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Trauma and Dissociation Service

How our service can help you

The Trauma and Dissociation Service (TDS) is a national specialist, outpatient assessment, consultation and treatment service for adults who are suffering psychological difficulties following trauma and/or dissociative disorders. We assess and treat survivors of a range of traumatic events (both adult and childhood) including domestic violence, childhood abuse, assault, torture, war, rape, major disasters and accidents.

We are the only NHS specialist service offering treatment for people presenting with complex post-traumatic stress disorder (PTSD) and severe dissociative disorders.

  • Treatment type: Outpatient
  • Contact the service

    Site Location: Maudsley Hospital Email: TDS@slam.nhs.uk Phone Number: 020 3228 2969
  • Address: Maudsley Hospital
    Denmark Hill,
    London,
    SE5 8AZ
  • Other essential information

  • Conditions: Trauma, Dissociation, Outpatients

Interventions

NICE guidelines

  • Eye movement desensitisation and reprocessing (EMDR)
  • Trauma-focussed cognitive behavioural therapy (TF-CBT)
  • Dialectical behaviour therapy (DBT) - informed therapy

Attachment-based therapies

  • Individual sensorimotor psychotherapy (SMP)
  • Individual lifespan integration therapy (LI)

Group therapy

  • Sensorimotor psychotherapy (SMP)
  • For survivors of childhood sexual and physical abuse (CSA)
  • Systemic therapy for individuals and families
  • Psycho-education family sessions
  • Medication advice

All therapy, whether group or individual, is time limited. Treatment includes a range of interventions lasting between 14 and 24 sessions, for simpler cases, and for up to three to five years for more complex cases.

Eligibility criteria

Eligibility criteria

  • 18 years and over 
  • A diagnosis of post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (C-PTSD), dissociative disorders for example reliving traumatic experiences through flashbacks, nightmares and avoidance symptoms
  • Treatment resistant PTSD/dissociative disorders 
  • PTSD with comorbid disorders when standard treatments have not been effective Symptoms of depression, anxiety, psychosis, dissociation and personality disorders
  • People with head injuries and PTSD
  • Survivors of childhood abuse (physical, sexual or neglect)
  • Survivors of domestic violence 
  • Asylum seekers, refugees and veterans 
  • For complex trauma cases we often request that the patient is supported by their local community mental health team (CMHT) before therapy can commence  
  • If patient is being referred by a short-term intervention services (e.g. A&E or community liaison services) the GP must be made aware of the referral.

Exclusion criteria*

  • Active psychosis
  • Active suicide risk
  • Severe self-harm
  • Significant risk of harm to self or others including severe eating disorders
  • Current alcohol or drug abuse and/or dependency
  • When primary issues are forensic related
  • Severe learning difficulties
  • Severe pain or disability that may interfere with the treatments
  • This is not a conclusive list of exclusion criteria as there are other clinical/social factors that may impact the final referral outcome of the clinical decision to exclude

*Some of these exclusion criteria may be suitable for second opinion assessments on a case-by-case basis. Please send specific enquiries to TDS@slam.nhs.uk

Outcomes

  • Diagnosis or differential diagnosis
  • Proposed treatment plan
  • Reduction in symptoms
  • Reduction in risk behaviour
  • Enhanced self-esteem
  • Improvement in interpersonal relationships and quality of life

Care Options

Care pathway: We are a tertiary level service, which means that the patients referred have failed to respond at a primary and secondary level or there are no relevant services at a local level for the needs and treatment of the patient.

Outpatients

Care option: Assessment

Code: 39041

Unit: Not applicable

Description: Assessment includes two sessions of up to two hours each, consisting of a diagnostic interview and questionnaires. Referrers receive a report including recommendations for treatment, medication and any other clinical management issues. 

For people experiencing post-traumatic stress disorder, personality difficulties, dissociative disorders, and those who have suffered childhood sexual abuse, rape, domestic violence, or head injuries. We regularly see war veterans, asylum seekers, refugees and victims of torture or terrorist attacks. Referrers are given a comprehensive report with recommendations for treatment which cover both medication and clinical management.  

