Tag Archives: CPD

Reflecting on Risk To Others

Next month, Jenny Marshall and David Harvey are coming together to lead a CPD day on using CAT Concepts in Working With Risk of Harm To Others in Leeds. We caught up with them about their interest in this work and their thoughts on why CAT is well placed to support staff working with people who may pose risk to others.

In your work roles as CAT consultants in forensic settings, you’ve both worked a lot with staff teams rather than just directly with clients.  What drew you to this?

David: It just made more sense to me. The settings and contexts were complex with high levels of emotion for staff too. So, I could see how it important it was for staff well being. It was also a chance for me to learn from the staff teams too about their ideas and ways of approaching risky challenges and complex clinical work. I feel an increasing sense of wanting to support, nurture and look after staff who are coming into this line of work so it helps me channel that too.

I could also see how the relationships in a person’s day to day life with staff were so important. They were vehicles for modulating or increasing emotion (and so risk). So the consultancy work seemed like a clear way to help service users have the best chance of change, recovery and living in the least restrictive setting possible. Although an hour a week of therapy can be helpful, it’s not always enough.

Risk is an issue that can create anxiety in us all.  What do you think helps us to think, as well as feel, in situations that make us feel concerned about risk?

Jenny: This is such a great question and really encapsulates some of the challenges in working with risk. Of course we will all try to manage difficult emotions in a range of ways. At times, and for some of us, this is by not feeling. Suppressing our emotions might lead to an overemphasis on thinking, intellectually. Or else making judgements. And at other times emotion might dominate. That can feel overwhelming and it’s easy to neglect more rational thought.

In working with risk, we need to balance both. I find the observing eye in CAT helps with this and a map can help us to hold different perspectives in the team about risk. This bigger picture can then be used as information to inform our understanding of risk, as opposed to ending up as conflict in teams. It’s easy for this to happen if we don’t “hover” above these different styles of relating. 

In your experience, what are some of the main pushes and pulls for staff assessing and trying to respond to risk of harm to others?

David: I think Laura Hamilton’s see saw model captures the control versus care dilemma beautifully. It really is a great example of CAT taking complex theory and making it accessible. It’s a bridge to having meaningful conversations and joint thinking to help address issues in real life practical ways.

I think that the roles of neglecting-neglected have perhaps had less attention in the wider and CAT literature. We know that omission of care, attunement or boundaries can be just as harmful in the past and the present as the commission of harmful relational acts. Karen Shannon’s chapter on CAT and men with aggression is a great way to start holding these neglectful relational patterns in mind in relation to risk. I have just finished a book chapter about we can use CAT to spot the pulls of overlooking and potentially neglecting important aspects of running high quality mental health services so watch this space!

How does CAT support work with teams in ways that other approaches don’t?

Jenny: Where do I start?! There are some great chapters in the reflective practice book which really highlight this. My co-editor Jamie Kirkland did a great chapter on helping the helpers, and there was also David’s chapter on leadership.

If I was to pick a couple of points, I think CAT really allows us to hear multiple voices and perspectives. This is so key to teamwork, where different voices can be seen as valuable, not threatening. CAT also allows us to hold the hurt or more vulnerable position alongside the part that can hurt others. This allows for a richer understanding of risk.

Finally CAT allows us to explore interactions in a way that considers the impact of what we all bring:- my patterns, others’ and the system or wider culture. These interactions can prove so helpful in our understanding of risk. Importantly, this gives voice to frontline staff who often spend the most time with those service users, patients or prisoners. 

CAT would see risk as a very relational thing, with many aspects embedded in relationships in the past, the present and a person’s relationship with themselves. Where amongst these do you see the most potential for change and shifts?

David: Two things spring to mind. The first is when something live happens in a therapeutic relationship between you and a client who has posed a risk of harm to others and you work through it with the person using CAT tools as scaffolding. This feels like a real leveller to me. Two people, neither of whom have the answer, trying to work something out together. It’s almost always these moments that stand out for me and clients when therapy comes to an end and where the learning is deepest for both of us.

The second is using CAT theory to help someone make sense of their personal history and life adversity and how this relates to risky behaviour. The CAT tools open up this as an explanation, not an excuse. A person can then hold compassion for themselves and also be quite rightly accountable for their own risk management. It is one of the things that makes me feel the saddest really – when someone hasn’t had the chance to go at their pace and make sense of how their own adversity has led to risky behaviours. So being able to offer that feels really important for me.

If you could give three top tips for team wellbeing and staff retention in high risk settings, what would they be?

