment to establish suicidal tendencies, ideations and attempts, coping mechanisms/behaviours, mental health diagnoses, lifestyle and relational issues as well as general information. A Core outcome measure form will also be completed to measure subjective well-being, problems/symptoms, life functioning and risk/harm. Dyadic relationships (if any) and the impact therapy may have on the familial structure (roles and norms) will also be assessed. This also informs the patterns of relating style for each. Trauma, core beliefs, defence personalities and ACE’s are usually identified at this point. A proposal will be included with a more detailed account of what therapy is necessary as well as exact outcomes and measures expected additionally any other services that we feel could maximise client outcomes.
This report will be an analysis and assessment of information given including but not limited to:
- Work undertaken with client
- Overview of outcomes met
- Any changes to negative behaviours, relationships, and other external factors showing change
- Health and well being
- Social support
- Risk review
- No of sessions with client
- No of sessions DNA’s, cancelled and any reasons
- Consultants feedback and thoughts
Sessions can either be face to face, over telephone or online. This will be deciphered depending on suitability and necessity to travel. Therapy is used to enable the client to process untreated trauma. Due to confidentiality and the ambiguity of therapy and individuals, there can be no specifics given primarily of the therapeutic work. However, it is for the client to focus on behaviours/feelings that are unmanageable and these lead to work on negative attitude of self, others, cognitive associations, narratives as well as unregulated emotion. A Core outcome measure form will be used every 6 sessions to measure efficacy of therapy as well as routine evaluation specifically for risk/harm.
Sessions to be provided for anyone having a substantial impact on the client and their care. For example, parent care giver transitioning from being full time carer to giving responsibility to a staff team. One of our consultants would have sessions with the parent/caregiver and support them to help grieve their identity as carer and move forward to a new relationship with client as parent/child. This can take longer depending on how long the parent has been caring for the client. This is an example, however mediation, is giving support to someone to communicate their needs/wants/fears etc and ensure they also understand the view of others. Mediation can also be given if communication has broken down between client and professionals.
These are ad hoc and are at crisis point only. If a client is in extreme distress and is having, suicidal thoughts, making plans to commit suicide, causing harm to self or others (excluding manageable self-harm) then a consultant can contact the client and support to stabilise them. Efficacy can be dictated by the level of relationship/involvement there already is with the therapist. These are the only types of sessions that can be carried out without consultants meeting client/family face to face prior to session. If crisis is extreme, consultant can be requested to attend in person.
Family update meetings are sporadic and uncommon but have been requested by clients. Professional update meetings are more usual as to discuss the scope, length and efficacy of the therapy as well as other services undertaken. This also allows for everyone to have a more in-depth awareness of trauma informed working, therapy and staff support whilst maintaining confidentiality.
Training can be written and presented for an extra cost if client staff need specific area of trauma information. As written before, Trauma informed training includes the neuro-scientific approach as well as a customised process group and supporting material using the information to understand the client. In addition to this, there are many specific presenting issues that can be discussed including but not limited to: Attachment issues, substance misuse, domestic violence, sexual violence, and risk-taking behaviours. There may be a specific mental health disorder a client has that would need in depth training such as personality disorders, dissociative disorders and anxiety disorders.
.png)
