Our Treatment Model
At CHT, we take our unique approach to providing community, housing, and therapy and combine it with a distinct clinical model that allows us to welcome, nurture, and support those experiencing severe mental health difficulties.
Our Support is trauma-informed and based on a relational treatment model.
HOUSING
COMMUNITY
We help residents engage in activities, both within the CHT community and in their local area, such as education, employment volunteering, social activities, promoting social inclusion and participation. Helping residents to find structure and meaning to there daily living.
Our residents live with others in CHT housing to encourage engagement and help them learn responsibility and independence. There is strong encouragement to engage with others to take responsibility for the communal aspects of the social and physical environment of the house. This includes active participation in the Community meetings, cooking, cleaning, budgeting etc.
THERAPY
We provide psychological, social, individual and group sessions that are informed by best practice and individually tailored to each resident.
The clinical aim is both to enable residents to better understand the impact of their early experiences, particularly experiences of trauma, on their feelings, thoughts and behaviours, and to find more effective ways of managing themselves in their interpersonal, community and social relationships.
Psychologically Informed Environments
The Psychologically Informed Environment (PIE) enables us to take the past experiences, personalities, psychological and emotional needs of our residents into account, alongside providing a holistic community space where they can develop important connections, build confidence, and gain independence, which will ultimately lead to them moving on and thriving in life.
The PIE model acts as a framework for overall service operation and is designed to ensure that the day to day running of the service provides a psychologically and emotionally safe environment that reduces incidents and self-destructive behaviours, whilst increasing engagement in pro-social activities.
At the heart of CHT’s treatment model is the importance and power of reparative relationships
Advances in our understanding of neurobiology have shown that early life experiences, particularly those related to our core attachment relationships, help shape and form the human brain and internal world in relation to these experiences; impacting a person’s perception and prediction of future experiences, their sense of self and the direction of their lives.
Often these experiences are compounded by later relational experiences such as abuse, deprivation or social isolation, as well as experiences of powerlessness and lack of self-agency through poverty, socio-economic conditions and hospitalisation.
However, it has been demonstrated that later positive life experiences and relationships, over time, can help restructure the brain thanks to the retention of neuroplasticity.
Group Based Activities, Therapeutic Keywork & Individual Therapy
A programme of group-based therapeutic activities such as the Community Meeting and Reflective Group support the resident to re-orient their relational styles, form beneficial attachments to both peers and staff, and develop a sense of agency through activities of day-to-day living, voluntary work, education, training and social and recreational activities.
Therapeutic Keywork supports the resident to take a directive role in their recovery, supporting the resident to plan their day-to-day activities, track progress and to encourage the resident to monitor and assess their risk management strategies. Each service has a qualified Community Psychotherapist that offers Individual Psychotherapy, facilitates reflective groups as well as co-leading the Therapeutic direction of the Community.
Therapeutic Communities
Therapeutic Communities (TCs) are structured environments, which take a group-based approach to treatment. They are places where the social relationships, structure of the day and different activities together are all deliberately designed to help people’s health and wellbeing.
The Therapeutic Community model developed as a way to support those who have experienced trauma and loss of self-agency in their lives, and has shown that by creating a living-learning experience, where service users and staff form Communities, where agency and direction can be shared with residents to support them to recognise and experience their own self-expertise and their capacity to both be the care seeker and care giver.
Outcome Measures
We use clinically validated self-reporting tools (ACE, CORE 34, Honos, QPR and Dialogue Plus) that measure a person’s history of trauma, and aspects of recovery such as: wellbeing; social functioning; skill development and risk.
We assess the percentage of residents moving onto less supported accommodation, those taking up educational or training opportunities and those moving into paid or voluntary employment.
We work with participants through surveys, conversations, and group sessions to identify some of the wider benefits of our work, asking them to share feedback on their experiences at CHT.
Further reading
PIE
Therapeutic Communities
Psychodynamic Psychotherapy
Interpersonal Neurobiology
Recovery
Cockersell P, (2016), PIE: Five Years On, in Mental Health and Social Inclusion, 20:4 p221-230
Cockersell P, ed., (2018), Social Exclusion, Compound Trauma and Recovery, London: Jessica Kingsley Publishers
Pearce S & Haigh R, (2017), Theory and Practice of Democratic Therapeutic Community Treatment, London: Jessica Kingsley Publishers
Caligor E, Kernberg O, Clarkin J & Yeomans F, (2018), Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning, New York: American Psychiatric Association Publishing
Shedler J, (2010), The Efficacy of Psychodynamic Psychotherapy, in American Psychologist, 65:2, p98-109
Solms M, (2018), Scientific Standing of Psychoanalysis, in BJPsych International, 15:2, p5-8a subheading
Porges S, (2013), The Polyvagal Theory, London: Norton
Schore A, (2013), The Science of the Art of Psychotherapy, London: Norton
Shepherd G et al. 2008, Making Recovery a Reality, accessible at https://www.centreformentalhealth.org.uk/publications/making-recovery-reality
Slade M, (2015), Empirical Evidence for Recovery and Mental Health, in BMC Psychiatry, 15:285, p2-14
*Felitti V J, Anda R F, Nordenberg D, Williamson D F, Spitz A M, Edwards V, Koss M P (1998), The relationship of adult health status to childhood abuse and household dysfunction in American Journal of Preventive Medicine 14:245-258.
*Van der Kolk B, (2005), Developmental Trauma Disorder, in Psychiatric Annals, 35:5, p401-408
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