“Young people can sniff out inauthenticity a mile away”

1st May 2023CPDCognitive Analytic Therapy, CPDrhona

We’re fortunate that Lee Crothers is running a CPD day with Catalyse while she is in the UK in June. Her day “A CAT Approach to Inclusive Practice With Young People” takes place on 9 June in Manchester. You can also join the day remotely, using the Zoom platform. Over the course of the day, Lee will share with UK cognitive analytic and other therapists her rich perspective and experience working with adolescents, young people and their families in the Australian context. Curiosity got the better of us, and we posed Lee a few questions in advance of the day.

How did you find CAT? What was your journey into CAT?

I was fortunate to be part of Orygen youth health when we were offered training by a UK group including Ian Kerr that initially visited Australia in 2003. I was even luckier that Eva Burns Lundgren supervised me through phone conference (no zoom then!), supported by Louise McCutcheon. The three of us would huddle around the phone very early or very late in the day and fax our maps and reformulation letters.

What brought you into work with young people in particular and why do you like it?

I like the energy and hope young people bring to the room. Don’t tell my two teenagers but I like a bit of attitude too! Of course, you can have attitude and energy at any age but it is more common in young people who are finding their feet in the world. I also like how young people’s emerging perspectives of the world can challenge me and be challenged too. Young people are adaptable. They are often keen to try new things and haven’t got long histories of being stuck in relational patterns.

In your work with young people, is there a CAT tool or idea that tends to work particularly well or that you find yourself drawn to?

I am often drawn to mapping with young people. I like it when they take a photo of it on their phones and change it up with memes or phrases. Recently one of my clients told me the map needed a “glow up”. I use the visual of a target problem and maps do that well.

The idea of the target problem is one I value highly and use in my work with young people even if I am not doing traditional CAT. Establishing a shared sense of the problem is crucial; a must-do. Digging down to the real issue does bring relieved looks. I am often saying things like “it seems that what got you here was your parents being concerned about self-harm but the real issue seems to be that you feel like you don’t belong”. Writing or reformulating in a narrative way is fun to do through email exchange. Together we can put it together from bite sized pieces. It is how we take in information now – through small pieces. Putting it together with the young person is a useful process.

What is it about CAT that makes it so useful with your work with young people?

The collaborative, doing with style of CAT and the adaptable tools. I also like the direction but not the rigidity of CAT and how the ‘Three Rs’ are useful signposts. CAT has given me permission and confidence to use myself in the room in a relationally helpful way. And you can be transparent about it! Young people can sniff out inauthenticity a mile away.

While young people might lack life experience they often carry many strengths and resources to enable healing, recovery and growth. What have been the most useful ‘healthy islands’ or strengths you’ve seen in this client group over the years?

I think I may be repeating myself but the flexibility and openness of young people is a great resource. Young people today have access to so much information and I admire their energy and ability to synthesise and engage with it. They often want to help others with what they have learned. I feel hope about the world and its future working with young people. They have inherited a great climate burden and yet show such sensitivity and passion in change and shaking us up.

As well as your therapy practice you’ve done lots of work with headspace National and running CAT trainings via Orygen. What are you proudest of in this part of your work?

I feel proud and lucky that I have been part of new innovative ways of working with young people. Particularly at Orygen I’ve been part of early intervention services for young people seen as the most complex and at risk.

Recently I am proud of writing with headspace National and Orygen about a relational definition of complexity in young people. I am proud of the message that often the complexity is within the relationships between worker, system and young person rather than solely located within the young person. This became a practice principle for Orygen and headspace National that supports over 150 headspace centres in Australia. It worries me that young people take in this label of being “complex”. This work has sparked training called Relate and Reflect www.relateandreflect.com.au that teaches the relational formulation skills to headspace centres.

And….I am really proud of the book I am editing with Nick Barnes, Honorary Associate Professor at UCL. For this I’m writing a chapter with a young person, Mel, about a relational approach to working with young people with eating disorders. We had so much to say and we think we could fill a whole book. It’s a start to a working friendship that I hope continues.

In the UK there is much concern about the lack of available therapy services for people generally, and young people in particular. Is there anything you think services here can learn from the Australian experience?

The headspace services have been a great initiative where young people aged 12 to 25 can access services without referral or cost. Professor Pat McGorry has been a tireless advocate for early intervention for youth. headspaces are youth friendly accessible services that don’t just offer counselling but things like vocational support. Often the referral pathways make access difficult for young people and there is a “no wrong door policy” with headspaces.

