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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

Zoom detail of complex threads (for CAT Skills Training)

CAT Skills Training for 2019: deadline approaching

Interested in developing a relational approach in your care setting using skills and concepts derived from Cognitive Analytic Therapy?  The deadline for the sixth run of the CAT Skills Case Management Training course is fast approaching on 31st July 2019. 

This course is led by our associates Dr Marisol Cavieres and Dr Karen Shannon who invite you to six training days.  These take place in Liverpool between October 2019 and March 2020.  Training content includes formulation, intervention, care planning and risk assessment using a cognitive analytic approach. It is not a therapy training but instead helps participants learn how to use CAT skills and concepts to influence and enhance relational skills in their own care settings.  Both community based and residential or accommodation-based settings can benefit from this approach

Supervision groups support you through a required 35 hours of clinical practice applying CAT case management in your own setting.  Depending on your location, these can be set up via face-to-face or remote means.

As CAT is a relational model, trainees are expected to engage in personal development using a CAT-informed approach.  This is usually attained by completing a brief personal reformulation.  The course also includes the opportunity to capture your reflections on using CAT case management in one written piece of work.

Those who successfully complete all components of the course are eligible for the Six Month Skills Level Certificate in Cognitive Analytic Therapy (CAT) (Case Management). This is awarded by the Association for Cognitive Analytic Therapy.

The course is open to a wide range of people including psychologists, psychiatrists, nurses, offender managers, therapists, counsellors, support workers, occupational therapists and social workers.  Applicants needs to have some familiarity with psychological approaches.  Additionally you are expected to demonstrate a leaning or openness to interpersonal and relational approaches to working with complexity.  If you’re not sure whether you’re eligible to apply, contact Marisol Cavieres to find out more.

A couple of blogs on our site may give you more information on the experience of undertaking CAT Skills Case Management training, and its application in an accommodation based service.  Do contact us for more information.  Or better still submit your application before the end of July.

For more information or to apply for the CAT Skills Case Management training, click this link.

Excerpt from wordcloud of comments about what skills abilities and achievements have resulted from CAT practitioner training

Did you miss it? Reflections on our celebratory conference

It’s now just over a month since our celebratory conference took place on 17th May in Manchester. Over eighty colleagues gathered at the University of Manchester’s Chancellors Hotel for a packed and pacy day.  We’ve sifted through the feedback and current Catalyse chair and practitioner course director Dawn Bennett has shared this with those who attended, contributed and made the day such a success.  In this blog we give an overview and a few images of the conference.

The people

Inage of Dawn Bennett and Mark Evams opening the Catalyse 25 years celebration conferenceDawn Bennett and Mark Evans led trainers involved from the practitioner course’s earliest days in sharing stories of how it had come into being.  Both intentional and organically evolving processes seemed to have had a role to play. Some of the founding trainers had since moved on or changed roles. With an eye on the future, some were hoping to beckon and welcome in new blood to replace them. This was a key theme over the course of the day. It was both a celebration but also an invitation for people to become involved in the future of CAT practitioner training in the North.

Graduates attended from across most of the 25 years of the course’s existence.  We hope that people managed to mingle and catch up with others in their cohorts. Some of those present had not yet taken the step of applying to train as practitioners. We hoped they might consider this at some stage, or find other ways to remain connected with the local CAT community.

Image of Frances Free, Catalyse administratorAll were treated to meeting our stalwart administrator, Frances Free, face to face.  Frances keeps the whole Catalyse boat afloat remotely, with her customary good cheer, attention to detail and capacity to think for us all when needed.  She’s infrequently in the North but the event gave us an excuse to bring her upThis provided embodied proof that she’s not just a legend, but also an expert meeter-and-greeter.

A rich day

The day included plenaries, workshops, plus small and large group discussions. We extend our gratitude to all those course graduates who stepped up to present something of their work. This includes many who offered taster workshops on how they’d integrated and developed CAT since qualifying. A number of suggestions for further CPD events emerged from feedback from these well-received sessions.

