Tag Archives: Complexity

Zoom detail of complex threads (for CAT Skills Training)

CAT Skills Training: One Graduate’s Perspective

We are grateful to David Harvey, clinical psychologist and current CAT Practitioner course trainee, for this guest blog looking back on his experience of completing the six month CAT Skills Case Management Training course led by Dr Marisol Cavieres and Dr Karen Shannon.

I decided to apply for the CAT skills training course two years ago because I worked in a service that was part of the Offender Personality Disorder pathway. I spent a lot of time trying to understand, and help others understand, the challenges and complexities of working with men and women who posed a risk to others. Many of those we worked with also had complex needs and ways of relating to professionals and services. I had already done the two day ACAT introduction to CAT which was a good way to get my head around and refresh some of the foundations of using CAT.

My experience of the application process (and the whole administration of the course) was that it was very well organised and informal. Everyone I had contact with were warm, friendly and supportive. Although I had to do a telephone interview, this felt very much like a two way conversation and I was put at ease quickly. It definitely felt that they were more interested in me and my reasons for thinking about doing the course than trying to catch me out with any tricky or technical questions!

I found the teaching was of a very high quality – either Marisol and Karen were always present on each the teaching days which meant that there was consistency and no unhelpful repetition. There were also guest speakers so there was some diversity within the continuity. All the facilitators were clearly knowledgeable and experienced. Although there was a wide range of experience and skill in our group, my sense was that we were all catered for.

I think the focus on risk and complexity, and using CAT not just directly with clients, but with other professionals in teams and wider systems, really made the teaching unique. As a result it was applicable to work in a wide range of settings with people who may pose risks to others, for example prisons, probation, hospitals, mental health teams and community settings.

The way that CAT concepts were introduced and then linked throughout the course to understanding risk and complexity was extremely helpful. I learnt a huge amount about CAT-informed approaches to conceptualising risk, and this included wider psychological concepts and tools beyond CAT. A focus on enhancing risk assessment, management and intervention provided great insights for me to take back into my day to day work. As an example, CAT helped me in my work with people struggling to acknowledge their roles in offending and risky behaviour. CAT allowed us to speak about wider relational dynamics involving harmful ways of acting towards others, albeit in much less serious ways. Over time, these shared understandings eventually helped to open up conversations about how more serious risk to others might be posed, through reciprocal roles named together in earlier sessions.

Weekly supervision was arranged by telephone conference call and included four of us with a mix of backgrounds in psychology, psychiatry and probation. This provided specific space for each of us to to have guidance in applying the concepts in our workplace. This meant that the training was directly applied to our day to day work with structured support from the facilitators from the outset. I found this to be of great benefit in that it started to directly develop my practice and enhance my work from the very beginning, with weekly support. Likewise, there was plenty of support for the two pieces of academic work required by the course. Feedback was detailed, tailored and really helpful in thinking not only about the academic aspects of my work but also the client or team work that was the focus of the essay.

The course did demand certain things: time and commitment for the weekly supervision, academic work and attendance (and engagement) in the teaching. For me it was wholly worth it. As you can probably tell, I really enjoyed the course and felt very impressed by the quality of the teaching and supervision. Having completed this course I was able to take the concepts and tools back into my place of work and decided to apply for the CAT practitioner training to continue to develop my skill and knowledge using CAT with this and other groups.

I really would recommend the CAT Skills course to others working with people who challenge services because of the complexity of their needs or the possible risks they may pose to others. Either as a stand-alone piece of CPD, or as the start of a journey on to further training and development in CAT, it is well worth the outlay and investment in time and effort for the framework and clarity it can help provide in working with complex needs.

You can find David on Twitter at @dawahar

Catalyse is hosting the next national CAT Case Management Skills Training which starts in January 2018 (hashtag #CATskills18).

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Working Creatively with Complexity: a thoroughly dialogical act

In our third blog, Rhona Brown tells the tale of how our November event on “Working Creatively in CAT with Dreams and Stories” came about, with more details of co-presenters Sophie Rushbrook & Nicola Coulter and what they plan to share on the day.

Our forthcoming CPD event on “Working Creatively in CAT with Dreams and Stories” has garnered much interest, not least for the striking image of an SDR embedded within an artwork of a ship which has accompanied information about the day on the website and Twitter.  We were delighted when co-presenter Nicola Coulter offered this as a promotional image, with the consent of one of her clients who had produced the artwork during a CAT therapy.

