Above and Beyond: A CAT Approach to Group Therapy

Guest blogger Ruth Carson shares how group CAT became an integral part of the services she leads for people with eating disorders, weight management and bariatric care needs.  This sets the scene for the CPD event Working with CAT in Groups which she and Uma Patel are running on 6th February 2017.  Ruth is a CAT practitioner currently completing her IRRAPT CAT psychotherapy training.  She works as a consultant psychotherapist with Mersey Care NHS Foundation Trust, and is also a trustee for ACAT.

I have now been running groups for over 7 years so in part feel able to share some of the practical skills I have learnt.

Running groups for me initially started as a result of an initiative to extend the range of therapies offered within the eating disorder service that I headed and also to address the increasing demand for our service. My initial stance was that of ‘not reinventing the wheel’. The first groups within the service were therefore CBT groups, run on a format that was known and had been taught to the team as a whole. Despite being dual qualified as a CBT therapist and a CAT practitioner, my preference is certainly CAT, so I was happy to encourage my colleagues to run the CBT group!

This worked fairly well with group recruitment and retention being fairly standard (drop out rates of around 30-40%). All went well until a key member of staff was off sick and so I needed to co-facilitate the group program. The facilitators had already worked with the group to “socialise to the CBT model”, to help members recognise negative automatic thoughts and start to challenge or restructure these. As a new therapist entering the group I heard something more in the narratives about relationships with eating, and found myself mapping these on a flip chart in a way that seemed to make sense of and deepen the shared discussion. This made it possible to make links between early relationships and ways in which people could learn to be controlled and restricted. My contribution seemed well received by the group, and this first positive experience got me thinking – why did we not use CAT in groups?

For me the answer was fairly simple: time. I’d read about a group format described by Duignan & Mitzman (1994) in which each individual client was offered a series of individual sessions where a reformulation letter was created. At this point the person then moved into the group, using the reformulation letter as a point of introduction. This seemed like a great use of CAT but, within my service I felt I did not have the luxury of being able to offer this level of input to 9 potential group attendees.

So, an alternative was needed. At the time I was being supervised by Steve Potter and I described my dilemma to him. Together we looked at an alternative way of working, incorporating his passion for active mapping and my need for a narrative.

We designed a group format that offered two initial teaching sessions which introduced group members to the basic concepts within a CAT approach. This was followed by an individual personal reformulation (PR) session with each group member. The narrative detail discussed within the PR was used to co-create a “story board” which each individual member could keep to themselves. This informed a summary life map for each individual which was shared with other group members and referred to within the following group sessions. This fitted with the useful group strategies described by Jason Hepple (2012) of ‘what is outside of the group stays outside of the group’ and ‘what’s inside the group stays inside the group’.

So, with this format in mind, my colleague Uma Patel and I began our first group. It was a success: we started with 10 people and we ended with 10 people. The group ‘got it’ and by the end of the 16 sessions they all wrote goodbye letters in which they described their journey in terms of reciprocal roles and procedures. Like the band whose album “Group Therapy” is one of my favourites, CAT was taking us “Above and Beyond” what we’d come to expect with a less relational format.

We have continued to run CAT groups, initially within the eating disorder service but then expanding to the weight management services. We have run groups for people experiencing similar problems and also for those with a range of different issues with eating, and found that the group format works equally well for both.

We have also expanded our skill set and began running a long term group with clients who had recently undergone bariatric surgery. This group uses CAT skills and tools but does not offer the personal reformulation. People are invited to join the group for between 9 – 12 months and as a space becomes available, a new person is recruited into the group. Thus the group rolls over, never ending.

Our skill day on 6th February is aimed at allowing people to think practically about running a group. We want to share what we have learned as a starting point and also to hear about participants’ experience of using CAT in groups. There will be time to describe and then demonstrate skills. Participants will be able to practice skills using role play and live group work. It will be fun and we will be able to share both our enthusiasm and our experience. We can let you know what’s worked and what hasn’t. Hopefully together we will be able to inspire you to run a group, or to expand your skills and ideas if you’ve already begun. We hope the day can also help to create ideas on how different group formats can be developed and expanded upon.

You can find Ruth on Twitter – @ruthcarson26

To find out more or to book onto the Working with CAT in Groups event on 6th February 2017, click here.