Traumatic stress service
Our Traumatic Stress Service (TSS) is national specialist service which works with people suffering from Post-Traumatic Stress Disorder (PTSD) and associated conditions.
We offer assessment, psychological treatment and consultation for people with PTSD. This can include victims of rape and sexual assault; victims of serious physical assaults; victims of serious road traffic accidents; and victims of other ‘single incident’ traumas.
Over the years our work has expanded to also include the needs of refugees and asylum seekers, many of whom have experienced multiple traumas including war, torture and violent bereavements. In addition, we treat service and ex-military personnel, as well as victims of terrorist attacks. We work with patients from a wide variety of ethnic groups and many of our clients do not speak English.
The service primarily covers five boroughs of London as well as taking some national referrals. We provide psychological assessment and treatment of PTSD on an outpatient basis. We do not have inpatient or community outreach facilities. Our clinicians work within a Cognitive-Behavioural Therapy (CBT) framework and can also offer Eye Movement Desensitisation and Reprocessing Therapy (EMDR). We offer appointments on Monday-Friday between 9am and 5pm.
As well as treatment, we provide teaching, training and supervision to colleagues working with PTSD. We also undertake and support a range of research activity in the areas of trauma and recovery.
Eligibility
This service is for adults who have experienced severe trauma and subsequently developed Post-Traumatic Stress Disorder (PTSD).
PTSD is an anxiety disorder caused by experiencing or witnessing life-threatening events. PTSD can develop immediately after someone experiences a traumatic event or it can occur weeks, months or even years later.
Inclusion criteria
- People over the age of 18 years. There is no upper age limit.
- People who have experienced one or more traumatic events in adulthood and have subsequently developed PTSD from those events.
Exclusion Criteria
Concurrent conditions requiring treatment in their own right:
- Active psychotic symptoms
- Alcohol, drug or medication abuse or dependence
- Severe depression and/or suicidality
- Other severe current risk to self or others
Please see our referral guidelines for more information on inclusion criteria for the service.
Read more
How to refer
The service accepts referrals from local Talking therapies teams (IAPT), secondary care (RST) and specialist mental health services. The service does not accept direct referral from GP’s or primary care workers – these should be sent to local Single Point of Access teams. Referrals from outside the Trust catchment area are also sometimes accepted where funding is agreed in advance.
Access to the TSS is via written referral – either completing the referral form or via detailed assessment report. The referral should include a detailed assessment that covers relevant background and personal history, trauma history and current symptoms. It should also include details of any previous treatment, a risk history and an up-to-date risk assessment.
Please see our referral form.
Read more
Treatment
The service’s treatment orientation is cognitive behaviour therapy (CBT), specifically trauma-focused CBT. Our main treatment models are Ehlers and Clark’s (2000) integrated cognitive model, and Judith Herman’s (1996) phased treatment model.
Treatments include anxiety management and emotion skills training, reliving and reprocessing of traumatic memories, cognitive restructuring outside and within reliving, imagery rescripting, behavioural experiments, in vivo (field) work, and schema-level work.
We offer treatment in the following formats: standard (12-16 sessions), extended (16-40 sessions) and intensive (18 hours over 5 days). Our clinicians also provide EMDR therapy for PTSD as a secondary or alternative evidence-based treatment.
Treatment is delivered by trained specialist staff using a phased treatment framework. All our treatments are compliant with NICE guidelines for PTSD, other anxiety disorders, depression, self-harm and personality disorders.
Treatment is always individually tailored to the patient based on a detailed assessment of their needs. Condition-specific outcome measures are used to evaluate the effectiveness of treatment and the service.
Training and Supervision
We offer teaching and training on PTSD at four levels:
- Introductory courses for professional groups at increased risk of developing PTSD (such as aid workers and paramedics)
- Teaching sessions for clinicians likely to encounter PTSD in the course of their work (victim liaison officers and medical staff);
- Multi-sessions training packages for clinical psychologists and CBT therapists in the identification and treatment of people with PTSD
- Combined supervision and training packages to whole psychological services to help them improve their outcomes for people with PTSD.
Tailored training programmes can be developed and delivered to services to meet their requirements. For example, a training package in TF-CBT comprising face-to-face workshops, webinars and supervision was recently delivered to therapists across 10 IAPT services. Evaluation of the programme revealed large improvements in therapist knowledge, skills and self-efficacy in treating PTSD.
