Therapy & Coaching
CAT Personal Reformulation for Personal and Professional Development
Introducing personal reformulation as an adaptation of cognitive analytic therapy
CAT’s brief structured approach to psychotherapy with an emphasis on active, collaborative and early written and diagrammatic reformulation (mapping) lends itself to a shortened, mapping-focussed reformulation experience. A distinctive personal reformulation (PR) approach for mental health professionals has developed over the last fifteen years. Its focus is on shared mapping of patterns, roles and coping strategies that have most bearing on professional practice. It is being increasingly used in a range of training contexts and with different professions.
Catalyse currently offers personal reformulation sessions to professionals who are training as clinical psychologists. We also offer PRs to those engaged in ACAT accredited training at CAT Skills Case Management and CAT Foundation levels. Other professionals interested in making use of the approach are welcome to contact us.
Personal reformulation as a form of personal and professional development
A personal reformulation experience is an opportunity to meet with a therapist using the relational approach of cognitive analytic therapy to identify and explore relational patterns that you might get drawn into. The focus is negotiated collaboratively but develops from exploring your work role with clients, colleagues and peers.
A central aim is to develop a CAT understanding and a map of the likely patterns of interaction triggered for you when undertaking professional work. This can naturally overlap with more personal ground. If this does occur the therapist will be thoughtful with you about what can be safely explored within the time limits of the sessions. You and the therapist may decide this is something to return to. This could take place in follow up sessions. Alternatively, you may contemplate undertaking a separate therapy at a later point.
The emphasis on your work role helps to provide focus and containment. Although a PR is not formally therapy, it gives the opportunity of experiencing a therapeutic approach and being in the ‘other chair’.
How are personal reformulations structured?
Personal reformulations (PRs) are offered in slightly different formats, typically in one of two forms:
1) An extended single session of 2.5 hours with a break. This was the original model for the PR and is the minimum requirement for the personal development component of ACAT accredited CAT Skills or Foundation training and necessary for accreditation.
2) A two hour session with a one hour follow-up session at an agreed interval, usually a month later. The latter model developed as a follow up session was valued and is now the model used in our work with clinical psychology trainees.
Participants are of course welcome to arrange additional follow-up meetings beyond that funded the course fee.
A page on the ACAT website explains more about personal development or therapy at different levels of training in cognitive analytic therapy. Click here to go to ACAT’s information on personal development and therapy.
How did PRs develop?
The use of an extended single session grew from the need to provide an experience of CAT therapy for visiting Australian CAT trainees.
Steve Potter and colleagues’ work using CAT in student counselling settings had demonstrated the value of a ‘reformulate and go’ approach to very brief therapy. In this setting, clients might attend for crisis help but have good underlying mental health. In these circumstances the client can make rapid psychological use of a collaborative reformulation. Brief work could quickly enable the person to step out of their difficulties and recover a healthy empathic stance towards themselves and their situation.
Community Mental Health Teams in Sheffield undertaking an intensive week-long CAT skills training made use of an extended half day session as an element of personal development. This was initially developed by Ian Kerr. Dawn Bennett also applied this brief approach for staff in inpatient services. Subsequently visiting therapists from Australia and New Zealand made use of personal reformulation.
An important assumption is that the client using the personal reformulation is well motivated and intends to make use of the understandings and resulting map to help themselves further with their clinical or professional practice. A follow up session has been rated as valuable.
What happens in the initial session?
The beginning of the first session will look at the boundaries of confidentiality and some reflections on your thoughts and feelings about the sessions. The therapist will have a collaborative approach when exploring your goals for the sessions and how you might work together towards these.
The CAT approach of mapping is used to track the conversation to establish relational (or reciprocal) roles, the feelings that occur and how these are managed. The map helps with recognition and supports change through establishing exits. The map will be yours to take away. If you plan a follow up session you are expected to return with your map as a working tool to review and develop.
At the end of the sessions the therapist will reflect with you on the experience and what might be helpful to take away and work on in the future.
What goes on in the follow up session(s)?
A follow up session provides a valuable space to review the first session and helps consolidate the initial experience. It provides an opportunity to consider how you have used the conversation and the map to help you to recognise patterns and consider exits. Any goals established at the end of the initial session can be reviewed, and additional exits added. It is also an opportunity to gain additional understanding.
What happens at the end?
The therapist will reflect with you on the whole process and how you might continue to use the new understandings and the map. It might be an opportunity to consider whether having any further sessions would be helpful.
