Any experiences of using nhs "traumatic stress services"?

[Teasel]

My GP has made a lot of effort to try and make sure that the referral went to secondary services this time and not just to IAPT

This was key in me getting referred for proper help for PTSD. Though I was diagnosed as borderline (twice) before finally getting the c-PTSD diagnosis.

The help I've had from the nhs since (though not enough to fix me by any means) has been the best I've ever had.

In my experience having or not having a private therapist did not affect me getting the help from the nhs at all. And one of the private therapists didn't like me getting help from the nhs at the same time as seeing her though the others were fine with it.

Just to add, I had been through IAPT or equivalent years before and had 2 lots of standard CBT with them. They did recognise I needed help for trauma and referred me to a waiting list which I was on for 4 years before being told they don't offer that kind of help. But that was years ago now.

And it seems more help for PTSD is available nowadays.

 

[barefoot]

Thanks for the replies @digger and @berlinda and apologies for my slow response. It's been hard to find some alone time to reflect on this and revisit the thread.

I'm also not sure that I haven't reached some kind of plateau with what we can achieve.

I think I'm wondering this too. We've done some good work together and I have made significant progress with some things eg dissociation. And part of me is incredibly attached to her (ugh!) More recently we have spent more time on my work/business than anything else - I guess that really I have been using her more as a business mentor. Which has been very helpful. But I think I now find it a bit difficult to switch between different topics - eg from having a few sessions of business coaching to then doing deeper therapy stuff. Plus, since she's not a trauma therapist (as many UK therapists aren't!) I wonder whether a more specialised approach would create something a bit different and perhaps kickstart things a bit again.

Though having said all that, I have posted fairly recently here about getting very emotionally flooded in sessions lately if we talk about anything other than very practical stuff (ie work) so perhaps it isn't her lack of trauma expertise that have caused us to plateau. Perhaps I am still just shit at therapy! And that it's my inability to talk about my feelings and stay regulated that have got me a bit stuck.

Perhaps a trauma service where trauma specialist are focused on working with me on trauma will just create even more avoidance and resistance! But then maybe they will have more ideas on helping me overcome that??

My GP has made a lot of effort to try and make sure that the referral went to secondary services this time and not just to IAPT, so, in theory, I may end up with some actual trauma relevant therapy

Fingers crossed for you on this! I am now wondering whether my GP didn't refer me as specifically as she could have then. I guess I'll see how the call goes next week and then go back to my GP for her help getting me to the trauma service if that's not what's already happening. I strongly suspect I am just going to get an assessment for how anxious/depressed I am and whether they can offer me face-to-face or online CBT.

I clearly should have taken action when I first posted 3 years ago when I would have been able to self-refer to the trauma service!
Perhaps if I can steel myself to make a phone call, I could ring the trauma service sometime this week and explain the situation and they may be able to advice re whether I'm on the correct path to actually getting access to them?

They are aware that I currently have a therapist

And this wasn't problematic in any way for them?

I personally feel better for being open about it with all parties involved from the outset

Yes, normally this would be me so I'm not sure why I have tied myself into a knot about this...

I guess I am worried about an unfavourable judgement.

Having thought about it a bit more, I think I am also worried that my therapist will think I don't think she's good enough or something...that I'm trying to find something/someone better. I know it's not my job to take care of her feelings. But I feel like, if I tell her about asking for this trauma services referral, I will want to start reassuring her that it's not that I'm not finding her useful etc.
Silly, isn't it?

The help I've had from the nhs since (though not enough to fix me by any means) has been the best I've ever had.

This is great to hear!

In my experience having or not having a private therapist did not affect me getting the help from the nhs at all.

And this is reassuring. I don't know why I have made it into such a thing in my head! I think I am worried that, by being honest, I will shoot myself in the foot somehow...but I don't know why that's come to be a worry.

referred me to a waiting list which I was on for 4 years before being told they don't offer that kind of help.

Good grief! That's awful!


The more I think about it and the more honest I try to force myself to be with myself...I wonder if some (perhaps a lot!) of my anxiety around this situation – and particularly the dilemma around whether to be honest with/about my current therapist – is actually more about worrying that this change will somehow be the beginning of the end of my time with my T. While part of me does think perhaps I have reached a plateau with her, part of me is very attached to her and the thought of stopping our regular work together fills me with panic and dread and is very upsetting. And maybe that's partly why I don't want to bring this whole thing up with her.

 

[digger]

And this wasn't problematic in any way for them?