We also offer CPD placements to clinicians inside and outside the Trust, who already have a foundation in CBT skills and wish to develop their competencies working with PTSD and trauma.
Please read more for our training leaflet.
Read more
Staff
Our core team is made up of clinical and counselling psychologists and a team administrator. We also have an assistant psychologist who works part-time on our research and training projects.
Our core team is:
- Dr Sharif El-Leithy, Consultant Clinical Psychologist
- Dr Eleanor Cross, Principal Clinical Psychologist
- Dr Abigail Pain, Highly Specialist Clinical Psychologist
- Dr Jenny Rahemtulla, Highly Specialist Clinical Psychologist
- Dr Lauren Williams, Highly Specialist Clinical Psychologist
- Dr Maria Mateen, Highly Specialist Clinical Psychologist
- Dr Alex Kasozi, Highly Specialist Counselling Psychologist
- Dr Belinda Graham, Highly Specialist Clinical Psychologist
- Andrea Phillips, Assistant Psychologist
- Dr Alicia Griffiths, Highly Specialist Clinical Psychologist
- Bartholomew Tenerowicz, Team Administrator
A number of other psychologists and psychiatrists work in the service part-time, undertaking specialist continuing professional development (CPD). We also offer clinical and counselling psychology trainee placements on a national basis.
Outcomes
The Traumatic Stress Service routinely collects information to help us monitor the effectiveness of the treatments we offer. We use a number of standardised symptom questionnaires to do this.
Every patient completes the Post Traumatic Stress Diagnostic Scale (PDS) and the Beck Depression Inventory (BDI-II) at their assessment and then at the end of their treatment. The PDS questionnaire measures the severity of their PTSD symptoms. The BDI-II measures the severity of their depression symptoms.
Our results show that, in terms of PTSD symptoms, 74% of our patients report a significant improvement after treatment, with 51% making a recovery. In terms of depression symptoms, 60% of our patients report a significant improvement after treatment, with 47% making a recovery.
Testimonials
Some things our patients have told us after treatment:
“The Traumatic Stress Service has helped me to achieve many things in my life, and also with my family. When my friends see me now they see the change in me.”
“That was the hardest part for me…admitting that I had a problem. Since then, it has been difficult getting through the treatment but the end result is my life has become more manageable”.
“The doctor asked me several times to recall the incident which happened. It was really difficult to confront this memory. It was so distressing talking about the past that I wanted to leave, but after a few sessions, I started to use the treatment techniques at home and I realised that what the doctor had told me was helping me to deal with my memories of the incident”.
“When the doctor said that he wanted me to talk about what happened in the past, I was not willing to do it. But after he explained that it would help to talk about the past, I agreed. I told the doctor I would only talk about what I was able to. It was very difficult in the beginning but it got easier”.
“My advice would be to continue coming to the treatment sessions and not to stop. It will be difficult at first, but they will get results and feel much better in themselves if they finish the whole course of treatment, and they need to have patience”.
“It’s hard getting it out of you, and bearing your soul so to speak, but it is definitely worth it”.
OCD/BDD service
We are a multidisciplinary national service providing treatment for the most severely ill patients with Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD) in the form of intensive homebased therapy, outpatient, and inpatient treatment.
Trustwide service
The service is a tertiary service serving five boroughs – Wandsworth, Merton, Richmond, Kingston and Sutton. We provide assessments and treatment for people with OCD or BDD, and we often work closely with other teams. We provide advice and consultation to primary and secondary care services, and the voluntary sector for OCD and BDD.
Referral inclusion criteria
- Adults aged 18 and above.
- Living in the boroughs of Merton, Kingston, Wandsworth, Richmond or Sutton with a registered GP in the borough
- Main presenting problem : Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Panic Disorder with/without Agoraphobia, Health Anxiety Disorder, Emetophobia, Specific Phobias, Social Anxiety Disorder, General Anxiety Disorder and Hoarding Disorder
- Previous treatment required: At least one previous trial of CBT for the anxiety disorder(s) that the person is being referred for – CBT should include at least 10 sessions with an emphasis on behavioural change.
- At least one trial of appropriate SSRI medication at maximum dose for OCD or appropriate medication for the anxiety disorder they are referred for. If patients can not take medication by virtue of their diagnosis or intolerable side effects, we welcome discussion first.
- For young people transferring from CAMHS to adult services, we request that the person is already under an adult CMHT.
Eligibility
Usually it will be expected that patients have failed to respond to two trials of appropriate medication for OCD/BDD as well as a previous trial of CBT.
