CLIENTS’ COPY
“The CBT enabled me to get in control of what was in my head. Everything is less chaotic and my mind is now freed up to do other things”
Dolly Sen
Service user at PICuP
ABOUT PICuP
PICuP works in partnership with you, helping you to think more about how to solve some of the problems that currently upset you.
Where is PICuP?
PICuP is based in the Out-Patients Department at the Maudsley Hospital, Camberwell, South London (South London & Maudsley NHS Foundation Trust). When possible, clients who live in Lewisham or Croydon can be seen by a PICuP therapist in their local team base.
What does PICuP offer?
PICuP offers a kind of therapy called Cognitive Behavioural Therapy (CBT) for people who have unusual and distressing experiences, such as hearing voices, feeling paranoid or having some interference with their thoughts. It consists of talking to you about your experiences, beliefs and feelings, how they arose and what you understand about them. New ways to think about things, or new things to try out to cope with your problems, are discussed with your therapist, and practised by you during the week. Therapy involves meeting with a therapist regularly for approximately 6 months, usually weekly or fortnightly, for approximately 1 hour.
PICuP also offers Family Interventions (FIs), which aim to support service users and their families, together, in managing the impact of mental health problems on their relationships and day-to-day functioning. The family sessions focus on what the service user and their relative need and decide is important, but are designed so that each person has equal time to talk about how they feel and what they want.
The sessions can involve sharing information that people want about:
• What is psychosis?
• Why has it happened?
• How can we understand this?
• Helpful strategies and practical ways of helping the service user with their recovery.
It can also involve talking about any issues that have been making life difficult.
The family intervention sessions involve the service user and their relative(s) having a meeting with two therapists. The meetings usually last for one hour and are held over a period of 3-9 months, with the option of having sessions in the family home.
PICuP will not be involved in prescribing your medication, and you would continue to see your local team or GP for medication issues. It will not affect the care you receive from your local team or GP in any way, we are an “add-on” service for the duration of therapy.
Could PICuP help you?
PICuP may be able to help you if you have unusual experiences (such as hearing voices) or beliefs (such as feeling you are being persecuted) that have left you feeling distressed in some way, or perhaps if you feel like you have no control over your own thoughts or actions. The aim of PICuP is to help alleviate some of the distress and to help you cope with the things that upset you. It may not get rid of all your problems and unwanted experiences, but it should help you to be less bothered by them, and feel more in control of them.
We may also be able to help you if you had unusual distressing experiences in the past, but still have ongoing difficulties with your mood (such as feeling depressed, anxious, or upset by past traumatic experiences).
Overall this kind of therapy is most useful for people who are willing to work with the therapist to try out new ways of thinking and coping.
Who are the therapists who work for PICuP?
PICuP therapists are mental health professionals who specialise in CBT and/or FI, and their trainees. Some work for PICuP full-time, while others have other jobs and see 1 or 2 people as part of their Continuous Professional Development for a specified period of time. They all receive supervision by an expert in the field to ensure their work is of the highest standard.
What do our clients say about PICuP?
“I wouldn’t be here today if I wasn’t referred to PICuP. Not only did it help me recover but it was educational and empowering”; “During therapy I found ways to cope with my problems, and have continued to use them throughout my experience”; “I’d tried therapy twice before – unsuccessfully. But at PICuP they knew my problems, they knew my issues. I felt well-handled and cared for. They were highly motivated people who had my best interests at heart”; “My therapist was a kind, warm woman who helped me make maps of my thinking. The value of positive thinking is the most precious CBT has given me”; “PICuP is the Ferrari of mental health services”.
WHAT IS CBT?
CBT is a ‘talking therapy’ designed to ease distress from emotional problems. It is widely used in the NHS as an intervention for a variety of problems such as depression, anxiety and obsessive compulsive disorder, and more recently, ‘psychosis’ and ‘bipolar disorder’. It is a therapy that works alongside, rather than instead of, any medication you may be taking.
CBT works on the ‘here and now’, and assumes that unpleasant emotions, for example feeling low or paranoid, are closely linked to certain thoughts or beliefs about the self eg. ‘I’m worthless’. Such thoughts also lead to types of behaviour which may be unhelpful, such as withdrawing from, or confronting people, thereby setting up vicious cycles which are difficult to get out of. Therapy involves identifying these unhelpful thoughts and behaviours, and gradually attempting to understand them, test them out, and hopefully change them. Therapy also involves trying out new coping skills for dealing with unusual experiences, such as hearing voices or having frightening thoughts. Therapy may also help you to deal with past traumatic experiences that may still be upsetting or impacting on the way you feel or behave.
HOW DOES CBT WORK?
The approach is to try to work with you to an agreed goal. No pressure is placed upon you to change your view on things. CBT is not a way of necessarily getting rid of your experiences and beliefs altogether, but rather a way of alleviating distress and learning how to cope better: e.g. CBT may help to reduce the upset that accompanies hearing voices, and make you feel more in control of them.
CBT works by meeting a therapist weekly or fortnightly for about 1 hour. ‘Homeworks’ are jointly decided each week to help you practice between sessions what you talked about in therapy. An example of homework would be to keep a simple diary of some of your distressing experiences, or to set up an experiment to “reality-check” a distressing belief.
DOES IT WORK?
The recent National Institute for Clinical Excellence (NICE) guidelines (2014) recommend CBT for people who continue to have unusual and distressing experiences on top of taking their medication. Research has found that after CBT people can feel less distressed and preoccupied, and sometimes have fewer disturbing experiences. It has also been found that people continue to improve even after therapy has ended. Typically, around 50-65% of people who receive therapy benefit in some way.
