Severn Deanery Advanced Training in Forensic Psychotherapy
Job Description and Person Specification
Section 1 - Introduction
This training scheme offers five years of higher specialist dual training in forensic psychotherapy. The objective of the training is to prepare the trainee for future appointment as either a consultant in forensic psychotherapy, a consultant forensic psychiatrist with special responsibility for forensic psychotherapy, or a consultant psychiatrist in psychotherapy. The training scheme has been designed to conform with the Royal College of Psychiatrists guidelines for training in forensic psychotherapy. The scheme is based on two established single specialty training schemes in the Severn Deanery in Forensic Psychiatry and Psychotherapy. This combined training will lead to a dual award with CCTs in Forensic Psychiatry and Psychotherapy.
Section 2 - Organisation of Training
The scheme is designed so that forensic psychiatry and psychotherapy training are integrated throughout the five year programme. The Training Programme Director for the scheme is Dr Andrew Clark. Whilst the following description gives an overview the training scheme it should not be regarded as set in stone as we are committed to adapting the training to suit the training needs and interests of the individual trainee.
Progression Through Training
In the years 1 and 2, the major component of the training will be forensic psychiatry with two special interest sessions in general psychotherapy. In years 3, 4 and 5 the major component will be psychotherapy and forensic psychotherapy. The scheme has close links with the Forensic Psychiatry Advanced Training Scheme in Devon and there may be an option of a forensic psychotherapy placement at Langdon Hospital, Dawlish, Devon. There will also be opportunity for links with the Forensic Psychotherapy Department at Broadmoor Hospital. During these years, two special interest sessions will be maintained in forensic psychiatry. There will be a gradual progression from gaining a solid grounding in forensic psychiatry and general psychotherapy to increasing specialisation in forensic psychotherapy. There will be academic components throughout the programme in forensic psychiatry, general psychotherapy and, in the latter years, forensic psychotherapy.
Throughout the five-year training there will be two sessions allocated to research. There are ongoing research projects in each of the training settings.
The main training will be in forensic psychiatry based at Fromeside, Blackberry Hill Hospital Bristol. Fromeside is a purpose built 80 bed medium secure unit. The Consultant trainers will be Dr Paul Cantrell, Dr Rosanne Macgregor Morris, Dr Peter Wood, Dr Nicola Claxton and Dr Theresa Tattan and the newly appointed Consultant Forensic Psychotherapist Dr Daniel Beales. The training will comprise in-patient and out-patient experience including the Pathfinder personality disorder service, prison sessions and the writing of court reports. The two special interest sessions will be devoted to general psychotherapy. These will be based with Dr Andrew Clark and Dr Thanos Tsapas in the Psychotherapy services at Blackberry Hill Hospital and Petherton Resource Centre in Bristol. The main experience gained in these placements will be in psychotherapy assessment and supervised case work in psychodynamic (brief and longer term), and group psychotherapy.
The main component of training will continue to be forensic psychiatry experience at Fromeside. The trainee will undertake a minimum of 30 days gaining experience in a high secure setting at Broadmoor Hospital. This would normally take place before the end of the second year. The general psychotherapy placements in Bristol will continue as in Year 1.
The third year of the training will have four sessions devoted to general psychotherapy with Dr Andrew Clark and Dr Thanos Tsapas in Bristol. This will provide further opportunities for training in psychotherapy assessment and supervised casework in psychodynamic (brief and long term), cognitive behavioural, cognitive analytic, systemic and group analytic psychotherapies. The cognitive behavioural therapy will involve one session a week for a year and will be supervised by Prof Glyn Lewis (Professor in Psychiatric Epidemiology). The forensic psychiatry experience will continue via two sessions at Fromeside Bristol. The emphasis will be on developing psychotherapy skills within forensic settings through experience in the Pathfinder Personality Disorder service under the supervision of Dr Daniel Beales. There will be opportunities for specialist forensic psychotherapy assessments and supervised casework in forensic psychotherapy and consultation work in different forensic settings. The trainee will be encouraged to make links with Dr Brian Darnley, Consultant Forensic Psychotherapist at Langdon Hospital, Devon and with Dr Gwen Adshead, Consultant Forensic Psychotherapist in the Psychotherapy Department, Broadmoor Hospital.