Exceptions to the above can be made in individual circumstance depending on severity and need of the individual patient.
Referrals
Intensive home-based, community or outpatient treatment
Referrals for complex assessment and treatment may be made by the healthcare worker direct to the therapist or the service directly.
Referrals can be made by Primary and Secondary Care.
All referrals should contain:
- a brief description of patient's current problems
- relevant history
- current care plan and risk assessment.
If significant risk is identified then details of the patient's care co-ordinator and their continued involvement must be provided.
Referrals of patients under section are not accepted. We are happy to assess once the patient is voluntary. This is to ensure that the patient is providing informed consent to undertake therapy.
Referral Criteria
Referral Form
Joint working with other healthcare professionals
Referrals for joint assessment and joint working, supervision and support may be made direct to the therapist or to the address above by Primary or Secondary Care Mental Health Teams.
The therapist will work with the CMHT or referrer to deliver therapy as part of the care plan.
Exclusion criteria
- A body mass index (BMI) of under 18. We welcome discussion about this prior to referral to evaluate the reasons for a low BMI.
- Current and active alcohol or drug dependency/harmful use. A six-month period of stability is recommended if the use has recently ceased.
- Significant acute unmanaged risk issues requiring stabilisation prior to therapy.
- Active psychotic symptoms – unless the referral is for OC induced or worsened by clozapine, which will be discussed on a case-by-case basis
- Primary diagnosis of an untreated personality disorder
- Organic conditions such as dementia.
- Patients who are detained under the Mental Health Act. Once the section has been lifted we would consider a referral, assuming the patient is in agreement.
Referral for a Hoarding Assessment
- Living in the boroughs of Merton, Kingston, Wandsworth, Richmond or Sutton with a registered GP in the borough and have stable accommodation
- Willingness to have a home-based assessment including photos being taken as part of the process.
- Willingness to take part in CBT treatment for Hoarding Disorder and be able to independently implement the strategies learned.
- An ability to tolerate a degree of emotional distress that goes along with behavioural change
- Although it is not essential to be on medication we do recommend that clients consider a referral to their local IAPT or attend a Hoarding support group to start the process of therapeutic change.
- It is preferable for clients to have other avenues of support during the treatment if offered. As such we strongly advocate a multidisciplinary approach to treating Hoarding Disorder.
- We ask that all prospective referrers contact us by phone in the first instance to talk through any possible referrals. This is now a requirement due to the number of inappropriate referrals received.
- A referral form needs to be completed in full
Exclusion criteria for Hoarding Assessment
- Alcohol or drug dependency
- Significant risk issues currently in evidence
- Actively psychotic
- Primary diagnosis of an untreated personality disorder in particular those with poor emotional regulation skills, anger management issues etc.
- Organic conditions such as dementia
- Lack of insight into Hoarding behaviour
National service (NHS England funding)
We offer home-based therapy throughout England and inpatient treatment as the ONLY 24-hour staffed dedicated service. We accept referrals from throughout England for patients who have profound treatment refractory OCD or BDD. It is a service for patients who meet criteria for Tier 6 (funded by NHS England HSS). There are strict criteria to be accepted as a Nationally funded patient.
About the service
The National OCD/BDD Service, affiliated with St George's University of London, is a nationally and internationally renowned treatment centre dealing with severe, complex and resistant obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD).
It is one of two services offered by the OCD/BDD service. The other is a local service for clients living in south west London.
The National OCD/BDD service is an enhanced community service offering intensive home-based treatment, liaison work with other teams and telephone monitoring advice for patients throughout the United Kingdom.
We combine behavioural and cognitive methods with state-of-the art psychopharmacological and other treatments where necessary. We liaise closely with specialists who work in the neurobiology and psychopharmacology of these disorders as well as with psychotherapists of various schools.
We have an experienced staff-base. Some staff have worked with these complex patients in our unit for 20 years. Our commitment to teaching and research, however, means that we have young enthusiastic professionals also joining the team which ensures we are continuously challenged to ensure our treatments are at the forefront of modern psychiatric and psychological treatment.
Each patient is fully assessed and has an individualised treatment programme. Progress is constantly monitored using questionnaires of known reliability and validity. Thus, any treatment which is not effective is discovered early and the reasons why this is the case are examined and treatment changed or modified.
