The Rivers Centre in Scotland: An Attachment‐Based Service Model for People With Complex Posttraumatic Stress Disorder

Abstract

The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment-based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover.

Posttraumatic Stress Disorder and Persistent Somatic Symptoms During the COVID-19 Pandemic: The Role of Sense of Threat

“…Medical settings may enhance an individual’s sense of threat if they have previously experienced trauma and are now experiencing distressing previously symptoms. For example, long periods in busy, loud waiting areas; being intimately physically assessed by a stranger in a position of power; or awaiting test results may all heighten the arousal system and potentially contribute to somatization symptoms (37). Clinical interventions that might benefit from recognizing the impact of hyperarousal on somatic symptoms and engagement in medical care would be to redesign services in line with a trauma-informed care approach.…”

Commentary on the Special Section on Complex PTSD: Still Going Strong After All These Years

“…Fyvie et al. () provide a case study of the transformation of a clinic that had provided standard evidence‐based individual PTSD psychotherapy for physician‐referred patients to a trauma‐informed (Fallot & Harris, ) open‐door resource center in which the setting and the delivery of services were designed to enhance clients’ sense of safety, personal control, choice, self‐efficacy, partnership, access to socioeconomic resources, and continuity of care. Attachment theory was the guiding framework for this redesign, based on recognition that the modal client had a childhood history of interpersonal trauma.…”

Introduction to the Special Section on Complex Posttraumatic Stress Disorder (CPTSD): The Evolution of a Disorder

“…Although neither paper is empirical, we hope that this work will inspire future studies of CPTSD care and treatment approaches. The paper by Fyvie and colleagues (; this issue) describes an attachment‐based model of care for people with CPTSD in which it is proposed that for services to be effective, they should provide people with an alternative model of attachment. A new model of care was introduced in the Rivers Centre for Traumatic Stress in Scotland (United Kingdom) following evidence of dissonance between clinical practice and research findings, where it was not possible to deliver evidence‐based interventions without significant modifications or adjustments.…”