Again, four sessions will be available for general psychotherapy training. The training will extend experience in the range of psychotherapeutic models. There will be increasing emphasis on work with people with personality disorders. There will be an opportunity to work within the mentalisation based therapy specialist personality disorder service within Bristol. There will be opportunities to gain general psychotherapy experience in other settings for example in Cheltenham under the supervision of Dr Svetlin Vrabtchev. One session a week for this year will be devoted to systemic therapy supervised by Dr Alcuin Wilkie (Consultant Psychiatrist). There will continue to be two sessions a week based at the Fromeside and ongoing experience in the Pathfinder Personality Disorder service.
Either year 4 or 5 could be spent on a placement at Langdon Hospital, Devon under the supervision of Dr Brian Darnley, Consultant Forensic Psychotherapist.
Section 4 - Forensic Psychiatry Training
The main base for the forensic psychiatry training is Fromeside, Bristol.
The clinical experience is specifically designed to enable the trainee to meet the objectives of higher training in forensic psychiatry laid down by the Royal College of Psychiatrists. The clinical settings are as follows:-
This is a purpose built PFI medium secure unit comprising eighty beds including fifteen beds for male continuing care and twelve beds for women serving a population of approximately 2.5 million. There are five multi disciplinary teams each delivering services to a defined geographical sector. A specialist team for assessment and outpatient treatment of people with a personality disorder is being established.
The Service covers the whole of the Trust area together with the neighbouring Gloucestershire Partnership and Somerset Partnership Trusts. In addition, for Women Service users only, the service covers the peninsula of Devon & Cornwall.
On behalf of the various PCTs it delivers forensic psychiatric advice to some 100 Consultant teams. It acts as the gatekeeper for all medium secure and high secure care throughout its catchment area, whether NHS or independent sector. It has operational links and a service interface with the Forensic Learning Disability Service, the Child & Adolescent Forensic Mental Health Service (UBHT), Broadmoor Hospital (West London MHST) and the various prisons within its catchment area.
The Service operates according to an integrated service model, which has been agreed with all the relevant commissioning agencies. Applicants will be provided with a more detailed account of how the service model works in practice in an accompanying document (Integrated Service Model). In essence, the service exists to provide expert consultancy and liaison to referring agencies by way of assessment and advice regarding case management. This may include acceptance for in-patient care in medium security, where indicated by clinical needs.
Bristol Prison is within a few miles of Blackberry Hill Hospital and provides the male remand services for the area in a prison adapted for Category B status. Eastwood Park Prison is the remand and training facility for female inmates from a wide area from the South West of England and South Wales. It is located some 15 miles from the hospital. Nearby is Leyhill Open Prison with the largest “lifer” population in the country. The trainee will be expected to gain clinical experience in these settings.
The trainee will undertake a minimum of 30 days gaining experience in a high secure setting at Broadmoor Hospital.
Special Interest sessions
The demands of this training mean that special interest sessions will be used to maintain the two strands of training (forensic psychiatry and general psychotherapy) throughout training. In years 1 and 2, the special interest sessions will be devoted to general psychotherapy. In years 3, 4 and 5, the special interest sessions will be devoted to forensic psychiatry. There will be scope within these requirements for the trainee to develop areas of particular interest within forensic psychiatry and forensic psychotherapy.
One day a week is devoted to academic research or private study. The Forensic service in Bristol have strong links with the Department of Mental Health, University of Bristol, particularly through Dr Tim Amos, Senior Lecturer. There is also a research interest group at the Fromeside Clinic led by thDR Julian Walker who is currently the Trust Lead for Research and Development. There is a good forensic library at Fromeside.Academic Training
At the Fromeside Clinic there are weekly forensic journal clubs and case conferences. There is also a programme of regional and supra-regional academic meetings.
Thoughout the training the trainee will have one hour a week of educational supervision with their educational supervisor.
There are many opportunities to provide teaching for medical students, core trainees and other disciplines. There will be opportunities to learn lecturing and presentation skills throughout the academic programme.
In-house management training is available sites both in relation to normal managerial duties of consultants, medical director duties, and College roles. In addition there is a formal management training provided by the South West Division Training.
On call experience
The basic salary will be enhanced with a banding supplement which reflects the intensity of the working pattern involved. As those patterns change, so do the supplements. The individual Trust will notify you of the working pattern and the associated banding.
Section 5 - General Psychotherapy Training
The main clinical base for this will be the Psychotherapy Services at Blackberry Hill Hospital, Bristol and Petherton Resource Centre, Bristol. There will also be opportunities for sessional work in the Psychotherapy Service in Cheltenham and the Psychotherapy Department at Wonford House Hospital, Exeter.