The day is an extension of workshops previously presented by Nicola and her colleague Dr Sophie Rushbrook at the Malaga ICATA conference in 2013, and the 2014 Liverpool ACAT annual conference.  Karen Shannon, Catalyse’s CPD lead, attended the Liverpool workshop and was struck by how clinically relevant it was and how it helped her think “on a different level, out of awareness”.  Catalyse invited Sophie and Nicola to present a day event in order to bring their refreshing approach back up to the north from their work setting in Dorset.

Nicola and Sophie work together in the Intensive Psychological Therapies Service (IPTS), a Beacon service in Poole, Dorset. The service provides CAT, DBT and Radically Open DBT to people attracting a diagnosis of personality disorder, often with a background of complex trauma.  They have worked together for many years, blending their respective skills as occupational therapist and clinical psychologist, underpinned by their shared practitioner training in cognitive analytic therapy.  Throughout this, their independent clinical work, and supervisory and other roles with the Jersey Practitioner Training Course, is a seam of creativity and playfulness in the way they approach complex difficulties.

Their 2010 Reformulation article on “Playfulness in CAT” outlined their position regarding the thoughtful use of play, risk-taking, humour and use of the therapist’s self in order to engage more authentically and productively in therapy with people with complex presentations.  “When we use playfulness, particularly higher order playfulness, the function may be either to create a break by offering a moment of relief from the distress or to engage in exploration, by creating some distance”.

Their subsequent 2012 publication “Sleep Tight: Working Creatively with Dreams in CAT” described how they have adapted Fritz Perls’ approach to working with dream material. Contrary to a more psychoanalytic approach to dreams, they describe how their techniques help to make use of this material via “a thoroughly dialogical act” between therapist and client.  The training day will elaborate on ideas presented in this paper, and will also incorporate Sophie and Nicola’s more recent work applying the same techniques to stories generated through the Six Part Story Method.  In addition there will be an emphasis on using these techniques in therapy to further explore and develop jointly derived metaphors.  The training will demonstrate how this approach elegantly fits with the CAT model and CAT tasks.

Participants can expect a day of lively experiential work in addition to theory and practical examples.  As Nicola explained, playfulness “is a cornerstone in the way we work clinically and in presentations, hand in glove with the creativity of the embodiment techniques presented”.

Sophie noted how pleased she is to have another opportunity to share their thoughts and experience to help CAT and other therapists in the north build confidence in working more creatively with complexity.  She explained “through experience this is an excellent technique to use with complex clients, particularly when talking directly seems ‘stuck’ in some way.  I have found it useful in looking at how clients relate self to self and in particular accessing how they can be in the top roles to themselves (and then ultimately others).  It facilitates a discussion that might not otherwise have been possible by more direct means.  It has alleviated PTSD symptoms, and certainly psychological distress, sometimes quite dramatically.”

Sarah Littlejohn, one of the lead trainers within the Catalyse Practitioner training course, and supervision lead for Catalyse, welcomes the event.  She sees benefits for practitioners, supervisors and trainees in developing a broader repertoire of clinical approaches, noting how use of creative techniques forms part of the trainee appraisal within practitioner training.  She emphasised “both supervisors and current trainees, particularly those in their second year of training, might find it really helpful as they integrate the different aspects of their practice”.

Ultimately the benefit lies with the experience of the person in therapy. CAT uses a range of active and collaborative techniques alongside talking, most notably collaborative mapping and use of letters between therapist and client.  However these may remain overly reliant on the spoken or written word.  Speech and writing within CAT can be a rich source of metaphor and provide many opportunities to develop jointly elaborated signs but are not easy or accessible for all.  Story and dream material offer more indirect yet potent sources of sign, symbol and metaphor through which to collaboratively explore and develop shared language to articulate emotional experience.  This may be of particular value where therapy has either run aground in the “shallow waters” of direct talking, or become lost in choppy therapeutic seas.

If you’re keen to increase the adaptability and creative potential of your practice through these techniques, then join us for this event.  It takes place on Wednesday 30th November 2016 in Manchester.  It is open to trainee and qualified CAT practitioners and psychotherapists, and other therapists who have some knowledge of CAT concepts.  Places are limited and booking can be made via this link.

Rhona Brown, CAT Practitioner
Rhona tweets for Catalyse @CatalyseC