At the referral stage it hasn't been, but I am assuming that I won't be able to continue seeing my current therapist alongside any NHS provision offered, even if I could afford to. I don't think either party would be happy with that, unless they were offering very different services from each other.

think I am also worried that my therapist will think I don't think she's good enough or something...that I'm trying to find something/someone better. I know it's not my job to take care of her feelings. But I feel like, if I tell her about asking for this trauma services referral, I will want to start reassuring her that it's not that I'm not finding her useful etc.
Silly, isn't it?

Not silly at all, this part of it has thrown me into some chaos over the past three months since setting things in motion, despite my current therapist actually being so bloody good about it :rolleyes: I am struggling with guilt about it. I'm also struggling with massive anxiety about not being able to see her any more (attachment stuff I guess).

The whole process has been really spinning my head out to be honest, but I do think it's something I probably need to do, even if it all it ends up in is solid confirmation that they are not going to offer me any adequate help, so I know where I stand with them.

 

[digger]

referred me to a waiting list which I was on for 4 years before being told they don't offer that kind of help. But that was years ago now.

Also a few years ago, but my first attempt at getting some NHS help resulted in me being put on a waiting list for a service that didn't actually exist! :rolleyes:

 

[barefoot]

At the referral stage it hasn't been, but I am assuming that I won't be able to continue seeing my current therapist alongside any NHS provision offered, even if I could afford to. I don't think either party would be happy with that, unless they were offering very different services from each other.

It's the referral stage I am most bothered about, for some reason. Whether they will think I am undeserving of access to the service if I already have some support in place (vs people with no current support who may be prioritised)

There are a few potential options if I get accepted into the service – group education sessions around PTSD, self-compassion, shame etc; group therapy, 1:1 therapy. The bits I am most interested in at the moment are the groups, though I don't know much about them and don't really know why I'm drawn to them (the thought of sitting in a 'shame' group feels intellectually that it could be very useful but also feels like a pretty horrifying prospect!). I'm guessing that if I did group stuff there I could potentially continue seeing my T for 1:1 alongside, especially as we're not currently diving into much trauma stuff. I'm not sure how keen I am to swap my therapist and start doing 1:1 work with a new therapist. I guess it depends on what is likely to be different – if it's not going to be radically different, I don't really see the point. But I also have to be mindful not to pass up a potentially valuable opportunity to work 1:1 with a PTSD specialist because I feel panicky/upset about the idea of stopping seeing my current T...

The whole process has been really spinning my head out to be honest

I can understand that....I'm feeling increasingly tizzy about it and am starting to wish I'd never asked my GP to refer me! Turns out she has also referred me to the general IAPT service, rather than this specific trauma service...I've messaged my GP asking if she can make the direct referral instead but am still thinking I should have just left it all alone in the first place...

And I completely get the struggle around not being able to see your therapist anymore and how attachment issues can significantly add to the pain and distress involved in the situation. I'm sorry you're having to go through that. I know it's very hard.

my first attempt at getting some NHS help resulted in me being put on a waiting list for a service that didn't actually exist!

I do love the NHS and am so, so grateful for it. But, more often than not, the stories I hear from people re NHS mental health services are just awful!
Wishing you much better luck this time round @digger

 

[barefoot]

An update because I'm feeling a bit stressed:

So, I started to think that I hadn't been referred to the right place because the appointment for the initial assessment call was coming through my area's general talking therapies service rather than the specific trauma centre. I phoned the trauma centre and they said my GP could refer directly to them. Contacted my GP surgery...GP said she had referred me to there so didn't know why it had been picked up by the general service. Said she would look into it and get it sorted. An admin person at the surgery picked it up and made several calls, was great at keeping me updated...final message was that I needed to keep this appointment as it was the right route because it's all part of the same thing anyway. Fine.

Did the call a couple of weeks ago. It didn't go brilliantly.

The questionnaires I had filled out that morning and submitted online hadn't got through to the therapist who called, for some reason, so she had to ask me all those questions again. She also assumed when I said partner I was referring to a man and kept saying 'husband' until I told her 'it's my wife, actually.' I don't get wildly annoyed or offended when that happens...it happens all the time that people assume I'm married to a man. But it just felt a bit rubbish in this context....first assessment call with a psychological service and they're making assumptions about sexuality/my relationship. She hurriedly apologised then said 'I'm sure you said husband...' Well, no, I didn't. Because I wouldn't. Because I have a wife! Anyway...

She then really threw me by referring to a traumatic experience I had with a doctor when I was a kid. No idea how she knows that. A GP made a note on my file about it after I accidentally blurted it out to him...I then asked my current GP to put a note on that note saying not to talk to me about it unless I bring it up because the GP I told then saw that note and mentioned it every single time I went to see him about anything. So...there's something about it on my file...exactly what I don't know...along with a later note to say don't bring it up. So, for the therapist on the call to know about it and mention it to me a couple of weeks ago...she must either have been able to see that note in my medical record or my GP must have included this information in her referral letter.