In PICuP we find that our clients’ distressing voices and beliefs, depression and anxiety, and post-traumatic stress all go down, while quality of life goes up.Furthermore, 91% of people who had CBT with PICuP (over 250 people) report that they were satisfied with the therapy they received.
The NICE guidelines (2014) also recommends that FI is offered to all families of people who have unusual or distressing experiences who live with or are in close contact with the service user. Research has found that FIs can be helpful in improving relationships with caregivers and reducing rates of relapse and readmission in service users.
HOW TO GET IN TOUCH
If you think that you could benefit from CBT or FI, the next stage is to ask your doctor or care coordinatorto complete our referral form (obtained )andsend/email/fax itto the address below.In some circumstances we can also accept self-referrals. Please ring or email us for further details.
Because we are a specialist service we will need to check that we have a “contract” with your Clinical Commissioning Group (CCG) before we can offer you an appointment. Your referral may need to go through a funding panel before we are able to see you. This will all get sorted between your referrer and us, although there may be some delays. If there are no problems with contracts then we will organise an initial meeting with our Psychology Assistant. At this assessment you will be able to talk about the problems you would like help with, and we will assess your suitability for the clinic by asking you to complete some interviews and questionnaires. Our assistant will also be able to tell you a little more about the therapy (see overleaf for more details).
If your referral is rejected by the panel, and there is no access to CBT or FI in your local NHS services, we also see self-funders i.e. people who pay for their therapy either themselves or through an insurance company. Please ring or email us for further details.
Referrals should go to:
Mrs Dorothy Abrahams
Administrator
PICuP Clinic, PO79
Clinical Treatment Centre
MaudsleyHospital
Denmark Hill
London SE5 8AZ
Tel: 0203228 3524 Fax: 0203 228 5278
Email:
PICuP Staff:
Prof. Elizabeth Kuipers, Founding PICuP Director
Dr. Emmanuelle Peters, PICuP Director
Dr. Juliana Onwumere, Consultant Clinical Psychologist; IAPT-SMI FI lead
Dr. Nadine Keen,Consultant Clinical Psychologist & PICuP Clinic Coordinator
Dr. Majella Byrne, Principal Consultant Clinical Psychologist, Training lead & IAPT- SMI lead
Dr. Vaughan Bell,Principal Clinical Psychologist, Joint R&Dlead
Dr. Rumina Taylor, Principal Clinical Psychologist
Dr. Sarah Grice, Principal Clinical Psychologist,
Dr. Annis Cohen, Principal Clinical Psychologist,
Dr. Liam Mason, Clinical Psychologist
Ms. Angela Morford, Peer Recovery Officer
Mrs. Zara Kanji, Clinical Psychology Assistant
Mrs. Dorothy Abrahams, Administrator
PICuP-IAPT SMI staff:
Ms. Lisa Grünwald,Clinical Psychology Assistant
Ms. Sara Tookey,Clinical Psychology Assistant
Ms. Jenny Beardwood, Clinical Psychology Assistant
Dr. Rosanna Philpott, Clinical Psychologist
WHAT WILL HAPPEN NEXT?
Once you are referred or the funding panel has approved your referral, you will be sent an initial assessment appointment with a Psychology Assistant within a few weeks. This will be an opportunity for you to talk about your needs and to ask any questions you may have about PICuP or CBT/FI. We will also go through a few questionnaires and interviews with you, which will help us to assess your suitability for our clinic. This initial appointment ensures that we do a thorough assessment, which then allows us to monitor and record changes carefully throughout the therapy and beyond. Seeing an independent assessor also allows people to give us feedback about the therapy and therapist.
If after that meeting you decide you are interested in seeing a therapist, and we feel we may be able to help you, we will put you on our waiting list, which is usually between 3 to 4 months. We will let you know once you are second on the waiting list, at which stage you will be invited for a further assessment to see if anything has changed since your first assessment.
Once you have begun therapy you will see a therapist on a weekly or fortnightly basis, usually at the Maudsley Hospital, for approximately 6 – 9 months(or at your home for approximately 3 – 9 months for FI). During therapy you will continue to meet with your doctor and/or care coordinator as normal. Your medication (if any) will continue to be offered to you by your local clinical team or GP, both while you are on the waiting list and during therapy. We will continue to monitor how you are doing by inviting you to three further assessments, one 3 months into therapy, one at the end of therapy, and a final one 6 months later.Any discussions with the Psychology Assistant or therapist are confidential. The only exception is if you appear to be at risk to yourself or to others, in which case your local team will be informed immediately. During therapy, your therapist will write to your team to update them on the general progress you are making. At the end of therapy your therapist will write a report with his or her view of the outcome of therapy and any further recommendations. If you want to see these letters and reports before they are sent just ask your therapist.
At the end of therapy, and 6 months later, you will be sent another appointment with the Psychology Assistant to repeat the questionnaires and interview you did at the initial assessment, and also to tell us how satisfied you were with therapy and your therapist. This allows us to measure and record specific changes you may have made for auditing purposes, and to allow us to continue to improve our services.
PICuP is a research and teaching clinic. You will be asked to join a research register, and you may be asked to have mental health professionals in training sit in on your sessions, or your therapist may need to tape your sessions as part of further professional training they are undergoing. Joining the research register and participating in training is entirely voluntary, and even if you decide to take part in a research study or training you may withdraw at any time without having to give a reason. Your decision whether to take part or not will have no effect on your therapy or local care in any way.
You can also find more information on our website
and see our booklet at
and watch our video at