Tag Archives: Psychotherapy Research

Neon lettering against a cloudy blue sky, reading 'understanding'

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

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.

You can contact Peter using the details below.

Dr Peter Taylor, Senior Clinical lecturer & Clinical Psychologist

Division of Psychology & Mental Health| Room 2.33, Zochonis Building| Brunswick Street| University of Manchester| M13 9PL| Tel: 0161 306 0425| Email: peter.taylor-2@manchester.ac.uk| Twitter: @PJTaylorClinPsy

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

Black and white image of geese journeying together across a cloudy sky in a rough formation

Journeying Together: A Second CAT Research Conference

Plans for a second research conference hosted jointly between ourselves and ACAT have now come to fruition.  ACAT is leading on the organisation of this second event – The Research Journey From Start To Finish: Motivating-to-Motivated – which takes place in London on 1 March 2019.  Again this conference aims to bring together people interested in hearing about and developing the evidence base for cognitive analytic therapy.

You’ll be welcome to attend whether you want to gain an update on current and future research in CAT, make connections and develop your research networks, or get support in developing your own research ideas.  Those with roles supporting the research activity of others are also most welcome to attend.  This could be a useful day to attend if you are a research tutor or supervisor on a core professional training.  Similarly if you have responsibility for supporting psychotherapy research activity within a  mental health or learning disabilities trust, you may make helpful connections.

The theme of a research journey was present throughout last year’s conference.  People shared stories of projects at different points along the way and reflected on what had helped or hindered them complete different stages. Alison Jenaway’s guest blog about the 2018 conference tells you more about that day.

When thinking about an image to help promote the 2019 event, we liked the metaphor of migrating geese.  Apparently they fly together to help reduce air-drag and conserve energy.  Different flock members move in and out of the front position depending on who has energy and resources to lead.   Of course following is as important as leading in this context.  We share a direction and learn from each other.  As peers we can reciprocally motivate with helpful “honking” in order to keep up a pace.

Of course none of this precludes solo flyers who want to take their own direction.  After all, would CAT ever have developed without a bit of independent thinking?

We’re not content, of course, with merely developing a metaphor or an understanding of relational processes in research.  As with the CAT model, some action is expected and encouraged.  To support concrete action getting “off the ground”, this year ACAT is offering three free places for people planning a project on CAT.

To be considered for one of these places, you’re invited to share a maximum 2000 word outline of a realistic project you can take forward, complete and publish. This should include:

  • Your main research question
  • Why it is important
  • The method you are planning to use to answer it
  • Any previous work or publications that you would be building on
  • The next steps you intend to take to get the project off the ground

The deadline for submissions is 10 January 2019.  If you’re successful we may be able to match you with a mentor from within the CAT community or related networks.  We will of course welcome you back to present at a future CAT research conference.

Whether or not you wish to apply for a free place, you can get some inspiration from the list of presentations lined up for the day, offered by Stephen Taylor, Barney Dunn, Steve Kellett, Steve Jefferis, Liza Messing and Samantha Hartley.   Topics include integrative models for nurse supervision, learning from research into other therapies, making use of data on CAT in IAPT, qualitative research into mapping, group interventions, and coproduction with young people around brief therapy for self harm.

You can also follow the hashtag #CATres19, and add to it with any queries and comments. Please also feel free to share any links or resources you think may be useful in the run up to the conference.

We look forward to seeing you there.

For more details and to book your place at the conference – The Research Journey From Start To Finish: Motivating-to-Motivated – visit ACAT’s event page at this link

 

 

CAT diagram showing reciprocal role and procedure around research, with exit of coning to this research conference

Building Our Research Community Together in Manchester

Have you seen details of the research conference which we are running run jointly with ACAT?  This takes place on 13th April in Manchester. The title “Encouraging to Engaged” sets out what we intend it to do, through bringing together CAT peers to consider how we can all become more confident, skilled and active in relation to research. Manchester does of course have an international airport for easy connections with other countries where CAT has a presence.  Colleagues from beyond the UK are most welcome to attend too.

A range of research-active colleagues involved in psychotherapy and practice-based research, and already playing a part in building CAT’s evidence base, will present and share their experience as “more knowledgeable others”.  Small group work focussed around participants’ needs will provide thinking space, practical support and scaffolding to help us all feel more able to make use of CAT’s evidence base in our practice and to develop it further. It doesn’t matter what your starting point is in relation to research, there will be something for everyone on the day.  Further details of the programme will be available shortly. (Update February 2018 – full programme is now available as a download on the event page here.)

Of course it wouldn’t be a CAT event without a CAT angle on the process of engaging in research.  In addition to the playful map Alison Jenaway offered as an image to help promote the day, there’s a promise of more SDRs from presenters.  Perhaps Alison’s diagram has already prompted you to draft your own?

We very much hope you can join us in April to play a part in further building our research community and renewing ACAT’s research strategy together.

If you have any thoughts, questions, suggestions or discussion points in relation to the day, do please add them here, or on Twitter using the #CATres18 hashtag.  You can also use the members’ only Research Chatterbox on the ACAT site.  Perhaps we can get a conversation started in advance of the conference: we  certainly look forward to the conversations on the day.

You can find out more about the day and book a place by clicking on this link.  The early online booking rate of £95 applies until March 12th.  If you need anymore information or advice about accommodation options in Manchester, please contact us.