Either way, I am upset and angry about it. It is deeply personal, non-essential, non-medical information so the fact that it has somehow been shared without my knowledge or permission feels wrong to me.

Having a total stranger phone and mention it and call it sexual abuse when it is still a thing I struggle with was distressing and unhelpful. I am angry with my GP - which is a pity because I actually like her and have started to trust her. I'll probably have to mention it to her at some point. I feel like maybe I should ask to see what note is on my medical record about it. And, if it transpires that any service I get referred to can just see that record, I guess I will ask for it to be deleted seeing as no one ever asked if that could be made a note of in the first place. If my GP actually wrote about it in her referral letter, I'm going to be livid because, as I said, I really think that was non-essential info to share without permission.

Anyway...having spent a rather stressful 30 mins on the phone answering dozens of questions, I then managed to get a chance to say some more about what's going on and my needs etc. I said that I was actually interested in a referral to the trauma service and that's why my GP had referred me. She said the talking therapies and the trauma service are actually essentially the same. Er....then why have you got two different services?! (I didn't say that!) She said that, because the trauma service was inundated, they had taken on more therapists with ptsd training into their general talking therapies service - so I could do their 1:1 CBT sessions with someone and she could put a note to say it would be good if it had a trauma focus on it. And that would be a 10 week waiting list (though the email she sent later said 20 weeks)

I don't really want 1:1 CBT. And I'm not convinced that 'they have some PTSD training' really means they have real expertise? But I sort of just said ok because that was all that seemed to be on offer.

I asked about the group things they run. She said they didn't run any groups - it's all just 1:1 CBT. I said the trauma centre runs groups. She said she didn't think they did. I said they told me the week before that they do and that I could potentially join them.

So...yeah...the two services are just the same...not!

She has since phoned back and left a voicemail telling me she's spoken to the trauma service and it's a year waiting list to get an assessment with them and a year wait for treatment. So, I'm not sure if she's saying that's actually a two year wait in total until you get to actually properly get started with anything?!

She also said the trauma centre does run group stuff - educational groups and group therapy (I know - I told you!) But that I wouldn't be allowed to do their groups alongside the other 1:1 CBT through the general service.

So, I now need to make a decision - do I stay on the list for the normal CBT or do I swap to the longer waiting list with the trauma centre?

I really don't think the normal CBT will be useful. But a year (or two!) feels ages to wait. And I still don't really know what that service will be like when I get there anyway.

To be honest, I feel over it now. Wish I hadn't bothered! I just feel more stressed about it and now have decisions to make that I don't really want to engage with at this point.

@digger - hope you have a better experience with your assessment next month!

 

[Teasel]

I know that the services available vary wildly from one area to another. But even so I find myself hoping you will turn down the CBT in favour of the PTSD centre group therapies. Even if you do have to wait a couple years.

I just know the group therapies I've had with the ptsd stream of psychological services on the NHS have ben the best help I've had.

Like I say I'm aware services very lots so feel free to ignore me.

 

[barefoot]

Thanks @berlinda

I have read some of your posts about your NHS treatments and knew you’d found it very helpful but couldn’t remember exactly what you’d been doing. So, your group stuff has been group therapy rather than group education stuff? I’m quite intrigued by that but the idea of educational groups feels much safer than group therapy. Group therapy intrigues me...but I’m not sure I’d manage it very well! Have you found it difficult to participate and share stuff or did you actively want to share stuff with others?

I think the thing is that, right now, I wish I’d kept my mouth shut and not started any of this.

I’m pretty sure I don’t want the CBT. But I also don’t want to phone the woman back and have another conversation with her to change lists. Stupid isn’t it, that the thought of phoning and saying ‘please can you swap me to the trauma centre waiting list’ feels way too much! ?

 

[jaccat]

I did CBT through the NHS. 6 weeks in my area, though it was for anxiety rather than PTSD. Personally it wasn’t hugely helpful- it was basic CBT strategies, which I think anyone who reads about it can pick up, and it was not in depth enough or long enough to get to grips with any of my symptoms. I only came away with one or two helpful strategies at the end of it.

I was having this discussion with my T quite recently, and she said the training required for a lot of NHS CBT therapists is really basic, and there’s not necessarily anything to encourage them to develop beyond that.

Different service, may be different in your area, but I’d be inclined to wait it out for the trauma specific service.

 

[barefoot]

Thanks @jaccat

I don’t think this will be different in my area, to be honest. So, yes, I think I should decline the CBT. I’m not convinced at all that their ‘PTSD training’ will mean they’re much more clued up than me!