Please also see:
Advice on prescribing for adults with OCD
Eligibility
The unit is now a nationally funded tertiary service (commissioned by NCG), which specialises in treating people with severe, complex, resistant obsessive-compulsive disorders (OCD), and body dysmorphic disorder (BDD).
Referrals of patients under section are not accepted. Once the section has expired or been rescinded then assessment will be conducted. This is to ensure the client is providing informed consent to undertake therapy.
The OCD/BDD service is unable to accept clients with a primary condition of acute psychosis, depression, anti-social behaviour, drug/alcohol dependency or current self-harm/suicidal/violent behaviour.
Referrals
As the OCD/BDD service is a specialist service all referrals should derive from local community mental health teams (CMHTs) and will be ratified by a Consultant Psychiatrist.
Clients should have received the following prior to referral:
- treatment with at least two serotonin reuptake inhibiting drugs (SRIs) including clomipramine and/or an SSRI. Each trial should be for a minimum of 3 months and at optimal British National Formulary doses.
- two trials of cognitive and behavioural psychotherapy (CBT). A trial of therapy is defined as at least 10 hours of therapist time. One treatment trial should have taken place in the patients home environment or where the symptoms are maximal.
- augmentation of SRI treatment either with first or second generation antipsychotic drugs or by extending the SSRI dose beyond normal formulary limits.
- YaleBrown Obsessive Compulsive Scale (YBOCS) score of 30 or more out of 40.
Allowance may be made in exceptional circumstances, such as:
- Patient refuses medication due to OCD beliefs
- Patient is unable to take medication due to side effects
- Patient has not fulfilled the criteria for previous CBT treatment due to mental or physical illness.
NB. These exceptions will not be used to allow patients to gain entry to the National Service simply due to lack of organisation of local services. All CMHTs should have access, either locally or in a neighbouring Trust, to a clinical psychologist or other trained in CBT for OCD. Similarly some patients may prefer not to take medication but could do so and should be encouraged to do so before referral to the National Service.
All referrals will be expected to have a full risk assessment and description of ongoing Care Programme under the Care Programme Approach (CPA). The referrer will be expected to confirm commitment from the local CMHT (as far as possible) to collaborate with care plans drawn up by the National Service including to continue therapy and consolidate treatment gains during periods of home leave or following discharge from the Service.
Referrals of patients under section are not accepted. Once the section has expired or been rescinded then assessment will be conducted. This is to ensure the client is providing informed consent to undertake therapy.
The OCD/BDD service is unable to accept clients with a primary condition of acute psychosis, depression, anti-social behaviour, drug/alcohol dependency or current self-harm/suicidal/violent behaviour.
It is the referrers responsibility to notify the OCD/BDD service of any marked change in the clients condition once they have been assessed and are on the OCD/BDD service waiting list. The OCD/BDD service reserves the right to reassess if any significant change in a clients mental state occurs.
Written referrals should come from a consultant psychiatrist and should include presenting problems, past psychiatric history, prior treatment, medication history, current care plan and the appropriate forms.
National Referral Form
NSCT Referral Criteria
Referrers Guide
National service (non NHS England funding)
The National OCD/BDD Service, affiliated with St George's University of London, is a nationally and internationally renowned treatment centre dealing with severe, complex and resistant obsessive-compulsive disorder (OCD) , body dysmorphic disorder (BDD) and hoarding. It is a service for patients who do NOT meet criteria for NHS England HSS funding.
Eligibility
We provide level or tier 5 treatment inpatient or home-based or community treatment to secondary care mental health teams throughout the UK teams, who do not have an easy access to regional specialist multidisciplinary teams as per the NICE stepped care model.
If you are unsure of the suitability of a patient, we are always delighted to discuss the case with them and offer advice or specialist comprehensive assessments (subject to funding approval).
To be accepted for treatment, patients must be over 18 years and be at level 5 severity according to NICE guidelines.
Funding for this service should be sought from the local CCG.
Referrals
All written referrals should come from a consultant psychiatrist and should include presenting problems, past psychiatric history, prior treatment, medication history, current care plan and the appropriate forms.
You can view Seacole ward here
Eating disorders
Eating disorders are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour.
Someone with an eating disorder may focus excessively on their weight and shape, leading them to make unhealthy choices about food with damaging results to their health.
Outpatient service
Our eating disorders service is a specialist outpatient service which provides assessment, treatment and monitoring for people aged 18 and over with conditions such as anorexia nervosa, bulimia nervosa and binge eating disorder.