The clinical experience is designed to enable the post holder to fulfil the requirements of advanced training in psychotherapy laid down by the Royal College of Psychiatrists.
The Psychotherapy Service, Blackberry Hill Hospital
This service, led by Dr Andrew Clark, Consultant Psychiatrist in Psychotherapy, is part of the South Gloucestershire Psychological Therapies Service which receives approximately 200 new referrals per year from the community mental health teams within South Gloucestershire. It offers a range of psychological therapies, including brief and long-term psychodynamic psychotherapy, group analytic psychotherapy, cognitive behaviour therapy, art psychotherapy, mentalisation-based therapy, dialectical behaviour therapy and systemic family therapy. The Psychological Therapies Service works closely with the functionalised community teams (recovery, intensive, early intervention and primary care liaison) in South Gloucestershire. Case discussion and supervision groups are run for the rotating core trainees in psychiatry as well as other interested mental health professionals.
The Psychotherapy Service, Petherton Resource Centre, Bristol
This service led by Dr Thanos Tsapas, Consultant Psychiatrist in Psychotherapy, is part of the Psychological Therapies Service in Bristol. It receives referrals from the community teams in Bristol and offers a range of psychological therapies including brief and long-term psychodynamic psychotherapy, group analytic psychotherapy, cognitive behaviour therapy, art psychotherapy, mentalisation-based therapy, dialectical behaviour therapy and systemic family therapy.
Personal therapy is seen as an essential part of this training. It is recognised that trainees’ needs and preferences will vary in this regard. However, given that the emphasis of the psychotherapy component of this training is on psychodynamic and group analytic psychotherapy, personal therapy should preferably be of this nature. There are a number of experienced Psychoanalytic and Group Analytic Psychotherapists working in Bristol and Bath and the trainee will be given every assistance in deciding what experience will be right for them. It is expected that the personal therapy will last for a minimum of three years in parallel with the main psychotherapy component of the training. The intensity of the personal therapy will depend upon whether the trainee chooses individual or group analytic therapy and what level of intensity they wish to work with patients. It is felt that personal therapy should be at least as intensive as the most intensive work with patients. Funding has previously been partly met by the Severn Deanery.
One day a week is dedicated to research. All the psychotherapy services within the region are actively involved in research projects and have good links with Professor Glyn Lewis at the University of Bristol. The trainee will be expected to discuss potential research projects at an early stage with their educational supervisor and the academic staff identified above.
The main academic teaching takes place in Bristol. There is a weekly seminar led by Dr Emma Lanham (Staff Grade in Psychotherapy) covering basic texts in psychoanalytic theory and practice and a weekly psychotherapy reading seminar run by Dr Thanos Tsapas covering clinical texts. There will separate seminar series in conjunction with clinical supervision for cognitive behaviour therapy and systemic therapy.
In addition there are local opportunities for further training in psychotherapy including Group Analysis South-West which offers an introductory, advanced and qualifying course in group analysis; the Severnside Institute of Psychotherapy which offers a UKCP accredited training in psychoanalytic psychotherapy and the University of Bristol which offers introductory and intermediate training in family therapy.
There is ample opportunity for teaching medical students, trainee psychiatrists and multidisciplinary groups of mental health professionals in Bristol. The trainee will be expected to run psychotherapy case discussion groups for core trainees as well as contribute to the formal lecture programme on the Core Psychiatry Training Course based in Bristol.
In addition to formal management training organised regionally, there are many opportunities for shadowing consultants in service planning, managerial meetings and College roles.
Section 6 - Forensic Psychotherapy
This will be based in the Pathfinder Service for people with Personality Disorder based at Fromeside. The Consultant supervisor will be Dr Daniel Beales, Consultant Forensic Psychotherapist. The Pathfinder Team provide a specialist non-inpatient and gate keeping service to the West of England cluster of NHS South West as part of the Integrated Service Model. The service provides alternatives to inpatient secure care and the provision of community care and treatment of men and women with a diagnosis of Personality Disorder and a forensic history including serious harm to others (violence and/or sexual) and who pose a current risk of serious harm to others. The service does not exclude mental illness if this is a co-morbid diagnosis but does not manage acutely unwell individuals. The service offers specialised psychological interventions, primarily group interventions to address psychological needs and potential re-offending risk factors, to those individuals who express a desire to engage in treatment. The team also works closely with the National Offender Management Service (NOMS) to provide assessment, consultation, case management and teaching to prisons within NOMS South West. In addition, the service works closely with the inpatient forensic service to support the service with the management of inpatients with dual diagnosis who may also benefit from some of the group interventions or support upon discharge.
