Step 4 Psychology Service

Within the stepped care model, we are a secondary care specialist service offering assessment, formulation, and psychological intervention (individual and groups) to clients with complex levels of mental health difficulties. Clients who access our service may experience limitations to their functioning daily, but those presenting with levels of impairment that require more intensive multi-professional input will be supported within the LMHTs.

Our clients have a range of difficulties which can include anxiety, depression, trauma, relationship difficulties and chronic physical health problems.

Our service is for people aged 18 years and over registered with a GP in the city and county. We provide psychological therapy for people who have mental health / psychological difficulties which are chronic and complex enough to be unsuitable for intervention with a lower step of care.

Our services cover the Nottinghamshire area with bases in: County North, City and County South. Teams consist of clinical and counselling psychologists, psychotherapists, CBT therapists, assistant psychologists, trainee clinical psychologists and placement students.

We offer a range of NICE-concordant individual therapies such as Eye movement desensitization and reprocessing (EMDR), Cognitive Behavioural Therapy (CBT), Compassion focused therapy (CFT), Narrative Exposure Therapy (NET), Cognitive analytical therapy (CAT), Acceptance and commitment therapy (ACT), Intensive Short-Term Dynamic Psychotherapy (ISTDP), Mindfulness Based Cognitive Therapy (MBCT) and Psychodynamic therapy. Many interventions offer a combination of these, in an integrated and formulated way. 

Accessing our services

Referrals can be made through healthcare professionals, such as GPs, Nottinghamshire Talking Therapies and Local Mental Health Teams.

Service opening hours

  • County North: 8.30am to 4.30pm
  • City and County South: 9am to 5pm

Contact and find us

View our Step 4 Psychology Service map here (PDF Form) (opens in new window) or view details below:


County North Step 4 Service

Opening hours 8.30am-4.30pm Monday to Friday

74 Portland Street
Kirkby in Ashfield
NG17 7AG

Tel: 0115 956 0877


Opening hours 8.30am-4.30pm Monday to Friday

Kings Mill Hospital
Sutton in Ashfield
NG17 4JT

Tel:  0115 969 1300



City and County South Step 4 Service

Opening hours 9am-5pm

St Ann's House
114 Thorneywood Mount

Tel: 0115 844 0526
Fax: 0115 844 0530


Opening hours 9am-5pm

Mandala Centre
Gregory Boulevard



Clinics are also offered in a variety of other place-based locations around the County.

Information for health professionals

To discuss referrals, please contact the team directly.


Step 4 Referral criteria

Who we work with Who would likely not be appropriate
Clients aged 18 years or over Clients presenting with high levels of risk to self or others within last 6 months (e.g., recent suicide attempt / psychiatric admission), suicidal with plans and require crisis support.
Clients registered with a Nottinghamshire GP Clients who require out of hours support or other multidisciplinary mental health team input.
Clients with significant history of mental health/ psychological difficulties not amenable to intervention with Talking Therapies Clients with significant levels of substance misuse that would interfere with therapy (e.g., inconsistent attendance/attending under the influence, using substances to block emotions/traumatic memories that need to be processed).
Clients with longstanding (6 months plus) or recurrent non-psychotic clinical presentations Clients with an organic brain disease/injury or learning disability which would prevent effective engagement in therapy (i.e. significant memory problems, severe inattention, more extreme disinhibition) - refer to IDD or MHSOP[KS1]  if >65 years or YOD if <65 years
Previous interventions tried (stepped care and third sector) and despite their motivation and engagement have either been ineffective or require long-term therapy. Clients presenting with psychosis refer to Local Mental Health Teams or EIS 
Clients willing to attend therapy either in-person or remotely
  • Clients who are not yet ready to make active changes and are looking for something more akin to a supportive relationship - explore counselling or befriending services
  • Clients involved in current court proceedings, where the primary motivation for accessing therapy is to satisfy the court.
  • Clients with high levels of social instability, such as a lack of stable accommodation, repeated on/off relationships, high levels of unmanageable debt which may detract from the work in therapy and may be better managed using a multidisciplinary team approach.


Lead Clinician

County: Alison Smith, Consultant Clinical Psychologist / Lead Psychologist for Adult Mental Health or Catherine Hawkins, Clinical Psychologist -

City and County South: Dr Helen Booth, Principal Clinical Psychologist, and Dr Rebecca Trikic, Principal Counselling Psychologist -

Step 4 Psychotherapy service: Tom O’Reilly, Consultant Adult Psychotherapist and Team Leader



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