Because of the huge space of Australia and young people in rural and regional areas we are well prepared in offering ehealth and eheadspace is an exceptional service, well set up before lockdowns of COVID-19. Of course, we have the same difficulties of recruiting and retaining workforce. headspace National and many other CAMHS and CYMHS have early career programs or new graduate programs that perhaps UK have as well? The headspace National one supports hundreds of early career nurses, OT, social workers and psychologists over two years with extra training, supervision and clinical support.

If you’d like to hear more from Lee and build your own skills for working with young people, you can find full details and booking for her day at this link.

2022 Catalyse Round Up

28th January 2023CAT Practitioner Training, CPD, Newsletter, Personal Reformulation, Supervisor Training, Training FilmsCAT Practitioner Training, CPD, Personal Reformulationrhona

And so the last days of January 2023 are here. Before the new year is much more behind us, and ahead of our AGM in early February, we’ve been looking back over 2022. It proved to be yet another busy year.

Training

CAT Practitioner Training

A double cohort of 51 cognitive analytic therapist trainees began their first year of CAT Practitioner training in October 2022. We have been trying out new venues to accomodate these two sizeable groups. Our trainers are becoming accustomed to delivering the same material to each cohort, two weeks apart. It’s interesting to observe the relational and dialogical in action each time. Each group, with its unique composition, alongside the same trainers, connect with materials differently. The researchers amongst us might get excited about the potential for a naturally occuring experimental design. However we plan to keep the training as consistent as we can across the two groups.

The trainer team are grateful to all of you supporting CAT training in the North. Especially with an enhanced intake, which asks for redoubled efforts from all, we extend our thanks to all our visiting trainers, supervisors, seminar group facilitators, and markers.

The previous cohort of 24 who began their training in early 2021 remotely, in the context of the pandemic, managed to meet for in-person training days over 2022. They completed the taught component of the Practitioner training at the customary residential two days. For them this took place in November.

Again, as with each set of graduates, we feel enriched by the range and standard of written assignments. We’re excited to see some of their essays translating into blogs or articles in the future.

Catalyse Training Films

Several new courses (plus some returners and one or two individuals) subscribed to our original set of Training Films. We plan to repeat a survey for trainers & learners in early 2023 asking how they’ve supported learning. You can read the results of the previous survey at this link.

Our second set of Catalyse Training Films, featuring a range of fictional clinical scenarios & therapy dyads, has continued in post-production this year. A grant from Greater Manchester Mental Health NHS Foundation Trust made it possible to commence this initiative. A host of volunteer therapist/actors helped bring fictional outlines to life in an intensive weekend of filming in late 2021. Since then, the post-production process overseen by Kathryn Pemberton along with Brickoven Media has been moving towards completion. We look forward to making these new films available to stream in 2023.

CPD

In Conversation With Annie Nehmad

2022’s CPD programme began in March with a new informal online format. The first ‘In Conversation With….” event featured Annie Nehmad on ‘CAT & the New Psychotherapies‘. This was well attended & valued by participants, and we are starting 2023’s programme with another ‘In Conversation With….” online event. This time it is led by Elizabeth Wilde McCormick on the topic of ‘Personal Reflections on CAT’s Early Days‘. It takes place on 16th February, and there are still places available. You can read more about this event and book via this link. We’re looking forward to hearing more from Liz about her work with Tony Ryle as CAT was starting to develop. Curiosity and questions from those attending will make this session a really fascinating interactive dialogue.

CAT as a Tool for Leadership

Next up in May 2022 was a face-to-face repeat of David Harvey‘s “CAT as a Tool for Leadership“. This has been a consistently well-received event whether delivered online or in person. We are considering running a further Leadership day in 2023. Keep an eye on our Forthcoming CPD page if you are interested in attending.

Last May’s event earned very glowing feedback from participants.

“David was a really engaging speaker who incorporated our examples & questions into the content really well. Relating leadership to working with traumatised teams was especially pertinent to my work & made the course very practically useful as well as being theoretically interesting. It was also a really useful opportunity to meet with others and not feel as isolated when hearing the experiences of others. Containing and inspiring.”

A Graceful CAT: Embedding the Social Graces in CAT Dialogue

Paddy Crossling and Rhona Brown led a smaller-scale, half-day, in-person event on ‘A Graceful CAT: Embedding the Social Graces in CAT Dialogue‘ in July 2022. This built on a workshop they presented at the 2019 25 Years of CAT Practitioner Training in the North conference. One of the participants went on to enlist a further session on Social Graces for a national network event. Tools that Paddy and Rhona started to develop as part of their work are being piloted in some clinical and training settings.

