An independent provider in the City of Kingston upon Hull area

7. Mrs P complains about aspects of her care and treatment by the Provider between January 2024 and January 2025. She complains:

• she was supposed to receive Eye Movement Desensitisation and Reprocessing (EMDR) therapy sessions, but instead she received talking therapies (EMDR is a psychological treatment that has been found to reduce the symptoms of Post Traumatic Stress Disorder (PTSD)), which is a mental health condition caused by very stressful, frightening or distressing events) • serious disclosures she made during her therapy session were not recorded in the notes • there were missed opportunities to act on safeguarding concerns with signposting to appropriate support.

8. Mrs P says the talking therapies caused her to relive trauma, become hypervigilant and have nightmares. She says this would have been avoided if she had received the appropriate EMDR sessions. Mrs P also says the therapist did not provide her with support such as signposting after her sessions. Due to the lack of support, she feels isolated and unable to go out. She feels the Provider did not take her seriously, she does not trust it, and her complaint is a barrier between her and the Provider.

9. Mrs P is paying for private therapy and support following the lasting effects she is experiencing from therapy sessions provided by the Provider. She is on a long waiting list for NHS trauma focused cognitive behavioural therapy and EMDR.

10. Mrs P also has an ongoing police investigation against an offender who she has spoken about during her talking therapy sessions. The therapy records were not able to support her investigation with the police as they did not reflect what she told the therapist. She says this has impacted the evidence available to support her police case.

11. Mrs P would like service improvements, for the Provider to consider moving her up on the waiting lists for therapy and financial remedy to cover her private therapy costs and recognise the emotional impact on her.

12. Mrs P self-referred to the Provider in January 2024. The Provider assessed her to decide what type of therapy was appropriate to her needs, later in January 2024. Mrs P started counselling for depression in March 2024.

13. In April 2024, a therapist identified Eye Movement Desensitisation and Reprocessing (EMDR) therapy would be more appropriate. Mrs P had EMDR therapy sessions from April to October 2024, though says she did not receive EMDR at these sessions.

14. In October 2024, Mrs P complained to the Provider for the first time about its record keeping, lack of EMDR input, lack of safeguarding input and her care being ‘fragmented’. The Provider responded in November 2024.

15. In November 2024 the Provider reviewed Mrs P’s treatment and decided she would be referred to secondary care for trauma focused therapy. This is carried out by another service and not provided or commissioned by the Provider.

16. Later in November 2024, Mrs P requested her complaint was re-opened as she was not satisfied with the Provider’s response. She received its final response in January 2025.

17. Mrs P had a private assessment of her mental health carried out in January 2025, which diagnosed her with complex PTSD (C-PTSD, this is a mental health condition like PTSD with additional difficulties around sustaining relationships, regulating mood and a sense of worthlessness, guilt and/or shame around the experiences that led to them developing C-PTSD).

18. Mrs P complained to PHSO in April 2025.

22. Before we decide whether we should conduct a detailed investigation of a complaint, we look at whether there are signs the Provider has got something wrong. We do this by comparing what should have happened to what did happen. We have done this and have not seen any indications that something has gone wrong.

EMDR therapy

23. Mrs P complains about the EMDR therapy sessions she attended between April and October 2024, specifically that she did not receive EMDR therapy at these sessions. Mrs P says she instead received talking therapy at these sessions. She says this was not appropriate for her and caused her to relive previous trauma, become hypervigilant and have nightmares.

24. Mrs P says this has meant she is paying for private therapy due to the lasting effects of reliving her trauma, and she is back on a waiting list for NHS therapy.

25. The SAGE guidance ‘Eye movement desensitization and reprocessing therapy’ says EMDR consists of eight phases of treatment which comprise of:

26. History taking and treatment planning 27. Preparation 28. Assessment 29. Desensitisation 30. Installation 31. Body scan 32. Closure 33. Re-evaluation.

34. There are entries in Mrs P’s therapy records from the Provider between April and October 2024 that are marked as being EMDR therapy sessions. There was a change of therapist at Mrs P’s request in May 2024.

35. Mrs P says she did not receive EMDR therapy during these sessions as the eight phases of EMDR were not followed. Mrs P has also been told by a friend about their EMDR therapy sessions, and says her experience was very different. This has contributed to Mrs P believing she did not receive EMDR therapy.