 

Care option: Specialised second opinion assessment

Code: 92617

Unit: Not applicable

Description: An intensive assessment is completed over two or three sessions, for up to six hours in total, with a consultant clinician joining for all or part of the assessment. This assessment is often used for diagnostic reasons or when the patient is too severe to undergo treatment and when ongoing social risk issues are too high. We offer the SCID-D diagnostic assessment. This option is also for clarification of diagnosis or where a second opinion is sought specifically with SCID-D. 

For people experiencing post-traumatic stress disorder, personality difficulties, dissociative disorders, and those who have suffered childhood sexual abuse, rape, domestic violence, or head injuries. We regularly see war veterans, asylum seekers, refugees and victims of torture or terrorist attacks. Referrers are given a comprehensive report with recommendations for treatment which cover both medication and clinical management. 

 

Care option: Outreach assessment

Code: 92624

Unit: Not applicable

Description: This option is used when a patient is an in-patient on a ward or is unable to travel to the outpatient clinic here at the Maudsley Hospital. The clinician will travel within reasonable travel time to visit the patient off site. The cost will be adjusted according to the number of days and travel arrangements involved.

 

Care option: Treatment, individual

Code: 39042

Unit: Not applicable

Description: 1 hour to 90 minute sessions with a consultant psychiatrist, psychotherapist or psychologist. Treatment includes a range of interventions including, eye movement desensitisation and reprocessing (EMDR), trauma-focussed cognitive behavioural Therapy (TF-CBT), dialectical behaviour therapy (DBT) - informed therapy, sensorimotor psychotherapy (SMP) and lifespan integration therapy (LI). A minimum of 24 sessions, one session per week for simple cases, up to three years for more complex cases. 

 

Care option: Treatment, stabilisation group, sensorimotor psychotherapy

Code: 92616

Unit: Not applicable

Description: Weekly sessions for up to 14 weeks with two therapists. This option also includes an introductory session and a follow-up appointment. This is a body-centred talking therapy which focuses on the somatic memories of traumatic events. New skills are learnt and people are encouraged to integrate and use them on a daily basis. 
 
This group is particularly effective for people suffering from complex post-traumatic stress disorder (PTSD), personality disorders and dissociative disorders, as well as those who do not take readily to more established talking therapies.

We offer a Sensorimotor group for pregnant women and mothers with young children (under the age of 3).  This focuses on stabilisation and treatment, particularly in the early years of a child’s life, due to the impact of symptoms on the family.  We give support and patients learn techniques to help with the bonding and attachment process from birth to age 3.


Care option: Treatment, child sexual abuse group

Code: 92623

Unit: Not applicable

Description: Weekly sessions for two and a half hours, for up to 38 weeks with two therapists. This option also includes an introductory session and a follow-up appointment. The majority of the people who attend this group present with a long history of multiple psychiatric symptoms and disturbance, including self-harming and suicidal behaviour, alcohol and drug abuse, depression, anxiety, dissociative or psychotic symptoms, disturbance of family and sexual relations, and severe symptoms of PTSD and dissociative disorders. Many have a prior diagnosis of borderline personality disorder. 

This group therapy programme focuses on the different aspects and impacts of childhood sexual abuse.

 

Care option: Telemedicine assessment

Code: 92988

Unit: Not applicable

Description: A telemedicine assessment by a consultant is available for people who are not able to be assessed in hospital and for whom outreach is impractical. The assessment includes two sessions of up to two hours each, consisting of a diagnostic interview and questionnaires. Referrers receive a report including recommendations for treatment, medication and any other clinical management issues. 

 

Care option: Teaching, training and supervision

Code: Not applicable

Unit: Not applicable

Description: Supervision is available for clinicians who may need advice on a specific case or ongoing regular supervision. This can be offered on an individual basis or in groups. Price on application. 

Referrals

Please complete this referral form  referral-form-2020 and email to tds@slam.nhs.uk 

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