Glenys Parry‘s plenary on balancing risk and safety in CAT brought us up to date with her research into therapeutic harm. She kept quiet about her forthcoming book on this subject, but we suspect this will be a text worth having.

Regine Blattner and Rhona Brown shared a quirky CAT-based stop-frame animation they’d made while exploring creative approaches and six-part story narrative during peer CPD.

Image of Karen Shannon and Marisol Cavieres presenting about their 6 month CAT Skills training courseMarisol Cavieres and Karen Shannon described their six-month CAT Skills training. They iillustrated how CAT can enrich a Psychologically Informed Environment. Liverpool YMCA’s services for people with multiple and complex needs was shared as an example of how CAT can be used  fruitfully at all levels of an organisation.

Kate Freshwater and Jenny Marshall went on to describe the overarching relational framework developed within forensic services at Tees Esk and Wear Valleys NHS Foundation Trust. The theme of CAT as an organisational tool via reflective practice ran throughout both of these presentations. It also featured in several of the day’s workshops.

Research involvement

Image of Steve Kellett, Nate Shearman & Rebecca Dalby presenting atCatalyse' 25 year celebratory conference

Steve Kellett, Rebecca Dalby and Nate Shearman presented early results of their latest meta-analysis.  This looks at both published and unpublished single case experimental design evidence in CAT. By the end of this presentation we felt that CAT training was indeed worthy of celebration. Results indicated hfirstly that large effect sizes for CAT were evident. Secondly, effectiveness of CAT was shown to be further enhanced when delivered by therapists trained to practitioner level or beyond. So it has been worth running the course all these years! Steve and colleagues are in the process of completing further analysis of this data.  We look forward to the full publication in due course.

Microphone in hand, Glenys Parry presided over quick-fire poster presentations with a firm but fair eye on the passing of sixty seconds. Supplementing what presenters could precis in their minute, posters around the room described past and current initiatives.   Some invited participation in new projects. We’re pleased that conversations on the day about an informal meeting for research-interested colleagues in the North have since led to an initial date being set in July.

Our CAT tree

A CAT tree poster plus many sticky notes captured aspects of the journeys into CAT practitioner training in the north. People offered reflections on what they’d gained from training.  Comments were also left on what and who helped them sustain and nurture their practice day to day. Words shared will be worked into the CAT tree image, which will feature on our website and tweets.  Word cloud image of the "fruits of CAT" - strengths, abilities and achievements as a result of CAT practitioner training as listed on sticky notes by attendees at the Catalyse 25 year celebratory conference

In the meantime we have an apple-shaped summary of the ‘fruits’ of CAT training. These are responses to the invitation to list “the gifts you’ve received through CAT and/or your practitioner training eg skills, resources, understandings”.

Becoming more involved in Catalyse and the practitioner training

Part of the motivation for arranging this day was to encourage people to consider how we sustain CAT in the North into the future.  We were particularly keen to invite colleagues to become more involved in the practitioner course itself. The initial response to this invitation has been really encouraging.  People expressed interest in learning more about opportunities for involvement, what this means in practice and what commitment is required. Some firm offers were made too.  We’re looking into how to work these in to the many aspects of work which running the course entails.

For others, a graded introduction to course roles was favoured. We’re happy to offer small ways to be involved, with support. Hopefully this can help people become more familiar with the course and feel more confident to have a role. A helpful suggestion was the development of a peer mentor group or network of buddies.  This could serve as a way to connect those interested in being more involved with Catalyse, so they can support each other along the way.

To help progress possibilities for involvement, we’re arranging a free ‘CAT Futures‘ event for interested people. This will hopefully take place within the next six-to-nine months.

In the meantime, Jo Coggins has stepped forward to join the Catalyse Executive, taking on the role of CPD lead. We’re really pleased that she’s joined us and hope this will help action some of the ideas for continuing professional development which arose from the day.