And when I had CBT as part of my treatment at a sleep disorders clinic, I found it very simplistic and didn’t get much out of it at all (what I did get out of it wasn’t actually to do with the CBT content!)

My partner’s therapist used to do some NHS therapy alongside her private practice because she wanted to be able to help more people who couldn’t necessarily access private therapy. She said she had to leave in the end because she just really hated how it was all run and didn’t really want to be involved with it in the end. And yes, I think she said that a lot of the therapists there were trainees/not very highly trained.

It’s just so frustrating that I suspected this would happen and got assurance after assurance that ‘it doesn’t matter if you go through us or the trauma service.’ It does matter! They are two different services with different provisions! It’s so bloody frustrating to go round the houses and keep being told something that isn’t right.

I guess at the moment I am tempted to decline everything - I feel avoidant if all of it and just want to run from it all. But I think I need to make myself get in touch and request the swap to the trauma centre waiting list. If it’ll take a year to get an initial assessment I’ll have plenty of time to decide if I actually want to take it up when it’s finally offered.

I haven’t mentioned any of this to my T. Perhaps I should... I think I just don’t want her to think that I don’t think she’s any good so I’m looking for something better!
Thanks for sharing your experience ?

 

[Teasel]

Hi @barefoot happy to talk about what I've had.

There has been 3 phases of treatment so far. All of them for me have been in groups though not so much group therapy where you might be required to talk about your traumas and such. Actually quite the reverse in some of the groups.

The first was PTSD education and symptom management which was just excellent. Really good. I wondered if it would really make a difference as I thought I was pretty educated about PTSD already but I learned some things that were extremely helpful to me.

The symptom management skills were excellent but the psycho-education helped me to understand ptsd in a way that just cleared up a lot of the shame and big bad nasty confusing frightening way I saw my experience of it. Could see it in the others too, the change in the way they saw themselves and PTSD. Kind of like unveiling the wizard in the wizard of Oz. Like oh! Is that all it is?

It being a group was really good for me too. Was a relief actually, to be in the company of others who are like me and to feel accepted and understood.

In the first session it was explained what we would be doing and that as an education group we would not be expected to share painful experiences. And the group leader was good about keeping us on topic and so we would share a little about how we reacted to what we learned and how it was going with practising symptom management skills. It was a 12 week course.

At the end of the group our options going forward were explained and we had some choice about directions to follow. Options included trauma therapy or more groups. I didn't feel ready for trauma therapy, as it was explained we would have to be able to talk about all our traumatic experiences without major dissociation and such I am still not quite there.

About a year after that I did another group called Tree of Life, which sounds a bit wanky (lol) but was helpful too. This was about how when we are traumatised everything else gets pushed out of our lives and so we are left focusing on PTSD and stop doing things that matter to us or that we enjoy.

And there were exercises to think about things we value, things we are grateful for, what are our strengths, people in our lives, where we came from (our history, our culture, our family etc) and what we want in the future. This group encouraged us to talk more about these things than the first group.

I've just completed the third group which has been acceptance and commitment therapy which I just love. I've been reading the book the happiness Trap by Russ harris too - which explains acceptance and commitment therapy in a very accessible way and his website has free audio of the dropping anchor technique which I also just love.

I suppose it's basically about teaching you to be able to take a step back from whatever your mind is hooked on (eg flashbacks or racing mind or hypervigilance or whatever you might consumed by that makes things difficult) and how we can tend to react when that happens, and not necessarily in ways that move us towards what we value, but maybe instead go straight to coping mechanisms that move us away from what we value. Eg isolating, avoidance, addictive behaviours. That sort of thing.

And helping you to be able to un-hook yourself from that, take a step back and choose something you can do that moves you towards the kinds of things you value in life.

I've found that if I practise dropping anchor most days - and I tend to do it when I'm fine just as much as when I'm not - really quickly I'm finding I'm much more able / likely to unhook myself and realise I have a choice about what I want to do.

It's un-paralyzing me!

I start another short group soon about nightmare rescripting.

Perfectly understand your reluctance to make that phone call and walk away from the whole thing. I'm just the same.

 

[Mee]

@berlinda... your access to stuff sounds incredible.

My area has NO treatment for PTSD except a general CBT course ( not just for PTSD) and people who have attempted suicide are not accepted on it. :(. I was told my best bet was to stick with my therapist but I could call in them if I was in crisis.

If I had the option of waiting a year or two for courses like Berlinda is getting I’d take it and keep seeing my T in the meantime. My guess is it would still be helpful then.

CBT based therapy I tried initially and it was not helpful for me. I know it’s evidence based and I can see if works for anxiety etc , but for me I felt it was not hearing the cause of my trauma- and infact I think made me feel somewhat more ‘broken’ .