Category Archives: Uncategorised

purple lettering YMCA on a white background

Psychology Partner – Tender Opportunity with Liverpool & Sefton YMCA

In her second guest blog, Ellie McNeil, CEO of Liverpool  & Sefton YMCA invites interest in a tender opportunity to support CAT-related work in her service

Our journey to becoming a psychologically informed service using CAT as our means to understand service users, processes, people, teams and systems has been in motion for over 5 years. Beginning as one off training and emerging into CAT case management throughout our services and systems has been enlightening, rewarding and challenging.

We have taken the end of one project and the results of an evaluation conducted by Catalyse to pause and reflect on our past and our future in how we sustainably maintain our commitment to using CAT to deliver relationally informed care and support to people who use our services and in the way we think about our organisation and it’s processes and enactments at all levels.

We have applied CAT as a case management tool across our homeless services, we are working to embed it in our domestic abuse provision and mental health service. For the first time we have directly employed a CAT therapist and a trainee counsellor who we hope will progress to becoming a CAT therapist. These posts sit in our Rehabilitation service, working with people who are seeking treatment for a drug or alcohol issue.

The challenge of embedding change in a voluntary sector organisation is both simple and complex. We do not have the bureaucratic challenges faced by colleagues in the NHS or local government but we do not have the infrastructure and resources either. Change at scale is challenging and platforms for influence can often feel minimal but there is also a sense that we are a test bed for something so valuable for people who use our services that with robust evidence, tenacity and good connections we can begin to share the difference that CAT has made to how we think, feel and communicate about everything we do.

We are now tendering for an ACAT accredited partner to support us by facilitating supervision groups and helping us to develop some training to empower other organisation to become relationally informed. Our requirements are: 

We require the facilitation of four supervision groups per month:

  • Monthly Leadership Reflective Practice – 90 minutes
  • Monthly Recovery Pathway Clinical Strategy Group – 90 minutes
  • Monthly supervision group for facilitators of reflective practice – 3 hours with a break
  • Monthly supervision for CAT Therapist and Trainee CAT Therapist

We will be looking to deliver the training a minimum of four times a year and therefore 8 training days charged at a day rate will also be required.

The tender can be downloaded from our website www.liverpoolymca.org.uk and for an informal conversation please email me at ellie.mcneil@liverpoolymca.org.uk and we can arrange a time to speak.

YMCA Tender YMCA-Tender-psychology-partner2020.docx

neon lettering of word 'hello' against dark background

#SamTweetsCAT: Introducing @HartleySamantha as a Catalyse Tweeter

In this, her debut blog, Sam Hartley introduces herself in her new role as a Catalyse tweeter.  She ‘ll be keeping Rhona Brown company in @CatalyseC tweets, but read on to find out more about the particular topics and interests she’ll be tweeting about.  And how we’ll know it’s her…..

My own hashtag, imagine that?! A long way from when I reluctantly joined Twitter in 2011.  I then had a long hiatus while I completed the not so small tasks of two doctorates one straight after another.  (This is where the slightly tongue in cheek Dr2 comes in to my bio.) After qualifying as a clinical psychologist in 2015, I spent a couple of years in practice.  Then I came upon the opportunity to start an NIHR/HEE clinical lectureship.  This allowed me to do research alongside developing my clinical skills and continuing to practice in my role working with young people within inpatient mental health services.

Combining clinical and research work is something I’d always aspired to. I’m passionate about each informing and moulding the other. They “keep each other honest” as @PimlottBrenda once so eloquently put it. I believe research should be driven by clinical need and produced in ways that allow it to influence practice meaningfully. My fellowship has allowed me to explore the nature and development of therapeutic relationships within inpatient CAMHS, while working on methods to improve them.  This has taken place alongside my partners at @HealthyYM @PennineCareNHS and @FBMH_UoM. It was my clinical mentor on the fellowship, @rachelchin91, that encouraged me to give Twitter another chance.  It’s a  way to make connections in both the research and clinical world to allow me to learn what was already out there.  Importantly, it’s a means to disseminate my work and engage in ways that break down the usual barriers.

My @NIHRresearch funding also gave me the means to train in Cognitive Analytic Therapy.  CAT fits so well with both my research focus on therapeutic relationships and my clinical role.  I work within a complex multidisciplinary team supporting young people with difficulties in relationships and across a wide range of problem areas. Thus I embarked on a two year juggling act.  Not two doctorates this time; instead, a mix of clinical work and skill development, personal therapy, research programme delivery, mentoring and supervision. You might guess I have a strong tendency for busyness!