“I hadn’t come across ‘social graces’ before and I really liked the conceptualisation of diversity/a feeling of difference/not belonging. It was a great opportunity to explore this both in relation to ourselves and others, and to consider how we may apply this approach in our work settings. Weaving CAT into the ‘social graces’ was an extremely helpful way of stepping out of the theory into the practice.”

Creating a Tapestry: Weaving Together EMDR and CAT

In October 2022, Mark Walker and Alison Jenaway led a sell-out face-to-face day on ‘Weaving Together EMDR & CAT‘. This was very well-received by participants, many of whom are already integrating these two models.

“Rich discussions about integrating EMDR & CAT – having recently trained in EMDR, I really valued a chance to think more relationally with other CAT therapists. It was useful to talk through clinical dilemmas in processing work & to think more about bringing neurobiology-informed approach into CAT more.”

CAT Supervisor Training Workshop

A further sell-out event in November ended the 2022 CPD year via Mark Evans & Sarah Littlejohn‘s 2-day CAT supervisor training workshop.

“Time to think through issues, refresh and consolidate learning; exercises were well though through- speed supervision & mock group supervision – both facilitators were excellent – time with CAT community & peers.”

Given increases in training places locally, and the possibility of future HEE funded CAT training places nationally, we very much encourage eligible CAT therapists to consider qualifying as accredited supervisors. Availability of supervisors is pivotal in supporting the learning and development of therapists interested in CAT. For anyone considering this, ACAT provides a helpful pdf summary of the process; “New Modular Supervisor Training Programme”. You can download this from the ACAT site page at https://www.acat.me.uk/page/cat+supervisor+training

Dawn Bennett has also just produced a further document for those attending our supervisor training. Her document aims to answer questions raised on the day, and ahead of the follow up session. It outlines the stages of supervisor training in a little more detail. The ACAT Supervisor Training Handbook describes all of this further.

Personal Reformulation

Our team of personal reformulation (PR) therapists completed a number of PRs with people seeking this brief CAT adaptation for personal and professional development. There is uptake from CAT Skills trainees, clinical psychology trainees & a range of others.

In 2023 we hope to offer PRs as part of other training and consultation, including initiatives around leadership. If you are interested in investing in a PR experience for yourself, or for staff or teams within your organisation, then do contact us. You can read more, with links and information on how to book a PR at this link.

Other Commissioned Projects, Consultation, Training and Research

In 2022 we completed an ACAT-accredited 6 month CAT Skills training with a range of staff from a local NHS trust. We delivered a number of reflective practice sessions, in addition to staff training & consultation initiatives. These included a series of one- and two-day introductory courses on CAT Skills for NHS teams. Similarly, but with content adapted for a non-professional audience, we also helped to scaffold CAT-informed work with staff of a third sector agency. A bespoke training on Five-Session Cognitive Analytic Consultancy ended additional offerings for 2022.

There is always a lot of possible work in the pipeline. We are lucky to have the support of various associates & colleagues around the North who help us deliver additional initiatives.

Staying involved with Catalyse

We’re always pleased to hear from CAT colleagues interested in working with us in one capacity or another. You can get involved in small contained ways to begin with. Roles can extend into more substantial involvement in Catalyse as an organisation. If you’re interested, then check out the information about possibilities for involvement with Catalyse at this link. Please do contact us to express your interest.

So it’s been a busy one! More ahead in 2023. Many thanks to all those who sought out our support with Cognitive Analytic Therapy related things over the last year. We really appreciate all of you working with us to deliver trainings, CPD, PR, consultation, research & other initiatives.

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

23rd August 2022ResearchPsychotherapy Research, Researchrhona

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

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

Reflections on a CAT Journey

19th July 2022CAT Practitioner TrainingCAT Practitioner Training, Getting involved with Catalyserhona

In this blog, Jenny Marshall looks back over how she became involved with Catalyse. She joined us in 2021 to lead the Personal Reformulation workstream. Jenny has recently started another role with the Practitioner Training team as a core trainer. There have been a number of steps along the way as she’s grown in her readiness to take on such roles. Her blog aims to unpick these, and to encourage others who may be interested in becoming more involved.

