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Bringing Home Some Gold to Café CAT

Would you like to share, or hear about, some “golden nuggets” from this year’s ACAT conference in Keele?  Come along to Café CAT Manchester on Wednesday 25th July where we’ll be bringing back some highlights and opening these up for discussion whether you attended or not.

The twenty-fourth annual ACAT conference is almost upon us, taking place between the 5th and 7th of July in Keele.  Conference themes include therapist authenticity, creativity, and use of positive resources in cognitive analytic therapy.

Clive Turpin is offering a workshop there about Café CAT. This will include an introduction to the concept and history of the meetings, and also an experiential taster of its conversational approach.  To quote from the workshop outline:-

“Clive will introduce the topic and encourage the voices of others to contribute on the subject of therapist authenticity. This provides a valuable and rich opportunity to explore the topic as a group through conversation, rather than presenting a specific idea or approach in a usual workshop format. We don’t know where the conversation will go, which is both curious and exciting.”

The conference will be followed by some Café CAT reciprocation on 25th July – an opportunity for anyone attending the conference to feed back highlights, key learning and ideas to share with the CAT community in the north.  As usual these will be a springboard to conversation, and we hope a nice way to cascade proceedings even if you couldn’t make it to the conference this year.  Please come along if you’d like to hear, or share, these “golden nuggets” and develop the conversation.

This will be the fourth Café meeting and we’ll also be reviewing how it’s developing and future directions.

Looking forward to seeing you there at Z-arts, Hulme, Manchester.  The meeting will start at 6.15 pm and end at 8.15 pm; £5 on the door.

More information about Café CAT is at this link, or you can contact us to find out more.

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CAT Across Cultures: Challenge & Encouragement in Equal Measure

Are you using Cognitive Analytic Therapy across languages? With culturally diverse communities? Do you supervise or support such work by other therapists? Do you use CAT consultation in teams where staff get stuck around cultural or religious issues? Have you struggled to incorporate the impact of race and racism in formulations? Does your own heritage and identity figure strongly in how clients engage with you? Has your CAT training sufficiently addressed issues of power?

These can be emotive topics and can evoke powerful responses in us. How do we manage such responses and where can we take these within our CAT practice? 

CAT practitioner Rhona Brown shares some background to Jessie Emilion’s forthcoming training day and why it may be of interest.

We at Catalyse are delighted that Jessie Emilion took up the invitation to lead a day “Exploring Issues of ‘Race’, Culture and Language within a CAT Framework” on 20 July in Liverpool.

Cognitive analytic therapy is of course a radically social model which is explicit about how issues of cultural and subcultural difference are procedurally enacted in therapy. It offers us a way to make the political personal and create shared meaning across cultural divides. Establishing CAT training in Bangalore in India over the last six years, Jessie’s had ample first hand experience of adapting CAT in response to the cultural context in which it’s practised. She also articulates how CAT concepts are shaped by such international experience. Along with Hilary Brown, she published a chapter in Deborah Pickvance’s book, on CAT supervision in the Indian context which brought to life ways in which CAT theory is extending in order to more explicitly realise its radically social basis.

“…through our case discussions, we came to think about dilemmas, traps and snags as being held in the culture rather than exclusively in the individual….. A snag might actually be a prohibition, a dilemma a threat of exile as the punishment for non-conformity and a trap a vicious cycle created by poverty and disadvantage …..The metaphor of the ‘dance’ [in CAT theory] in which each individual seeks reciprocation from others, fails to acknowledge the power dynamics at work in a society. ….The dance does not happen in a vacuum but is structured on the basis of positioned roles, selectively occupied on the basis of class, race, age or gender.”

The Catalyse practitioner training has long included space within its twenty training days to consider what has become known as the “SCOPE of CAT” – social, community, organisation, political and economic aspects. It was a privilege to be able to contribute to these training days for a few years, thinking together with successive trainee cohorts on how to engage with such issues, alongside Deborah Pickvance.

The diversity of perspectives held within CAT’s interdisciplinary community felt like a resource to be mined on these days. We all bring with us our own personal identities, our pre-course experiences, and a range of core trainings with their own professional cultures. We each have our own baseline with regards to culturally competent practice. However to acknowledge areas where we may feel less competent and skilled, or feel perhaps more personally invested, can be a challenge. Starting to unpick some of these issues on SCOPE days always felt like an enriching dialogue, although as a white British facilitator I always felt limited in my capacity to authentically represent the lived and living experience of people of colour.