David: Mmm…well there is no one right way of doing things when we are trying to help other people and it can be stressful! I would go with:

  1. Try and find ways that are psychologically safe enough to talk about what is really going on in relationships, kindly but honestly. When relational tangles get complex try and find ways to feel confident enough to lean into it a bit. Slow things down and think about what’s possible together. CAT is fantastic at helping us do this
  2. Watch out for outrage and indifference in yourself and others – try not to get too consumed by either. I first heard this from Sue Walsh when she spoke at a supervisor training event about ten years ago and it has stayed with me! Both could be signs something is going on that might need a bit of attention for the well-being of those involved and for high quality forensic care
  3. Asking people what they think, want or need can be so important and often overlooked. I think it is a way to help us all feel more heard, connected and attuned and it usually makes the job much easier!
You have both written about, and specialised in, developments using CAT ideas that can enrich the work of non-CAT professionals – such as reflective practice (Jenny) and leadership (David).  How do you see these approaches helping staff and teams who work with risk of harm to others?

Jenny: Again there is much we could say but reflective practice allows for us to hold the complexity of working with risk. At the same time it helps us consider why we feel stuck, what we don’t know, and more importantly how we might play a part in it all. Only by tolerating this uncertainty can we be curious. With this we can arrive at a deeper understanding of risk. 

David: Those who have formal leadership within their job role heavily shape workplace culture and when working with risk of harm to other these cultures can easily become charged with destructive or harmful patterns. Through CAT’s relational and practical tools we can quickly start to decipher some meaning from what initially seems confusing. This is the focus of my chapter on CAT & leadership in the forthcoming Oxford Handbook of Cognitive Analytic Therapy to help leaders start to see possible ways forward based on a deeper understanding of the issues. Where risk is a core feature of the work, then we need to help people do this as thoughtfully but as responsively as possible, and that is what our teaching day is all about. 

What question about this training day have I not asked you that you really want to be asked?!

David: “Will attendees enjoy the day?”. Because they will! It’s easy to forget that in this line of work most of us enjoy learning, clarifying, (re)gaining insight, finding ways to recalibrate and refocus on helping others. Jenny and I have a good time working together. We’re a bit like chalk and cheese in some ways but we compliment each other! And when teaching together we all usually have a good time too.

Jenny and David’s CPD day takes place on 8 September in Leeds. For more information and booking options, visit the page at CAT Concepts in Working With Risk of Harm To Others

Still time to book: Gaining Ground 30 June 23

In case you’ve missed this opportunity, there’s still time to book in for this mini-conference style CPD day which has been led by trainee/graduating CAT practitioners from our 2021 intake. It’s a packed programme of offers, including several from clinicians in a liminal period as they complete the final parts of their their training and head towards qualification.

Several have stepped forward to present on work produced for year two written assignments. In these they weave CAT theory with contemporary clinical practice. The day includes live presentations plus posters. Topics include neurodivergence, race, physical health, masculinity, CAMHS services and integration of CAT with EMDR. In addition, there will be a feature on the new series of training films on Advanced Skills in Cognitive Analytic Therapy. We’ll be sharing and seeking feedback on a new tool in development for scaffolding conversations about the Social Self.

We’re also really pleased that ACAT’s Vice Chair for Supervisor Training, Yvonne Stevens, is attending the day in person. Yvonne aims to engage and inform on this important next step which supports the development of CAT going forward. Stephen Kellett is also attending to tell us about latest research developments and opportunities.

So it’s not just a day of looking back over achievements to date, but also an opportunity to look ahead to the future, beyond qualifying as a CAT Practitioner. So far we have a mix of trainees and more seasoned clinicians attending, and all are welcome. We’d love to see a whole range of attendees, from the CAT curious through to senior clinicians and service leads. In short, anyone who wants to learn about, support and celebrate CAT training in the north.

Thanks to everyone’s generosity with their time, we are running the day at cost. We hope this makes it affordable and accessible. There is a reduced fee of £40 for practitioner trainees from any course, and just £50 for others.

You can see full details of the programme and options for booking at the event page at this link.

Finally, acknowledgements and gratitude. We wanted to thank artist Brenda Mallon who offered her beautiful artwork as part of the event promotion. Its suggestion of geological forms, perhaps even crystals and gems, forming a basis for building and “gaining ground”, helped us arrive at a title for the day. We’d also like to thank all contributors who are listed on the programme below, for their enthusiasm and generosity. Thanks go also to Jo Qurashi, who has helped to co-ordinate contributions throughout.

“Young people can sniff out inauthenticity a mile away”

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.

Painted wooden sign pointing to past and future

2022 Catalyse Round Up

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.