Starting CAT training with @CatalyseC in the autumn of 2018 coincided with a flurry of tweeting for me, as I started to share my reflections, ideas and frustrations.  A retreat to Twitter was often when holed up (procrastinating!) in my research office rather than in the familiar hustle and bustle of a busy inpatient ward. Navigating through the #CatalysePT18 training days, seminar groups and reading materials, I found myself struck by the meaning, utility and personal resonance of the ideas. The dialogic self, the observer stance, the holding vessel of the therapeutic relationship. It made sense, it fitted with my experiences and felt like home. I wanted to share those ideas with others and the parsimony of CAT translated well into 280 characters. I enjoyed the process of reflecting, sharing and connecting amongst the CAT community and beyond.

So, here I am. I’ll be continuing to share some thoughts, questions and opportunities related to CAT with you, from the Catalyse account. This has been run to date by Rhona Brown @unfinalised.  Rhona will continue to tweet too, but our plan is that I’ll add a focus on the areas I know well.  Watch out for tweets from me on clinical research, practitioner trainee experiences, and uses of metaphors and signs. I’d really like to hear how others experience these and build our network of those practising CAT and those intrigued by the ideas.

You’ll know it’s me because you’ll see #SamTweetsCAT, and there might even be a GIF or two (inspired by @TomJewell17). If you have any ideas, queries or feedback, I’d love to hear from you.

See you in the Twittersphere!

Sam @HartleySamantha

Image of a person looking at shelves of books in a library - linked to blog theme of inviting research papers on cognitive analytic therapy

A Call for CAT Research Papers

In this guest blog, Peter Taylor offers an invitation to contribute CAT-related papers to a forthcoming special issue of Psychology and Psychotherapy: Theory, Research, and Practice. He also outlines his thoughts on how the evidence base in CAT might be strengthened.

Sam Hartley and I are editing a special edition of Psychology and Psychotherapy: Theory, Research, and Practice, focussed on cognitive analytic therapy (CAT) (see the submission details here). We are hoping this special issue will help capture where CAT research is currently, and serve as an impetus to those involved in or thinking about research relating to CAT. We are also hoping this special issue will also help showcase to those outside of the CAT community what this approach may have to offer, and so generate wider interest.

We welcome submissions focused on CAT, adopting a wide variety of research methodologies. These can include reviews, small-scale clinical evaluations or studies of theoretical principles and mechanisms. Please do have a look at the call details and consider if anything you are involved in could be submitted. Let’s see if this special issue could trigger some new interest and exciting research into CAT. The deadline for submissions is 1st November 2019.

In light of this special issue I would like to share some thoughts about where CAT currently sits with regards to research. I work as a senior lecturer at the University of Manchester and have an active research interest in CAT. Whilst I am a qualified clinical psychologist I am not a qualified CAT therapist. My experience of CAT came though my clinical training, but my interest since then has been primarily about researching the CAT approach to psychological difficulties and what it may offer clients.

The CAT community is currently a thriving network, supported by the Association of Cognitive Analytic Therapy (ACAT). A myriad of local special interest groups help maintain connections and shared ventures, as do partner organisations like Catalyse. However, from a slightly outsider perspective, I feel concerned that this growing clinical interest has often not transitioned into research interest and activity.

I have been increasingly involved in research concerning CAT over the last few years. I would argue that providing robust research evidence concerning its value is essential, both to support current practice, and to make the case for additional support of CAT within services. There has been a consistent ongoing stream of CAT-focused research, much of which was helpfully summarised in the 2014 review by Calvert and Kellett. However, I believe that a concerted and collective investment in both the scale and scope of CAT research would really help us to better understand how, when, and in what way, CAT may be of value to those in health services.

I recently ran a search on PsycINFO with the keyword “cognitive analytic therapy”. (PsycINFO is probably the main online database for psychology, including clinical psychology.) Two-hundred and ninety-four articles were identified, with fifty-three having been published in the last three years. A quick screening of these identified seventeen that could be considered empirical research. There are a few where the line between an evaluative research study and something more illustrative is blurry. Given the enthusiasm for training in CAT, and adopting the approach in many clinical settings, this number of empirical studies illustrates for me that the CAT research base is more limited than it might be.

There are various possible reasons why there has not been more research on CAT. My own feeling is that CAT has been adopted and championed by individuals with predominantly clinical roles. They may have less time for doing research, or may not feel confident in their research skills. Connections with academic departments and research groups have not quite flourished, in comparison with other approaches like CBT.