Diversity in groups we work, supervise and train within gives us all daily opportunities to engage with life experience that’s unfamiliar, but do we have places to take what this can evoke? Uncomfortable reciprocal roles and enactments might arise around ‘silencing-to-silenced’ or ‘privileged and well-resourced to exploited, neglected and marginalised’. Experiencing, or simply witnessing ‘hostile and attacking to harmed’ along racial lines can throw up intense emotions which might be difficult for client and therapist to name if a sense of safety within the alliance is uncertain. Such themes, ever-present for many communities, may more frequently be on the cusp of entering conversations within our consulting rooms in recent times where Trump, Brexit, austerity, #MeToo and Windrush have thrown the impact of power and social positioning into stark relief.

Insidious or more frank psychological sequelae of world affairs impact on all of our lives, illuminating multiple aspects and intersections of identity for both client and therapist. How we as therapists respond when such conversations arise can be crucial to the success or otherwise of a psychological therapy.  CAT gives us various ways to “name it, name it, and name it again”, and experimenting with ways to weave such themes  into formulations, diagrams and letters in authentic ways can be important.  At last year’s international conference in Nottingham, Jessie touched helpfully on putting CAT tools such as mapping to good use by helping to name & navigate ‘gut feelings’ felt by both client and therapist around racism & discrimination.

As team consultants or supervisors, when staff and supervisees share what’s come up in their work around social power and difference, do we feel equipped to respond? At her presentation in Nottingham, Jessie also made the gentle provocation:

“….if issues around race and culture have never come up in your supervisory practice, what’s being missed?”

So, have we had enough in our trainings to feel confident and competent as therapists and supervisors able to engage authentically with such issues, with sensitivity, respect, empathy where possible, and a lack of defensiveness? Perhaps it’s most useful to think about engaging in SCOPE issues as an ongoing learning journey for us all, rather than a certain destination we arrive at by the time we complete practitioner, psychotherapy or supervisor training. As the world and society changes, we and those we work with change, and hence the SCOPE in CAT is never finalised.

In my experience there’s nothing quite like a contained face-to-face dialogue with peers where we can feel safe enough to share both difficult procedures, and also approaches that we’ve found helpful.  Jessie, as a solid ‘more knowledgeable other’ can help take us into an area of more stretch and challenge, also providing an opportunity to develop and take away skills to apply in day-to-day work.  Her experience as psychotherapist, trainer and supervisor lend her many practical tools and resources to share with those attending.  Her training and experience as an interpreter offers an uncommon perspective on language and mothertongue in the nuances of emotional expression and intimacy in therapy. For those considering or already working with interpreters, this specific angle, merged with her CAT lense, may aid in understanding and managing the complexity of triadic relationships.

I expect she will bring to the day equal measures of challenge and encouragement. She herself hopes:

“…we could have an open dialogue about these difficult and complex issues without feeling blamed, frightened or persecuted and that we could use CAT’s mapping and positioning to understand and learn from the discussion”.

The event is open to therapists of all persuasions who are familiar with CAT concepts, plus all within the CAT community, including trainees, supervisors, and those applying CAT skills in case management and indirect work. We hope you’ll join us there.

For more information and to book on to ‘Exploring Issues of ‘Race’, Culture and Language within a CAT Framework’ click on this link.

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Inspiring and Connecting Through Research into Cognitive Analytic Therapy

ACAT chair Alison Jenaway reports back on April’s joint research conference in this, her first guest blog for Catalyse.

“Only connect” wrote E.M. Forster, in his book Howards End, as isolation is a killer. I am paraphrasing, but this is what I had in mind when I was planning the idea of a regular Cognitive Analytic Therapy (CAT) research day. I wanted to be able to gather a group of experienced researchers and lock them in a room with CAT therapists who are keen and interested in research. My hunch was that by some magical process, this would produce a future Professor of CAT.  Call me naïve if you like, but this was my hope when I persuaded Stephen Kellett and Glenys Parry to organise the first research conference to showcase CAT.

