Category Archives: Research

A blue graph against a white background

Research in CAT: opportunity and challenge

Featured, Job Opportunity, Research

In this guest blog, Dr Peter Taylor outlines some thoughts on the place of research on CAT, and shares news of new trial therapist opportunities in the North West and Yorkshire.

Research and Cognitive Analytic Therapy

There are many reasons why we should concern ourselves with research into CAT. Perhaps the most immediate is that, through evidencing the effectiveness of CAT, treatment guidelines can be updated to recommend it. This in turn encourages greater support and implementation of CAT within the NHS. Without supporting evidence, clinicians working within the NHS will increasingly be expected to apply other approaches. Opportunities to use CAT may diminish, limiting options for both practitioners and patients.

Beyond this practical concern though, there are other, more fundamental reasons for why research matters. I would argue that we owe it to our patients to stay curious, to seek to better understand where CAT can be helpful, and for whom. Likewise we should aim to evaluate where and how other approaches may be better placed to help. Given that research matters, it is positive that we are seeing steady progress in terms of research investigating CAT.

Relational approaches to treating self-harm

The RELATE trial (relational approaches to treating self-harm) was the first NIHR funded trial of CAT. We have now completed it, and are just working on publishing the associated papers. This was a feasibility trial looking at 8-session CAT as an intervention for self-harm in adults. In brief the results are positive, supporting the feasibility of evaluating CAT within a trial context. They indicate that this approach holds promise and warrants further evaluation. Through our work on RELATE I have heard from other clinicians and researchers across the UK who are exploring opportunities for further research into CAT, which is encouraging.

In other positive news we have successfully secured funding for another feasibility trial of 8-session CAT for self-harm. The trial is specific to young people aged 13 to 17 years. This is an important group, as we know self-harm often has its onset in adolescence. There is an opportunity here for early intervention that may lead to lasting change. We also know that Child and Adolescent Mental Health Services are often encountering high rates of self-harm and in need of therapies that can help support young people struggling with such experiences. The trial is imaginatively called RELATE-YP (Relational Approach to Working with Young People who Self-Harm). It is due to begin in December 2025.

Bringing an opportunity to fruition

These recent funding successes, whilst modest in scale when it comes to trials, suggest that funders are increasingly open to research into CAT. Obtaining funding is one thing though. The challenge we have now, to successfully set up and run this trial, is no mean feat. We will require trial therapists to help deliver the therapy who are:

  • CAT trained, or
  • have at least completed one year of CAT training, alongside
  • experience working with young people

We will employ a trial therapist for a day a week in each of the three sites:

  • Pennine Care NHS Foundation Trust
  • Greater Manchester Mental Health NHS Foundation Trust, and
  • Rotherham, Doncaster, and South Humber NHS Foundation Trust

Acting in a trial therapist role can be a great opportunity for a clinician. You receive focused training and supervision in delivering CAT within this particular context. We are also aware that life happens, and people come and go from these roles for various reasons. Consequently, we also need an idea of others in the area who might be interested in a trial therapist role. If we find ourselves short of a therapist for any reason, we would look to willing others to potentially step in and pick up some cases.

So, I am finishing this blog with a call to action of sorts: If you work in one of the Trusts mentioned above and might be interested in the trial therapist role, please do get in touch.

You can contact Peter Taylor via peter.taylor-2@manchester.ac.uk

Neon lettering against a cloudy blue sky, reading 'understanding'

Beneath the skin: The potential for CAT in helping people who self-harm

Research,

In this guest blog, Peter Taylor shares some thoughts on the value of research into cognitive analytic therapy as an intervention for self-harm. His blog also gives early notice of an opportunity for a feasibility trial therapist. This role, part of an NIHR-funded study, involves other therapist/researchers (operating in their NHS roles) linked to Catalyse through other work over the years.

Recently I was party to an online discussion around treating self-harm. A key theme from these discussions was about the challenges in treating self-harm, given that this behaviour was typically a manifestation of a broad variety of different underlying difficulties. This argument is one backed up by the research. Self-harm is a trans-diagnostic phenomenon that can co-occur with a wide variety of different psychological difficulties.

We know that people who self-harm report an array of different functions or reasons for this behaviour. For one person, self-harm may be a form of self-punishment, in response to feelings of shame or guilt. For another, self-harm may be a way to communicate their distress to others when other means of expressing this are not possible. Moreover, self-harm may serve multiple functions, serving a variety of personal needs. The functions that self-harm serves may change over time for that individual. Given the idiosyncrasy of this behaviour, we can see how a therapeutic approach focused on this presenting problem may struggle.

One argument I have seen is that we should not aim to develop interventions for people who self-harm at all, but instead concern ourselves with the associated psychological difficulties. For example, an intervention might instead target anxiety or depression where this is present. Whilst I agree with the principle of moving beyond the behaviour, I also think its important not to completely dismiss the idea of developing interventions that focus on self-harm. There is evidence that therapies that target self-harm specifically may be more effective than those which focus on underlying problems.

In an ongoing trial of a relational therapy taking place in Liverpool, one piece of anecdotal feedback from clients has been that having a therapy that actually talks to the self-harm they experience has been positive and refreshing. In addition, we know that people who self-harm are often disempowered and under-served by our current health care system. They face high levels of stigma, and often struggle to access support. Many fall down the gaps between services.

Instead of dismissing self-harm as a focus for psychological interventions, I see self-harm as an important starting point. In my view, it is a manifestation of deeper distress, unmet needs, and conflict. Therapy should seek to move beneath the self-harm, to map out these underlying patterns and processes. Doing so can be meaningful, respectful, and ultimately more useful to the individual. I believe Cognitive Analytic Therapy (CAT) may be especially well suited to this task. CAT is an approach with collaboration at its heart. Moreover, it takes a ground-up approach to forging a shared picture of what is going on for a specific individual. I think CAT therefore has potential as a therapy for people who self-harm. It does not dismiss the presence and relevance of self-harm in a person’s life. It also avoids the trap of getting hung up on the behaviour, and not what lies beneath it.

However, we need evidence. There is currently very preliminary research concerning CAT and self-harm. CAT has a strong tradition of practice-based evidence. However there is a need for larger clinical trials, to further build on these foundations. Such studies will allow for more rigorous evaluation.

RELATE (relational approaches to treating self-harm) is a National Institute for Health and Care Research (NIHR) funded feasibility trial of CAT for adults who self-harm. It represents an important step in evaluating the suitability of CAT as a way to help people struggling with self-harm. The trial will involve two sites, one in Greater Manchester NHS Foundation Trust (GMMH), and one in Rotherham, Doncaster, & South Humber NHS Foundation Trust (RDASH). The study is due to start in December, and we will be advertising for trial therapists for the GMMH site. If you are a CAT therapist working in GMMH, and have any interest in the role, please do get in touch.

Update – The advert for the RelATe Trial Therapist post is live at https://beta.jobs.nhs.uk/candidate/jobadvert/C9437-22-8649 – closing date 25 October 2022

You can contact Peter using the details below.

Dr Peter Taylor, Senior Clinical lecturer & Clinical Psychologist

Division of Psychology & Mental Health| Room 2.33, Zochonis Building| Brunswick Street| University of Manchester| M13 9PL| Tel: 0161 306 0425| Email: peter.taylor-2@manchester.ac.uk| Twitter: @PJTaylorClinPsy

https://www.research.manchester.ac.uk/portal/peter.taylor-2.html