Our clinical model
Our clinical model is based on the belief that severe mental distress arises from experiences of compound (repeated) trauma and damaged and damaging attachment relationships, often compounded by deprivation, inequality and stigma. These environmental factors create a psychosocial effect that profoundly influences a person's self-experiences, feelings, reactions, and behaviours.
​
Our clinical model is evidence-based and built around Psychologically Informed Environments (PIE), Therapeutic Communities, Recovery, Psychodynamic Theory, and Interpersonal Neurobiology principles. It comprises five key stages outlined below. This process is not linear; instead, it serves as a framework tailored to each resident, empowering them to progress at their own pace, with the ultimate aim of transitioning to lower support or independent living.
Engagement
Engagement is an ongoing process of creating meaningful connections that build emotional safety. At CHT, this begins at assessment and continues throughout our residents' journeys. Our therapeutic practitioners work closely with each resident to create their Recovery Plan, listen to their needs, recognise their strengths, and respect their boundaries while helping them build relationships with staff and peers and develop strategies for community engagement and daily task management. Successful engagement, whether with one person or the whole community, leads to attachment.
Attachment
Attachment is the emotional bond we form with another person. ​We form our earliest attachments as children through relationships with our parents or caregivers, and these foundational experiences influence our attachments throughout our lives. There are two types of attachment: secure and insecure. Secure attachments are formed from reliable, loving, and supportive relationships with our caregivers in early life. Children who do not have safe, loving or supportive care or whose early attachments have been damaged may become insecurely attached. Most people who develop mental health problems have insecure attachment patterns.
We work with residents to nurture positive relationships and foster a secure base of attachment through a programme of one-to-one psychotherapy and therapeutic activities where all members of the community can spend time together in rewarding and enjoyable ways.
Containment
Containment is the feeling of belonging and safety, both physically and emotionally. It underpins all of our work. Everyone has a 'window of tolerance' for good mental health where they can manage stress and emotions. Those with broader windows adapt to life's ups and downs, while people who have experienced trauma may feel rigid or chaotic in similar situations.
We support residents and staff in positive risk-taking and managing their emotions healthily, helping to empower them to recognise when they feel outside their window of tolerance and guide them back to a state of containment.
Exploration
The Exploration phase of recovery supports residents in (re) learning what they want from life and (re) discovering their potential within the CHT community and beyond. Exploration involves trial and error, courage, resilience, and curiosity, supported by the community's safe and nurturing environment. For some, it may include cooking a meal for the community or shopping alone; for others, it may involve pursuing new hobbies or finding a job or volunteering opportunity. This crucial phase builds greater self-awareness and self-agency, ultimately leading to Autonomy.
Autonomy
​​Autonomy is the final stage of growth for our residents. At this point, they will acknowledge their interdependence and develop the self-agency to make decisions that balance personal needs with fairness to others. Residents will become active community members, supporting peers, volunteering, and engaging in various work or study opportunities.
While Autonomy is a celebration of progress, it also often brings feelings of loss around friendship and identity. Staff are crucial in this transitional phase, offering support as residents navigate the emotional challenges of moving away from a familiar community.
Our clinical model in action - Jane's journey to Autonomy
Jane had grown up regularly witnessing domestic violence and had been in and out of foster care as a young teenager. With no sense of safety at home, she struggled to trust others and to express her needs in a healthy way. Sometimes, things felt overwhelming for her, and she ran away or harmed herself. Each breakdown of her foster placements deepened her feelings of being unwanted.
​
When she joined our community in 2020, Jane was nineteen and had spent nearly two years in hospital due to repeated incidents of self-harm and overdoses. ​Initially, she felt withdrawn, and it took time for her to feel safe. With regular one-to-one psychotherapy and support from her key worker (engagement), Jane began participating more in the day-to-day life of the community as well as the therapeutic programme (attachment). She found a way to express herself through a weekly journaling group and through art therapy, helping her rediscover the voice that she had lost long ago (exploration).
​
In acknowledgement of her growing confidence and commitment to reflective work, her psychotherapist suggested she may like to start managing her own medication. Jane worked alongside our clinical team to create a ‘self-medication risk management plan.’ Although there were times when Jane needed to take a step back, our staff met her where she was in her journey, working with her to set smaller goals over time with understanding and support. (Containment)
​
For the first time in many years, Jane felt like an equal participant in her care and recovery. She told us that being trusted to start managing her medication marked an important step in feeling like she could work towards being independent (autonomy). This experience was a stark contrast to her time in the hospital, where she felt that her autonomy had been stripped away.