To be honest they did not take much persuading. I don’t think the people who agreed to present their research on the day did either, nor the experienced researchers that gave up their time to support the day. My plan was that I would just be there to introduce the reasons behind the conference, and then watch the connecting happen from the sidelines. What I was not expecting, was how much I personally would be inspired by the day.

It really was fascinating, not so much the content of the research and the results, but the way each presenter described why they did what they chose to do, what went well, what went wrong, what they might do differently if they started again, and what they would like to do next. This felt different to other research presentations I have listened to in the past, where the presenter seems to be determined to convince you that the way they did it was the right way, indeed the only way it could have been done. It was like going behind the scenes at the theatre, and gave me more of an insight into the “researcher’s attitude”. It really made me feel that perhaps one day, just maybe, I could do this too.

The morning was made up of presentations for research projects at various stages of completion. Peter Taylor kicked off with an explanation of what a Delphi study is, and how his team used it to explore whether CAT seemed, to therapists, to be a helpful therapy for patients with psychosis.  Good luck to anyone who thinks they can get a group of CAT therapists to agree about anything, but there did seem to be some common themes emerging. His team have recently published a case series of CAT in psychosis which includes qualitative data from patients.

Craig Hallam was next, describing a huge amount of work, juggling multiple ethics committees and associated paperwork, in his study on CAT outcomes for people with learning disabilities.  Despite much solid effort and goodwill – his own, his supervisors’ and CAT colleagues working in this area – recruitment remained a challenge. Craig was pragmatic in moving on to a more manageable project that could be completed within the timeframe of his clinical psychology training. I hope that he will find a way to keep the study going once qualified, given the amount of work already put in. There were plenty of nods of recognition around the room as he generously shared a CAT map of reflections on this process.

Mark Evans described a fantastic piece of work, his small pilot randomised controlled trial of CAT for bipolar disorder, carried out with a tiny amount of funding, and what sounded like a massive amount of good will. Katie Ackroyd is similarly amazing, in her ability to get research into CAT consultancy going in the real world of a busy clinical job.

We have all come to expect that now from Steve Kellett, of course, which is unfair of us. As Steve said, he was jealous of the tiny amount of funding that Mark Evans had to spend! Steve presented his work exploring whether narrative reformulation is really necessary in eight session CAT for depression within an IAPT service, conveying in the process how much fun research can be if you are doing it as a team.

There was some great networking over lunch, and Barney Dunn, from Exeter University was available to talk to people who might be interested in applying for an NIHR ICA fellowship programme. In his view, this was one of the best chances we have in ACAT of getting funding for CAT research projects, and developing a future academic researcher into CAT, at the same time. He and other NIHR advocates are happy to support people looking for research funding .

After lunch we divided up into small groups and so I only have a small fraction of what went on. Frank Margison and I had a group of three keen people who were just starting to think about what research they might be able to do, and we all got excited about the possibilities. Frank has a great overview of how to frame a research question and how you might go about answering it. He didn’t seem to mind me interrupting every now and then to say “I’ve just had another great research idea”.

I think everyone else at the day was as inspired by it as I was. I am planning to lock people up in a room together again next year, for a similar day in London, but it may be that Barney Dunn’s ideas are a more practical way forward in the long run.

Dr Alison Jenaway is a Consultant Psychiatrist in Psychotherapy in the Liaison Psychiatry Service in Cambridge, working with patients with physical health problems and medically unexplained symptoms. She is a CAT therapist and supervisor and has been using CAT for around 20 years. She is currently Chair of the national Association for Cognitive Analytic Therapy (ACAT)

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Interesting, engaging, curious minded people?

With our joint Catalyse/ACAT conference Encouraging-to-Engaged in CAT Research now less than two weeks away, CAT practictioner Rhona Brown reflects on the backdrop to the day and conversations with some of those involved in making it happen.

Since qualifying as a CAT practitioner I’ve had several opportunities to hear colleagues presenting on research at ACAT conferences and through other local CAT networks. I’m always impressed by both the rigour and commitment of researchers and the favourable results emerging from recent work. I tend to leave with a more optimistic and energised state of mind in relation to the idea of research. Sadly in the wake of other demands, must-do’s, and familiar patterns of clinical working, this dissipates fairly quickly. I return to another annual conference back at my familiar starting point, ready to be impressed and energised again. But what changes?

