Inspiring and Connecting Through Research into Cognitive Analytic Therapy

5th June 2018UncategorisedCAT, Cognitive Analytic Therapy, Evidence Base, NIHR, Researchrhona

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)

Interesting, engaging, curious minded people?

29th March 2018UncategorisedCAT, Cognitive Analytic Therapy, Evidence Base, Researchrhona

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

Embodiment Event Now Open to Bookings

23rd March 2018Uncategorisedburnout, CAT, Cognitive Analytic Therapy, complex trauma, Embodiment, narcissistic wounding, therapist self care, vicarious traumarhona

Tim Sheard’s two day workshop on Embodiment, Relational Space and Working with Trauma to the Sense of Self is now open for bookings. The workshop, which takes place on 30th and 31st May, builds on previous training he’s delivered elsewhere in the UK and Finland. In it he aims to provide an embodied and theoretical exploration of our relational selves, narcissistic wounding to the sense of self, and how embodiment may reduce what he refers to as therapist burdening. This can take the form of stress, tiredness, exhaustion, burnout and vicarious trauma.

Tim offers understanding of these as embodied manifestations of a “hidden but powerful type of collusive reciprocation”, often occuring in a context of complex developmental trauma. He notes “the therapeutic relationship takes place in an embodied relational field, not simply between two reflective “minds”……embodiment skills may render it more tangible”. His position is that developing such awareness “may help clarify the kind of relational presence we offer as therapists” to people who have experienced significant early trauma. He believes that learning and practising embodiment skills can help to support the development of therapist self care via “healthy self-to-self reciprocal roles to resource us in the therapy room”, with potential benefits for both therapist and client.

His article in the Summer 2017 issue of Reformulation provides a more detailed account of how his experiential workshops, involving over 200 therapists to date, have evolved over the last seven years. It also provides more information about the kinds of areas he’s likely to cover over the two days.

He welcomes applications from CAT therapists at any level of pre- or post-qualification. Other therapists working relationally with people who have experienced complex developmental trauma, and who are well-versed in key CAT concepts such as reciprocal roles, are also welcome to attend.

This event takes place in Manchester in the leafy surroundings of Chancellor’s Hotel, and we hope that a more typical spring will have arrived by the end of May so that participants can enjoy the grounds. It is offered on a non-residential basis so those attending will need to arrange their own accommodation. Tim wishes to keep the event quite small so that participants can gain the most from it. If you’re keen to take advantage of his trip to the north, then we encourage you to book soon. Full details are at the event page at this link.

To book on to this event please click here. The hashtag for the workshop is #CATerst18

First States Day Fully Booked

22nd February 2018UncategorisedCAT, Cognitive Analytic Therapy, MSSM, Multiple Self States Model, Self States, State Shifts, Statesrhona

The first run of the CPD day offered by Sarah Littlejohn and Dawn Bennett on States, Self-states & State Shifts on 19th March has proved very popular and is now fully booked. If there’s sufficient interest it may be possible to run the day again at a later stage. Contact us if you’d like to be added to a waiting list for a repeat of the event.