Our multidisciplinary team provides assessment, advice, treatment and on-going support and some physical health monitoring alongside GPs where the person's eating disorder is severe enough to need more treatment or support than is available in Primary Care.
Adult day unit
The day unit is a 5 day service for up to 10 male and female clients diagnosised with an eating disorder and who require a more intensive treatment programme. Treatment is offered via groups and individual sessions including community based activities to assist in transferring skills to your home and social environments.
A range of professionals work in the multi-disciplinary team including nurse, doctor, occupational therapist, psychotherapist, dietician and outreach workers. Length of stay varies depending on individual goals for treatment from 4 to 6 weeks to a year.
Our wards
Avalon ward provides a highly specialist inpatient national service for adults between the ages of 18-65 years, both male and female, diagnosed with a severe eating disorder, mainly Anorexia Nervosa.
Wisteria ward is a 10 bed unit for young people between the ages of 11 and 18 throughout the country with severe eating disorders and weight loss related to mental health problems.
Family and Couple Therapy (Systemic Psychotherapy)
We offer training in Systemic Family and Couple Psychotherapy (also known as Family Therapy).
Years One and Two are accredited by the Association of Family Therapy (AFT) and are available as stand-alone courses. Successful completion allows students to apply for Masters Level training and registration as a Systemic Psychotherapist (Family Therapist).
Year One: Foundation
The Foundation course is available as an evening programme. The courses are held at Prudence Skynner Family & Couple Therapy Clinic at Springfield University Hospital in Tooting, South West London. The course offers an opportunity to explore family systems and life-cycle transitions, to develop skills of engaging with and interviewing families, and to understand how therapeutic changes happen. Several therapeutic models are presented, including solution-focused and narrative approaches. The course enables participants to think about their place in the system in a reflexive way, and can be taken as a stand-alone course or as the first step towards the MSc.
Year Two: Intermediate
The Intermediate course is run at the Prudence Skynner Family and Couple Therapy Clinic at Springfield. The course emphasises the use of systemic theory and practice in clinician’s day-to-day work with families and networks. The accrediting panel said the course was “excellent and provides high-quality teaching and context for learning. Participants gave very positive feedback on how they valued the course’s commitment to systemic work with families in the NHS, the flexibility and responsive of the teaching, and the diversity of teachers and students”.
2023 - 2024
Intermediate level training course – Contextualising Change
Intermediate course flyer
Course dates (dates are provisional only)
Reference request form
Years Three and Four: MSc degree
Students who have completed years One and Two at the Prudence Skynner Family and Couple Therapy Clinic have the opportunity to apply for Masters in Systemic Family Psychotherapy at the Institute of Family Therapy, validated by University of Bedfordshire. Live clinical supervision can be undertaken at the Prudence Skynner Family and Couple Clinic.
Supervision Course
Advanced Diploma in the Supervision of Systemic & Family Psychotherapy: Extending social justice and anti-oppressive practices to systemic supervision, training, and consultation.
If you are an experienced Systemic & Family Psychotherapist looking to further your career and develop your skills in systemic supervision, training and consultation, we are now accepting applications to our new course on Supervision of Systemic & Family Psychotherapy. This is a one-year part time course designed to meet the requirements for the Systemic Supervision level of training by the Association for Family Therapy and Systemic Practice (AFT)*.
Drawing on a wide range of resources from systemic theory and practice and beyond, the course aims to access and bring forth more marginalised voices and ideas. Our intention is to create a collaborative space where mutual exchange of knowledge, diversity and community become the main context and pinnacles of the participants’ learning. Using collaborative and creative teaching methods, participants will be able to develop their knowledge and skills in live and retrospective supervision of groups and individuals, systemic consultation, and facilitation of training and reflective practice. Please refer to flyer and application form for further information.
Supervision Course Flyer 2023 2024
Application Form
Clinical placements
Clinical Placements are also available at the Prudence Skynner Family and Couple Therapy Clinic.
More information
For further information on family therapy training in the Trust, please contact:
Heleni Andreadi – Courses Director
Stefania Zanelli-Cook, Ashlee Bowen, Nadine Donald - Courses Administrators
Email: ftcourses@swlstg.nhs.uk
Tel: 020 3513 6195 or visit the Association for Family Therapy website
How to find us
A-Z of services
Contact centre - 020 3513 5000
(not a 24/7 service)
Mental Health Crisis Line
Contact us
Mental Health Support Line
Childline
Samaritans