CAT on Film

Kathryn Pemberton, producer and director of the CAT training films, presenting them at the Calalyse 25 Years celebration conferenceA further practical suggestion we’ve been able to act on promptly is a longer screening and discussion of the series of CAT training films which Kathryn Pemberton produced and directed. Kathryn gave the conference some background to these and showed brief snippets of the final material. We are now piloting the films with current practitioner trainees.

In response to interest, we’ve arranged for the films to be the focus for the next Cafe CAT on a new time and day of 7 – 9 pm on Thursday 4th July. All are welcome to attend this open event (£5 to cover costs) which we’re excited to be holding at Manchester’s HOME venue. We hope to organise a second screening in Sheffield in the autumn. If anyone has suggestions for a good venue for this, please let us know.

Was it only us who missed it?

Finally, we end with a reference to the title of this blog. Following this very successful day, it would have been tempting to get into a self-congratulatory-to-self-satisfied reciprocal role. We confess we might even have entered this tired but happy state of mind for the evening, fuelled further by a celebratory beverage or two. However the following day it was gently pointed out to us that, hidden in plain sight, the wording on our commemorative mugs had omitted a couple of key letters. ‘Practitioner’ had somehow remained ‘Practioner’, and we had missed ‘it’. At least we’d been consistent. On checking, all promotion of the event over the preceding 6 months or more had contained the same error!

We’ve concluded this might be a nudge from the universe to remind us of three things:

1) striving procedures are highly likely to lead to disappointment;

2) it’s very easy to see what we want to see rather than what is actually in front of us; and

3) people in our world might either see what we want them to see too, or be very polite in not pointing out our inevitable imperfections!

We hope all those who came along enjoy whatever they took away from the day, typos or not. We look forward to seeing how CAT in the North grows and develops over the next 25 years, with your support, enthusiasm and involvement.

Image of egg and green shoots against black background, with wording Workshops Posters Celebration

25 Years Conference – Workshops, Posters, Celebration

It’s now just over a month before our conference celebrating 25 years of CAT Practitioner training in the North takes place.  The programme is now finalised and available to download.  We’re really pleased with the range of workshops and posters being offered by trainers and graduates of the course, past and present.

Workshops will be open for advance bookings at the end of April.  To start to decide on your preferred choices, have a look at the workshop details.  You can download these along with the programme by clicking on this link: Full Conference Programme - April 2019.pdf

We’re still open to offers of poster presentations.  If you have a development, a reflection, a story, a piece of research or an evaluation you’d like to share, get designing.  Let us know an outline of your plans so that we can make sure there’s space.  You’ll have the chance to give a sixty-second ‘call-out’ to the whole conference to draw people to visit your poster.

If you have a local or regional network, gathering or special interest group you’d like to promote, we’ll find a place for this too.

We are struck year on year by the quality and range of essays written as part of the course.  We know some of our graduates go on to publish articles based on these, or on subsequent work.  As a course we don’t claim any ownership of these but would like to provide space to collect, collate and celebrate graduates’ publications as part of the conference.  If you’d like to share any of your publications, send on details of your books, articles, chapters and blogs.

There may be other events or networks you’ve been part of or helped create that you consider have grown from your CAT training.  If you’d like to mark or record these too in some way at the conference, then let us know.

We plan to have some interactive space to help house all of these ‘artefacts’ on the day.  We’ll use the Twitter hashtag #CAT25celebrate to gather any images and online links. We also hope to create a virtual record through a website page linked to the conference.

Do feel free to pass on details of the day to colleagues, managers, trainers and others who might be interested.  All are welcome to join us to learn more about how CAT’s grown in and around the North, its evidence base, and future developments.

We look forward to seeing you there.

Book your place on our celebratory conference on 17th May by clicking on this link and scrolling down to the bottom of the page.