I suspect I’m not alone in this somewhat tame and occasional aspirational state. Within CAT there’s great enthusiasm for the model and a subjective and anecdotal sense that it’s an approach which can help both therapists and those seeking therapy to become unstuck and move on. Experience suggests that this is particularly the case where there’s a level of complexity in presenting difficulties, often where other more manualised and less relational approaches have yielded fewer benefits.

While the lived experience of both parties in the therapeutic endeavour can be favourable in CAT, we know that in terms of an evidence base, its “emerging” status  can lead to it being excluded as a recommended therapy within the majority of formal guidelines. Most recently, the updated NICE guidelines for eating disorders dropped CAT, despite a jointly produced submission by ACAT on the various RCTs which have demonstrated its value with this presenting difficulty.

So how can this change? The research meeting at the joint ACAT and ICATA 2017 conference in Nottingham brought together a small critical mass of research champions within ACAT’s membership. They updated each other on current work, generated ideas for future funding possibilities, and considered how we could collectively generate a list of manageable projects which could be picked up by those on D Clin Psych training. This meeting dovetailed with Alison Jenaway’s election as ACAT Chair.  Alison admits to being a “bright ideas” type of leader, generating new plans and possibilities, and “pushing where it moves” in a system to enable change.

At a time of much internal and external change, it’s a bonus that ACAT can benefit from this energy in relation to refreshing its research strategy. Outgoing chair Jason Hepple continues to hold a steady space for ACAT’s research committee.  Alison’s ideas for refreshing a research strategy stimulated northern-based research allies and Catalyse associates Glenys Parry and Stephen Kellett to put their networking and persuasive powers together. They have engaged a range of researchers with differing experience and stories to tell about how they have planned, conducted and reported on CAT research.  Glenys, Stephen and Alison will be joined by another six research-active colleagues on 13th April in Manchester to help deliver the first in what’s hoped to be a series of research-focussed events for the CAT community and other stakeholders who want to be involved.

So far the event’s attracted applications from a substantial group of enthusiastic CATs plus one or two others more new to CAT but keen to think alongside CAT community members about researching application of the model in their own fields. There’s a reduced bursary fee for people keen to attend but for whatever reason unable to cover the whole cost of the day.

Stephen Kellett, active in generating or supporting much of CAT’s recent evidence base, is characteristically optimistic about what might be covered. He considers that the evidence for CAT as an intervention with people with complex difficulties attracting a diagnosis of “personality disorder” is “looking good” to the extent that CAT can be considered an evidence based treatment according to the NICE bar for entry. Catch him on a day when he’s not too busy researching to share more ideas and he’ll tell you that the building evidence around CAT’s versatility enables us to “cut [our] cloth accordingly in terms of session contracting…..it’s useful to use 8 session CAT for common mental health problems or focal problems and extend to 16 and 24 for more complex presentations”. His recent work on the impact of reformulation letters demonstrates that “narrative reformulation is helpful for complexity, while less so for common mental health problems”. He goes on to highlight how the Personality Structure Questionnaire (PSQ) “is now a CAT specific outcome measure with really good psychometrics”. Get him onto evidence for CAT consultancy and he’ll enthuse that it “doesn’t really have a peer”.

When I asked Stephen what helped him get started (and keep going) in practice-based research, he shared that this has been possible through “thinking up clinically relevant questions whilst working with clients, matching an appropriate method to [them] and working with interesting, engaging and curious minded people”.

I expect that the research conference will be an opportunity for those assembled to distill and refine such questions based on their own clinical setting, and weigh up best methodologies alongside these key research guides. They’ve walked these paths before, know a whole lot more about the terrain than I do, and I hope that their insights and tips, combined with shared reflections from the larger group, can help make my research journey one which might actually get underway. Another hope is that the day will provide a stronger sense of those relational supports and networks which can keep momentum going between April and the next opportunity to hear the research component at an annual conference.

If you might be one of Stephen’s “interesting, engaging and curious minded people”, open to hitching a ride on Alison Jenaway’s energy for building CAT’s evidence base by starting or completing a research journey yourself, then please consider joining us in Manchester.

To book a last minute place at the conference, visit this page.  You can follow tweets about the day on the hashtag #CATres18