I’m writing to say how I have found myself as a member of the Catalyse CAT Practitioner course team. Catalyse have been reaching out for a few years to ensure the continued delivery of the course and other work. This has been prompted by those who started it retiring one by one. I hope this encourages others who may want to contribute to the future of CAT in the North of England to take steps on their journey.

The starting place: CAT Practitioner training

I started my CAT training a number of years ago. Whilst the service plan had always been for me to work towards supervisor status after practitioner training, I gave this little thought at the beginning. Instead, I enjoyed the Practitioner Training run by Catalyse. The long days travelling to Manchester were worth it. It has always struck me how much learning is inspired by being in the presence of others. These days were not only a welcome break from the day to day job but a space to think and develop. They always left me invigorated despite the tiredness from the 6am starts.

A further step: CAT Supervisor training

Years later when I began my supervisor training, I arrived at the residential similarly tired. This time I could attribute it to the early stages of pregnancy, but again had a similar experience. Despite the tiredness, I was alert and engaged when asked what sort of CAT we were. ‘Scaredy CAT’ and ‘Fraudulent CAT’ resonated as I didn’t feel ready to supervise others when there was so much to learn. But knowing this was definitely on my map (high standards, critical and not good enough). So I persevered with trying to hold a ’good enough’ position and I am glad that I did.

The last couple of years have been the toughest for many health professionals and particularly working in the NHS. Holding a relational way of thinking, even in my ability to notice that I was finding it hard to think, helped sustain me. Maintaining space to think relationally with supervisees was challenging but enjoyable. It certainly felt a welcome thinking space for all in the midst of the busyness of the job.

Contemplating Catalyse?

Doing this work, I never envisaged that part of the journey would be taking the step towards contributing to teaching. Nor would I have imagined marking others’ work. I attended the 25 year anniversary event of the Catalyse Practitioner Training Course when there was an active reach out to new people wanting to get involved. Even then, I did not consider I could do it. However perhaps it was then that the seed was planted. Reflecting on this now, I wonder about where I had put the course trainers on the map? Perhaps I had placed them in an ‘unreachable’ place. Had they seemed different, separate and far away from where I placed myself on the map? Despite this, several years later when I was exploring different options for my career, I reached out to Catalyse via Dawn Bennett.

Getting past the snags

I’m not sure what I was hoping for but perhaps this was the start of me ‘dipping my toe in’. Being aware of my own patterns, I know when overwhelmed with anxiety it pulls from me a desire to say ‘I can’t do it’. Over time I have learned to rationalise; ‘can I really not do it or do I just think I can’t?’. However this experience was a gentle but interesting one. Through conversation with Dawn I became aware of the possibilities and the variety of work within Catalyse. There was further ‘dipping my toe in’ by attending a Personal Reformulation meeting and feeling welcome.

One step at a time

I wanted a work/life balance, so getting involved with marking seemed like a good practical fit. Having not done it before though, I was unsure. A buddy system in place helped it feel like a safe and supported way to get started. I was surprised at how interesting it was and how much I learned. Marking was much more of a reciprocal process than I had expected! The biggest hurdle was teaching on the practitioner course. However teaming up with another in trainer pairs enabled me to feel I was ‘held in safe hands’.

I have experimented between safe and comfortable areas and pushing myself with newer territory. It is all a learning experience. It was said to me that if I waited to become an ‘expert’ in this, I might never do it. Perhaps the way to become ‘expert’ (in the loosest sense because we know CAT is not an ‘expert’ model), was to just do it. This resonated, and I was reminded of my journey with reflective practice. I recalled the lightbulb moment of realising that other ‘expert’ facilitators did not know where they were going. Instead, they trusted in the process. This may be similar; trust in the CAT tools, scaffolding and maybe you can’t go far wrong.

Roles for you too?

The world of CAT is expanding. With HEE funding for CAT now established, the value of the model is finally being recognised and invested in. With this comes greater opportunities. We know that we bring our patterns to work and you will bring your own patterns (just like my scaredy CAT and fraudulent CAT). Maybe you have a pattern of jumping straight in or maybe like me you like to dip a toe in and test the water. Whatever your pattern, I would recommend trying it – you never know what might happen or where you will end up.

For our 2022 intake, we are running two cohorts of Year 1 trainees. With an expanded intake, we are particularly keen to expand the pool of those who support the training course. If you’d like to become more involved with Catalyse in any way, then get in touch with us. You can read more about the range of training and other roles at this link.