Tag Archives: 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.

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

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


Image of a person looking at shelves of books in a library - linked to blog theme of inviting research papers on cognitive analytic therapy

A Call for CAT Research Papers

In this guest blog, Peter Taylor offers an invitation to contribute CAT-related papers to a forthcoming special issue of Psychology and Psychotherapy: Theory, Research, and Practice. He also outlines his thoughts on how the evidence base in CAT might be strengthened.

Sam Hartley and I are editing a special edition of Psychology and Psychotherapy: Theory, Research, and Practice, focussed on cognitive analytic therapy (CAT) (see the submission details here). We are hoping this special issue will help capture where CAT research is currently, and serve as an impetus to those involved in or thinking about research relating to CAT. We are also hoping this special issue will also help showcase to those outside of the CAT community what this approach may have to offer, and so generate wider interest.

We welcome submissions focused on CAT, adopting a wide variety of research methodologies. These can include reviews, small-scale clinical evaluations or studies of theoretical principles and mechanisms. Please do have a look at the call details and consider if anything you are involved in could be submitted. Let’s see if this special issue could trigger some new interest and exciting research into CAT. The deadline for submissions is 1st November 2019.

In light of this special issue I would like to share some thoughts about where CAT currently sits with regards to research. I work as a senior lecturer at the University of Manchester and have an active research interest in CAT. Whilst I am a qualified clinical psychologist I am not a qualified CAT therapist. My experience of CAT came though my clinical training, but my interest since then has been primarily about researching the CAT approach to psychological difficulties and what it may offer clients.

The CAT community is currently a thriving network, supported by the Association of Cognitive Analytic Therapy (ACAT). A myriad of local special interest groups help maintain connections and shared ventures, as do partner organisations like Catalyse. However, from a slightly outsider perspective, I feel concerned that this growing clinical interest has often not transitioned into research interest and activity.

I have been increasingly involved in research concerning CAT over the last few years. I would argue that providing robust research evidence concerning its value is essential, both to support current practice, and to make the case for additional support of CAT within services. There has been a consistent ongoing stream of CAT-focused research, much of which was helpfully summarised in the 2014 review by Calvert and Kellett. However, I believe that a concerted and collective investment in both the scale and scope of CAT research would really help us to better understand how, when, and in what way, CAT may be of value to those in health services.

I recently ran a search on PsycINFO with the keyword “cognitive analytic therapy”. (PsycINFO is probably the main online database for psychology, including clinical psychology.) Two-hundred and ninety-four articles were identified, with fifty-three having been published in the last three years. A quick screening of these identified seventeen that could be considered empirical research. There are a few where the line between an evaluative research study and something more illustrative is blurry. Given the enthusiasm for training in CAT, and adopting the approach in many clinical settings, this number of empirical studies illustrates for me that the CAT research base is more limited than it might be.

There are various possible reasons why there has not been more research on CAT. My own feeling is that CAT has been adopted and championed by individuals with predominantly clinical roles. They may have less time for doing research, or may not feel confident in their research skills. Connections with academic departments and research groups have not quite flourished, in comparison with other approaches like CBT.

A brief review of the seventeen studies I found leads to two observations worth highlighting.

First, the majority are small-scale evaluations of CAT or some aspect of this approach (n = 11). This observation highlights one characteristic of the CAT literature that I alluded to earlier. It has been very much led by clinicians and emerged from clinical contexts, where small-n designs have been embraced. What is notable though is the lack of larger-scale systematic research studies. I identified three larger studies, but still with small samples of around n = 30-50. This suggests a difficulty in the transition from smaller to larger scale studies.

Second, a large number of these studies involve the same individuals leading the research. For example, Stephen Kellett is a leading author (first or second authorship) on nine of the studies. This suggests research into CAT has not branched out beyond particular research-active individuals and groups as much as it could have. However t it also demonstrates that individuals knowledgeable in undertaking research exist in the CAT community. There is therefore potential for modelling and scaffolding of research capacity.

So how might we move ahead to encourage and support more research in CAT?

1) Focusing on the first observation, small-n studies (e.g. case series) are important. They are part of a recognised step within the MRC guidance on developing the evidence base for complex interventions. Crucially, they help answer important questions about feasibility and acceptability. The lack of CAT research outside of this area suggests to me both a challenge but also an opportunity to develop and expand the CAT research base further.

2) Larger-scale trials typically require funding, which is notoriously difficult to obtain. However there may be other ways of extending CAT research. Linking up researchers from multiple services or groups may help to establish collaborations for undertaking larger-scale research.

3) There is also potential in using routinely collected outcome data that many services hold, using common measures. I wonder if there is scope to collate this data to further evaluate the potential benefits of CAT. I recall there was some discussion of this latter possibility at the 2018 CAT research conference in Manchester.

4) Whilst much of the research concerning CAT has been understandably about the therapy, I also wonder about designing research directed at testing some of the conceptual and theoretical principles that underlie CAT. For example, we recently found that the Personality Structure Questionnaire (PSQ), a tool designed to assess mechanisms of action linked to CAT, is associated with difficulties around self-harm. Specifically, scores on this measure, which captures instability in self-concept or personality, distinguished those with recent (past year) and historic self-harm, with greater instability being apparent for those with recent self-harm.

Returning to a point in my second observation, I noted earlier my perception that CAT lacks strong links with academic departments and research institutions. It feels like currently in the UK there are a small number of academics who also have an active research interest in CAT. I would count myself in this group. My experience has been that many CAT clinicians have a real interest in research but either lack the capacity or confidence to develop research projects themselves.

Stronger links with academic departments and research-active academics is a possible solution here. Networking and collaboration with and between academic departments may help increase the spread of this interest and research activity.

We should perhaps also consider how the next generation of researchers could be involved in research about CAT. Funded PhD studentships with a CAT focus might be one option. For clinicians wishing to develop their research capacity further, clinical research fellowships such as those available through NIHR may also provide opportunities and ongoing support.

It will be interesting to see how the Catalyse practitioner training will be influenced by someone as research-active as Stephen Kellett joining the core trainer team as of this year.

I wasn’t able to make it along to the second CAT research conference organised jointly between Catalyse and ACAT in April 2019. However, following the Catalyse 25 Years conference in May, a small group of researchers and research-interested clinicians in the North arranged to meet informally this coming September. It would be great to hear of other local connections and collaborations which might be able to move forward with some of the ideas I’m proposing in this blog.

Moving beyond the submission deadline for the PAPTRAP special issue 1st November 2019 – I look forward to seeing research confidence growing, the evidence base for CAT becoming more solid, and generated by a broader group of clinicians and researchers.

You can follow Peter on Twitter via @PJTaylorClinPsy

CATCH Trial Recruitment

Can you help the CATCH trial recruit people for a Feasibility Trial on Cognitive Analytic Therapy-informed Containment for self-Harm?

Trainee clinical psychologists from the University of Manchester are conducting this study under the supervision of Dr Peter Taylor and Dr Samantha Hartley.  Participants need to have had no previous experience of cognitive analytic therapy and be:

  • aged 16 and over
  • from the Manchester and Liverpool areas
  • currently engaging in self harm
  • not currently in therapy

For full details of ethical approval, inclusion and exclusion criteria, participant information etc, please contact the research team on the numbers below or via catch@manchester.ac.uk

Flyer outlining the Cognitive Analytic Therapy-informed Containment for self-Harm (CATCH): A Feasibility Trial

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