In the second of our occasional blogs, Clive Turpin answers some common queries about Personal Reformulations to supplement information about this on our webpages.

What is a Personal Reformulation (PR)?
A PR is a way of using a cognitive analytic therapy approach, delivered in a brief and contained framework, to help people develop or improve relational awareness; ways of relating to themselves and others. It was originally developed to support those in helping or therapeutic roles to better understand their own relational pushes and pulls and how this might impact on their work roles. It also gives a bit of a taste of what it is like being in the ‘other chair’ as a client in therapy.   As helpers we all bring with us our own history, our strengths and vulnerabilities, and in a CAT way of thinking, our own reciprocal roles and patterns of relating with ourselves and others.  A PR provides a safe and confidential opportunity to identify and reflect on such relational roles and patterns, and how they impact on work roles.

So, are you really talking about personal therapy?
No, a PR is not a full therapy. People who train as a CAT practitioner over a 2 year course are required to complete a 16 session cognitive analytic therapy. This is an essential part of the course and highly valued as an opportunity for direct experiential learning about the CAT model.  It can also be valuable at a personal level for the training therapist. Being aware of our own identity and what has shaped our thoughts, feelings and ways of relating, helps us a great deal in identifying how these might impact on our role as a therapist or helper.

A PR on the other hand provides a very brief and contained opportunity to use CAT’s approach of collaborative mapping to provide a structure to identify and explore prominent relational roles and patterns as a framework to build upon. Although the personal and professional parts of us are obviously linked, a focus on work and professional roles sets a clear agenda and helps the person make the most of the brief and contained nature of the PR experience.  A typical PR includes a two-hour initial session plus a further one-hour follow up session at a later date.

Who can have a PR?
At the moment PRs are mainly used by trainee clinical psychologists and other professionals doing CAT skills training courses. A number of Doctorate training courses in Clinical Psychology highly value the benefit of PRs and have embedded them into training.  However PRs could be of benefit to a wide range of professionals such as GPs, nurses, psychiatrists, counsellors and others wanting to learn more about the CAT approach.

What happens if something unexpected comes up during the PR?
Personal exploration is likely to connect us to feelings and vulnerabilities that we might sometimes try to limit or hold back from sharing with others. Even during a brief PR you might connect with feelings in a way that can initially feel very intense and overwhelming.  Although this might feel hard in the moment, the therapist will be thoughtful with you about how to manage this and make sense of it. These moments, albeit challenging, can be very rich ground from which to learn within a safe and contained environment.  In feedback from people who have had a PR these are often referred to as important aspects of the experience which help to develop awareness and understanding.

An important part of the PR (and the CAT approach) is exploring “exits” through collaboration and conversation.  Exits are alternatives to well-worn patterns, or strategies to help manage relational pulls and responses. This is why the jointly produced map takes centre stage as it provides an immediate way of capturing what is being felt and thought about together.  The map provides some scaffolding to help develop awareness so that the person can more easily notice times when patterns are happening.  This gives an opportunity to think about ways of approaching things differently. An example of this could be of establishing a new healthy reciprocal role which encourages the person to pause, reflect and consider before responding or getting pulled into patterns.

Is it confidential?
Yes.  What is discussed in a PR is confidential and ordinarily there is no feedback to the course about content of the sessions or the trainee.  All therapists adhere to ACAT’s Code of Ethics and Practice.  As in any therapeutic contract, if an issue of risk or concern about professional conduct arises, the therapist is obliged to inform relevant third parties (in the case of a trainee clinical psychologist this would include the course, as employer).  If such concerns were identified they would be discussed in the session.

What sort of feedback have people given?
Feedback is generally very positive.  The Doctorate in Clinical Psychology courses at Universities of Lancaster and Liverpool highly rate PRs and have had ongoing contracts to enable their trainees to access them over the last 8 years. Some trainees from other Doctorate in Clinical Psychology courses access PRs independently.  Other courses are also expressing interest due to the positive experiences and feedback of those who have used PRs. Six-month long CAT Skills courses continue to incorporate PRs as an essential part of the training experience.

The University of Lancaster DClinPsych course has published internally two research projects on the impact of PRs.  Feedback gathered and collated by Catalyse is very positive with PRs being highlighted by some as one of the most valuable parts of training.   Specific feedback also includes how PRs can help the trainee:

• both personally and professionally;
• gain insight, recognition, awareness and understanding;
• identify and name difficult roles and patterns;
• improve their understanding of CAT and how it can be used/applied; and
• have some experience and insight into what it’s like to be a client and in “the other chair”.

Mapping out roles and patterns is consistently cited as being the most helpful aspect.  The map acts as a summary of the work, a portable tool to refer to later, and from which further exits can be developed.

There is an acknowledgement about the importance of therapist/client fit and some of the challenges when the fit is not a good one.

For most the brief time frame feels enough; for some it can feel a bit short.

The follow up sessions are considered “very helpful” to “essential”, enabling review of the initial session and revisiting the map to work further on recognition and exits.

Why might I consider having a PR?
In addition to the feedback above, in CAT the emotional world of the therapist or helper is seen to be important to address so that as therapists we can manage ourselves in a way that doesn’t interfere with the client’s needs.  Managing the psychological and emotional impact of clinical practice is also embedded into standards for mental health professionals, for example HCPC standards of practice for practitioner psychologists.

Relational awareness helps us to understand and separate out emotional responses that we encounter in therapeutic and working relationships, and is an explicit part of many therapeutic models.  For all therapists working in a relational way this is an ongoing process which is supported by clinical supervision.  A PR can be considered an early step towards building relational awareness, specifically using a CAT perspective.

Who offers PRs and how do I know they are skilled in this approach?
All therapists offering PR sessions will either be an accredited CAT practitioner or CAT psychotherapist. Currently there is a list of approved therapists on the Catalyse website. The listing includes location and some brief information on the therapist to help people decide who they are likely to work with best.

There is not a specific training required to offer a PR, but through experience and feedback some guidance has been established to ensure a standardised approach.  Naturally each PR will differ as each combination of people creates something unique and independent within the relational encounter.  However there is an established framework that contains the approach.

In addition to this I co-ordinate a process of governance amongst the network of existing PR therapists working as Catalyse associates.  This takes place through telephone conferences and an annual workshop, and actively uses feedback and peer review.

Does my course offer access to PRs?  
CAT Skills training course participants have a PR as part of the training.  Currently Lancaster University and the University of Liverpool provide funding for their DClinPsych trainees to access PRs if the trainee wishes to take this up.  These DClinPsych courses, plus those run by the University of Sheffield and University of Exeter, have selected CAT as one of their second therapeutic models under new BPS/DCP requirements.  As such, each of these courses are required to provide access to PRs for their trainees.

To help meet this expansion, ACAT is putting on a number of workshops for CAT therapists interested in offering PRs, to help to share good practice. The first is in Exeter on 7th October 2016.

Many trainees from other DClinPsych courses arrange PRs on a self-funding basis.  If you are interested in accessing a PR but are not sure how to go about this, you can find out more by contacting me.
 
I have other questions about PRs – how can I find out more?
Comments on this blog or via Twitter (@Clive_Turpin) are very welcome although I may not be able to respond immediately.  It would be good to hear what people make of the information and ideas shared in this blog.  You may help nudge us to write another!  If there is anything further you’d like to know about PRs, you can also contact me via Catalyse.

Clive Turpin, CAT Psychotherapist
Clive is on Twitter @Clive_Turpin

More information about ACAT’s forthcoming Exeter event on 7th October 2016 for therapists interested in providing PRs is available here.  A further course is due to be run in Reading at a later date.