A brief review of the seventeen studies I found leads to two observations worth highlighting.

First, the majority are small-scale evaluations of CAT or some aspect of this approach (n = 11). This observation highlights one characteristic of the CAT literature that I alluded to earlier. It has been very much led by clinicians and emerged from clinical contexts, where small-n designs have been embraced. What is notable though is the lack of larger-scale systematic research studies. I identified three larger studies, but still with small samples of around n = 30-50. This suggests a difficulty in the transition from smaller to larger scale studies.

Second, a large number of these studies involve the same individuals leading the research. For example, Stephen Kellett is a leading author (first or second authorship) on nine of the studies. This suggests research into CAT has not branched out beyond particular research-active individuals and groups as much as it could have. However t it also demonstrates that individuals knowledgeable in undertaking research exist in the CAT community. There is therefore potential for modelling and scaffolding of research capacity.

So how might we move ahead to encourage and support more research in CAT?

1) Focusing on the first observation, small-n studies (e.g. case series) are important. They are part of a recognised step within the MRC guidance on developing the evidence base for complex interventions. Crucially, they help answer important questions about feasibility and acceptability. The lack of CAT research outside of this area suggests to me both a challenge but also an opportunity to develop and expand the CAT research base further.

2) Larger-scale trials typically require funding, which is notoriously difficult to obtain. However there may be other ways of extending CAT research. Linking up researchers from multiple services or groups may help to establish collaborations for undertaking larger-scale research.

3) There is also potential in using routinely collected outcome data that many services hold, using common measures. I wonder if there is scope to collate this data to further evaluate the potential benefits of CAT. I recall there was some discussion of this latter possibility at the 2018 CAT research conference in Manchester.

4) Whilst much of the research concerning CAT has been understandably about the therapy, I also wonder about designing research directed at testing some of the conceptual and theoretical principles that underlie CAT. For example, we recently found that the Personality Structure Questionnaire (PSQ), a tool designed to assess mechanisms of action linked to CAT, is associated with difficulties around self-harm. Specifically, scores on this measure, which captures instability in self-concept or personality, distinguished those with recent (past year) and historic self-harm, with greater instability being apparent for those with recent self-harm.

Returning to a point in my second observation, I noted earlier my perception that CAT lacks strong links with academic departments and research institutions. It feels like currently in the UK there are a small number of academics who also have an active research interest in CAT. I would count myself in this group. My experience has been that many CAT clinicians have a real interest in research but either lack the capacity or confidence to develop research projects themselves.

Stronger links with academic departments and research-active academics is a possible solution here. Networking and collaboration with and between academic departments may help increase the spread of this interest and research activity.

We should perhaps also consider how the next generation of researchers could be involved in research about CAT. Funded PhD studentships with a CAT focus might be one option. For clinicians wishing to develop their research capacity further, clinical research fellowships such as those available through NIHR may also provide opportunities and ongoing support.

It will be interesting to see how the Catalyse practitioner training will be influenced by someone as research-active as Stephen Kellett joining the core trainer team as of this year.

I wasn’t able to make it along to the second CAT research conference organised jointly between Catalyse and ACAT in April 2019. However, following the Catalyse 25 Years conference in May, a small group of researchers and research-interested clinicians in the North arranged to meet informally this coming September. It would be great to hear of other local connections and collaborations which might be able to move forward with some of the ideas I’m proposing in this blog.

Moving beyond the submission deadline for the PAPTRAP special issue 1st November 2019 – I look forward to seeing research confidence growing, the evidence base for CAT becoming more solid, and generated by a broader group of clinicians and researchers.

You can follow Peter on Twitter via @PJTaylorClinPsy

CATCH Trial Recruitment

Can you help the CATCH trial recruit people for a Feasibility Trial on Cognitive Analytic Therapy-informed Containment for self-Harm?

Trainee clinical psychologists from the University of Manchester are conducting this study under the supervision of Dr Peter Taylor and Dr Samantha Hartley.  Participants need to have had no previous experience of cognitive analytic therapy and be:

  • aged 16 and over
  • from the Manchester and Liverpool areas
  • currently engaging in self harm
  • not currently in therapy

For full details of ethical approval, inclusion and exclusion criteria, participant information etc, please contact the research team on the numbers below or via catch@manchester.ac.uk

Flyer outlining the Cognitive Analytic Therapy-informed Containment for self-Harm (CATCH): A Feasibility Trial