The Catalyse administrator who will send you a feedback questionnaire. When you have completed and returned the questionnaire, it will be anonymised. Catalyse welcomes all feedback. We regularly review this to see if any changes can be made to improve the sessions or information that you receive about the PRs.
Is it confidential?
What is discussed in a PR is confidential and if you are undertaking a PR as part of training, ordinarily there is no feedback to the course about content of the sessions or about you as a 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.
Why is my PR different from my colleague’s PR?
Although we have a standardised approach to the sessions, each is different and focused on the needs and wishes of the individual. This explain why there are different experiences of the PR sessions. However you can be assured that all the listed therapists are taking the same approach and hold the same values towards the sessions.
Who offers personal reformulations?
All therapists offering Personal Reformulation sessions will either be an accredited CAT practitioner or CAT psychotherapist. They are familiar with the aims and methods of the CAT personal reformulation approach.
There is not a specific training required to offer a PR. However experience and feedback has helped establish guidance 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.
Catalyse has a network of Associates who provide PR therapies on behalf of Catalyse. Follow this link to the list of therapists. This includes location and some brief information on the therapist to help people decide who they are likely to work with best. The Catalyse lead for PRs (Dr Dawn Bennett) co-ordinates 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.
Who can arrange a personal reformulation?
Personal reformulations can be used by anyone interested in getting a better understanding of their relational roles and how these might impact on them at work or in general life.
The cost of a standard personal reformulation (two hours plus one hour follow up) provided through Catalyse is £240.
Currently Catalyse have agreements to provide personal reformulations to professionals doing CAT Skills Case Management and CAT Foundation training courses and trainee clinical psychologists completing Doctorate training in Clinical Psychology with the universities of Lancaster and Liverpool. D Clin Psych trainees from the universities of Manchester and Sheffield are also accessing PRs on a self-funding basis.
Catalyse supported the introduction of PRs for the Trent Doctorate Course in Clinical Psychology.
There have been a number of other applications of the PR model in other services:
Mersey Care NHS Foundation Trust, Liverpool funded CAT introductory training for psychological therapists in their Trust with the opportunity for an extended session PR.
Mersey Care NHS Foundation Trust Eating Disorders Service, Liverpool. The Eating Disorders Service incorporates personal reformulation as part of a group programme. This involves a brief introduction to relevant ideas of mapping, and tracking patterns of relating to self and others, in the first two group meetings. Each group member then has an individual personal reformulation session in order to develop a life map. This is followed by further group meetings in which individual maps are shared and jointly explored with peers. In a group setting this helps members recognise and change problem patterns of relating and coping, both for themselves and alongside others in the group.
Lincolnshire Psychological Services funded some introductory training in CAT for staff, which included an extended PR with follow up. Group coaching sessions consolidated application of the personal CAT diagram.
Catalyse can offer personal reformulation to other Universities and services where there is interest in this approach to personal and professional development. 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. If you wish to pursue this further or have any enquiries, please contact us to discuss.
What sort of feedback have people given?
Feedback has been very positive, with trainees on ACAT accredited skills and foundation courses and trainees on Doctorate courses in Clinical Psychology course at the Universities of Lancaster, Manchester, Liverpool and Sheffield rating PRs highly.
The University of Lancaster DClinPsych course has had ongoing contracts to enable their trainees to access them over the last twelve years and has reported three internal research projects/surveys on the impact of PRs. In addition, feedback gathered and collated by Catalyse is very positive. Some trainees highlight their PR as one of the most valuable parts of training.
Specific feedback 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”.
Trainees consistently cite mapping out roles and patterns as a very helpful aspect. The map acts as a summary of the work and can act as a portable tool to refer to later. Further exits can be developed at a later stage with reference to patterns captured by the diagram.
Trainees rate the nature of the therapeutic relationship highly. Although brief, for many this is cited as helping to inform ‘what sort of professional I want to be’. For the majority this feels enough and they can work within the limited time frame. For some it can feel a bit short.
The follow up sessions are considered “very helpful” to “essential”. Trainees can review their initial session and revist their map, aiding further work on recognition and exits.
The Lancaster model of up to seven hours is highly valued.
How do I organise a personal reformulation session?
Follow this link to the list of personal reformulation therapists who work with Catalyse as Associates. You can contact any of these therapists directly to discuss further or to arrange an appointment.
More information about personal reformulation
Our Associate Clive Turpin previously co-ordinated provision of personal reformulation offered by Catalyse Associates. He wrote two blogs about PRs and we draw on some of his blog material in this updated page.
His second blog considered how people might prepare for a personal reformulation – read Clive’s second PR blog by clicking here
Page updated Sept 2019