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.