36. With the first therapist, in sessions between April and May 2024, the session records indicate ‘phase one’ of EMDR therapy was being worked through. This involves history taking and treatment planning.

37. The last therapy session with this therapist in May 2024 indicates ‘phase two’ of EMDR therapy was being done, with preparation and introducing safe place interventions to manage distress after sessions.

38. Mrs P requested a change of therapist at this stage as she did not feel like she was getting EMDR therapy with the first therapist.

39. Mrs P restarted therapy in July 2024, with the records from the first session indicating ‘phase two’ of EMDR therapy was revisited to review the safe place interventions and make sure Mrs P had self-soothing techniques after sessions (techniques to help her regulate her own emotions by herself).

40. In the records for the rest of July and August 2024, the session records show evidence of ‘phase three’ of EMDR therapy being worked towards. This is shown by mention of negative and positive cognitions being spoken about. This involved assessing negative feelings about a trauma memory and deciding the positive feelings Mrs P would like to have about herself when she thinks of the memory. The positive cognitions are the goal of where Mrs P would like to get to, which is recorded as being introduced in these sessions.

41. Mrs P was late to the therapy session in September 2024. The records from this session say this meant there was no time for ‘active processing’ work. Our adviser says this shows they were moving into ‘phase four’ of EMDR therapy, which is the desensitisation stage using eye movement work.

42. In the next session in October 2024, the records show the therapist revisited ‘phase three’ work with negative and positive cognitions being explored and reference to ‘installing work’ which our adviser says again shows the therapist moving towards ‘phase four’.

43. Mrs P complained to the Provider following this session, outlining that she was not receiving EMDR and expressing this therapy was damaging to her. She had a treatment review, and it was decided she would benefit more from psychotherapy, so the EMDR therapy came to an end.

44. Overall, we have seen evidence which shows Mrs P was receiving EMDR therapy and the phases of treatment were being followed, in line with the guidance ‘Eye movement desensitization and reprocessing therapy’. We therefore do not see indications of failings in this part of Mrs P’s complaint.

45. We appreciate this may differ with Mrs P’s expectations of EMDR therapy and how her friend experienced their therapy. We can also see how the delivery may have differed from her expectations of how the phases of EMDR therapy would be followed, which included more use of the desensitisation phase and closer to how her friend told her the therapy went for her.

Disclosures made during therapy sessions were not recorded in therapy records

46. Mrs P says disclosures she made during therapy sessions between April and October 2024 were not recorded properly. These disclosures included distressing events around assault and abuse. Mrs P says she has an ongoing police investigation in relation to these events, and the records could not be used to support this, due to not containing this information. She says the investigation is still ongoing now, without the use of these records as supporting evidence.

47. We do not doubt Mrs P’s account or the significance of these events and appreciate her concern that these events were not recorded. Mrs P explains these events should have been recorded to provide clarity around her struggles, and that these events continue to cause her considerable ongoing distress.

48. We have considered the action the Provider has taken in relation to these concerns. In the complaint response of 22 November 2024, the Provider acknowledges Mrs P’s concerns and explains it appreciates the importance of accurate clinical documentation.

49. In the same response, the Provider apologises for any inaccuracy in record keeping and says they have made addendums to Mrs P’s records in line with her complaint. An addendum is used to add detail to health records, such as further information or context from a patient, to help clarify the record. The Provider also noted it would implement an audit process for record keeping, to ensure records are accurate, complete and respectful.

50. We consider the actions the Provider took were appropriate, in line with the NHS England guidance ‘Amending patient and service user records.’ This says that records should not be amended or deleted if there are not factual errors (such as the wrong address or date of birth). Where a person disagrees with what is contained in the records, additional comment (an addendum) can be included to show the additional information or that the person disagrees with the content.

51. Our adviser says the records themselves are appropriate, in line with guidance that records should be legible, fair and accurate. We have not seen indications to suggest the inclusion of the additional information would have changed the care Mrs P received.

52. We recognise Mrs P’s concern that the initial lack of detail in the records may have affected her care and has meant she has not had necessary information for a police investigation.