The service was initially established in July 2007 as a three year pilot, and was awarded recurrent funding in October 2010. In April 2012, funding was confirmed for an extension to the existing service, providing an assertive case management function for out of area placements. The service will continue to develop in terms of personnel and service provision and focus. The team’s establishment and operation is consistent with the published Department of Health commissioning guidance for personality disorder services.
The team is based within the administration base of Fromeside. There is also the use of a supervised outpatient consulting area within Fromeside. The team is multidisciplinary and consists of:
Consultant Psychiatrist in Forensic Psychotherapy Dr Daniel Beales (full-time) due to start in May 2013
Team Leader and Consultant Clinical Psychologist: Dr Michelle Chauhan (6 sessions)
Consultant Forensic Clinical Psychologist: Dr. Julian Walker (4 sessions)
CBT and DBT Therapist: Mr Jeff Roche (4 sessions)
Music Therapist: Mr Dan Lewis (3 sessions)
Clinical Psychologists: Dr Victoria Knauer and Dr Megan Wilkinson -Tough (3 sessions each)
Adult Psychotherapist: Ms Suzi Sparham (6 sessions)
Occupational Therapist: Mr Robin Kendall (full-time)
Team Secretary: Ms Cindy Castle (full-time)
The trainee will gain experience of forensic psychotherapy assessment, consultation and treatment within outpatient and inpatient settings. The trainee will also gain experience of delivering reflective practice to staff groups. An important aspect of training is the development of an understanding of institutional dynamics particularly in forensic settings and how this relates to medical leadership. There may also be opportunities for a placement at Langdon Hospital in Devon under the supervision of Dr Brian Darnley, Consultant Forensic Psychotherapist. The scheme also has links with Dr Gwen Adshead at the Psychotherapy Department at Broadmoor Hospital and the trainee will be encouraged to gain some forensic psychotherapy experience in a high secure setting.
There is a weekly forensic psychotherapy reading seminar.
It is hoped that the trainee will develop a research project in forensic psychotherapy and the academic links within the Broadmoor Hospital Psychotherapy Department could facilitate this.
Trainees will be expected to contribute to teaching of forensic psychotherapy and to supervising others. There will be many opportunities for this both at Fromeside and at Langdon.
Management training will continue throughout the five years and this will include learning about management issues within a specialist forensic psychotherapy setting.
Section 7 - Key Professional Staff During 5-Year Programme
Dr Paul Cantrell Consultant Forensic Psychiatrist and Training Programme Director Forensic Psychiatry, Bristol.
Dr Rosanne Macgregor-Morris Consultant Forensic Psychiatrist, Bristol.
Dr Peter Wood Consultant Forensic Psychiatrist and Educational Supervisor, Bristol
Dr Theresa Tattan Consultant Forensic Psychiatrist and Educational Supervisor, Bristol.
Dr Dharjindra Rooprai Consultant Forensic Psychiatrist, Bristol
Dr Andrew Clark Consultant Psychiatrist in Psychotherapy and Training Programme Director Forensic Psychotherapy, Bristol
Dr Thanos Tsapas Consultant Psychiatrist in Psychotherapy and Educational Supervisor, Bristol.
Dr Svetlin Vrabtchev Consultant Psychiatrist in Psychotherapy and Educational Supervisor, Cheltenham
Dr Daniel Beales, Consultant Forensic Psychotherapist, Bristol
Section 8 -
Educational approval for this post has been granted by the Royal College of Psychiatrists.
There is a small forensic library at Fromeside and a larger psychiatric library at Blackberry Hill Hospital.
There will be a desk and computer access in a shared office at each training base.
The trainee will have access to good secretarial support.
Bristol is a regional centre with a broad industrial and commercial base. Its flourishing local economy relies on regeneration of its port, its historic harbour, aerospace technology and insurance services. Communications by road, rail and air are excellent and there are many natural attractions nearby. Its night-life and street-life are second to none.
Car parking – There are car parking facilities at Blackberry Hill Hospital.
Nearest shops – One mile away..
Local transport – moderate in Bristol.
For discussion of training scheme please contact:
Dr Andrew Clark 0117 378 4480