53. It is unlikely we would be able to comment on the impact of these records on a police investigation. This is because this process likely considers a number of pieces of evidence, and we are unlikely to be able to say if having the disclosures noted in the records would have changed any aspect of the investigation.

54. We also note the disclosures made were for historical events, though we fully take into account the ongoing impact these have had on Mrs P. We consider the additional information added to the records addresses the issues in recognising the ongoing impact to Mrs P.

55. Overall, we consider the Provider has appropriately considered Mrs P’s concerns about the information contained in her records and has taken appropriate action to put this right. We consider this is in line with our ‘Complaint standards’. These say organisations should act openly and transparently and with empathy, explain why things went wrong and identify suitable ways to put things right for people, and give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned.

Missed opportunities to act on safeguarding concerns and to signpost to appropriate support

56. Mrs P complains the Provider did not safeguard her properly when she made disclosures about assault and abuse. Mrs P says this has caused a mistrust of the Provider and like she was not taken seriously. She says she also pays privately for support now after feeling like she had not received this from the Provider.

57. The Provider’s response in January 2025 said it can only act on immediate danger and concern, not against circumstances that have passed. It says safeguarding against suicide risk, self-harm, substance abuse, third party and police involvement was documented throughout the therapy intervention.

58. It also noted a referral was made to Domestic Violence and Abuse Partnership (DVAP, a support service for victims of domestic abuse) by both Mrs P and the police.

59. The NHS Code of Confidentiality explains a clinician has a duty to hold information in confidence, unless there is an obligation to disclose this. In Mrs P’s case, she believes the information she disclosed should have led to a safeguarding referral.

60. We have considered this concern in line with the Provider’s local policy, which references the Care Act 2014. This says all three of the following must be met for a safeguarding referral to be made:

‘The Care Act 2014 outlines criteria for referring a safeguarding concern. Section 42 applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there):

• Has care and support needs (whether or not the authority is meeting any of those needs) • Is experiencing, or is at risk of, abuse or neglect, and • As a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.’

61. In considering this guidance, we do not consider Mrs P’s disclosure met the criteria for a safeguarding referral under the Provider’s adult safeguarding policy. This is because the events disclosed were historical. Mrs P was not experiencing or at risk of abuse at the time the disclosures were made, and she was being supported by appropriate services.

62. It is documented in Provider records that Mrs P had referred herself and had police referral for appropriate support. It is also documented in records and described in more detail in the EMDR section of this statement that Mrs P was worked with to develop safe place interventions and self-soothing techniques for after therapy sessions.

63. We understand Mrs P expected a different approach to safeguarding from the Provider and can see how its procedure did not meet this expectation. We also appreciate how this has left Mrs P feeling like she was not taken seriously and like she needs to pay for private support.

64. We can reassure Mrs P the Provider acted appropriately. We consider the Provider dealt with safeguarding in line with guidance and policy, and we see no indications of failings in relation to this aspect of Mrs P’s complaint.

Conclusion

65. From reviewing the information provided by Mrs P and the Provider, we are satisfied that the Provider provided care and treatment in line with the relevant standards and guidance.

66. We understand how the care and treatment has differed from Mrs P’s expectations and how this has been distressing and impactful to her. We are glad she is taking positive steps towards support more in line with her expectations and hope she continues to take forwards steps in her recovery.

67. We hope this statement clearly explains our reasoning behind our decision, and Mrs P can see how we have balanced the available evidence and used independent advice to come to this conclusion.

1. We have carefully considered Mrs P’s complaint about the Provider.

2. Mrs P complains she did not receive appropriate therapy, and that disclosures she may about significant and distressing events were not noted in her records, and appropriate safeguarding action was not taken.

3. We are sorry to learn of Mrs P’s experiences with the Provider and can see the impact this has had on her. We understand it was difficult for her to bring this complaint to us and thank her for doing so.

4. We have not seen indications of failings in the therapy Mrs P received. We have seen that more could have been done to record Mrs P’s disclosures, but we consider the Provider has taken appropriate action to add further detail to the records about these events. We have not seen indications to suggest further action is needed in relation to this concern.

5. Lastly, we have not seen indications of failings in the Provider’s handling of potential safeguarding concerns.

6. We have explained the reasons for our decision below and we hope this reassures Mrs P we have carefully balanced our decision based on the evidence available.