Thursday 18^th July

5.00pm – 5.30pm

Research presentation - 'The challenge to the CAT model of working cross-culturally, both conceptually and therapeutically, and as illustrated by attempts to develop a CAT-based conceptual model (‘Korowai ?ria’) and modified ways of working with recently colonised M?ori populations in Aotearoa–New Zealand'
Simon Waigth and Ian B. Kerr

It is well recognised that working with mental health problems across different cultures poses profound challenges to all therapeutic models including CAT, and notwithstanding the emphasis in CAT on the importance of internalised and current socio-relational factors. The Western focus on the ‘individual’ as the ‘locus’ of mental distress and disorder in particular is highly problematic when attempting to help people from more socio-centric cultures where any sense of ‘self’, of ‘distress’ or ‘disorder’ may be experienced very differently, and where the forms of help sought may also be very different. Conceptually our approaches, we suggest, need to be much more cognisant of background and current socio-relational factors in ‘treatment’, which in turn will need to be considerably modified to be appropriate to working with persons form such cultures. Some of these background issues may relate, notably and explicitly, to recent experience of colonisation and subsequent loss of traditional culture, language, and ways of life. We have been attempting to develop a broader, partly CAT-based, meta-conceptual framework to attempt to address such issues. In particular in Aotearoa-NZ where we have conceived of this as a ‘korowai ?ria’ , to attempt to bridge across and helpfully understand the considerable distress and problems that many M?ori experience, and also to bridge across to consider, respect, and learn from more traditional ways of healing. Consideration of the features of more traditional ways of life and healing may in turn, we suggest, constructively illuminate some limitations of Western, including CAT-based, understandings of mental health problems and of treatment for them.

Biography

Simon Waigth works for Health NZ-Te Whatu Ora in Northland-Te Tai Tokerau as a senior clinic psychologist and has recently completed the NZ-Aotearoa CAT practitioner training. His iwi affiliations are to Ng?ti Makino and Ng?ti Pikiao.

Ian B. Kerr is an experienced CAT practitioner, trainer, and author.  He currently works as Consultant Psychiatrist and Psychotherapist for Health NZ-Te Whatu Ora in Northland-Te Tai Tokerau and is an Hon. Senior Lecturer, Dept of Psychological Medicine, University of Auckland- Waipapa Taumata Rau, Aotearoa-New Zealand.

5:30pm - 6:00pm

Research presentation - 'Experiences of South Asian women in CAT therapy'
Dr Jenny Bowe and Dr Anam Elahi

People of South Asian descent are a significant and growing ethnic minority group within the United Kingdon (UK). Like other ethnic minority groups, South Asian people often experience elevated rates of mental health symptoms in comparison to the majority White UK population. There are also documented differences between generations, such as differences in awareness of mental health services and in the value of talking as a coping strategy. Within these talking therapies, some e.g. Cognitive Behavioural Therapy (CBT) have been more researched in ethnic minority populations in comparison to new therapies such as Cognitive Analytical Therapy (CAT). Within South Asian individuals, South Asian women hold intersectional identities that will be explored by considering the influence of gender and ethnicity on South Asian women’s experience of receiving this model of psychological therapy, including the role of the therapist’s own ethnicity. Seven women will be interviewed Interpretative Phenomenological Analysis (IPA), which is concerned with giving a voice to research participants and making sense of their experiences. The themes produced include the importance of understanding their cultural context, the power and influence of the therapeutic relationship, how the process of CAT was experienced and how ethnic difference was considered in the therapy space. These themes provide practical clinical implications, including the use of pretherapy socialisation sessions to allow to build authentic trust, including culturally contextual reformulations and culturally adapting the psychotherapy file. This highlights the role for future research to explore the utility of these recommendations.

Biography

Dr Jenny Bowe:  I am a Senior Clinical Tutor on the Doctorate of Clinical Psychology at The University of Liverpool.  I lead on adult mental health and am the CAT Foundation Pathway director which has been recently embedded within the Liverpool D.Clin. Anam and I supervise doctoral level research which looks at the experience of people of ethnic minority in therapy and within the therapeutic dyad. As a CAT therapist and supervisor, part of our research aims are develop skills in working with cultural sensitivity to support both therapists and people attending therapy to feel connected to what they bring to therapy in terms of culture, race and ethnicity. 

Dr Anam Elahi:  I am a lecturer on the Doctorate of Clinical Psychology at Liverpool University. I am interested in researching ethnic minority communities and hope that the current research in CAT and ethnic minorities will lead to external funding to develop culturally sensitive tools for use in CAT. Dr Jenny Bowe and I are supervising trainees looking at ethnic minorities and CAT (from both the perspective of therapists and clients). I am also interested in researching severe mental health (psychosis) in ethnic minorities and how this relates to social identities, and global mental health.

Friday 19^th July

5.00pm – 5.20pm

Research Presentation - 'Assessing change in target problems during CAT: a multilevel meta-analysis of the single case experimental design evidence-base'
Mel Simmonds-Buckley, Chris Gaskell and Stephen Kellett

Target problems (TPs) are one of the theoretical cornerstones of CAT and effective CAT would observe a reduction in TPs over the course of the therapy.  There is a CAT evidence base whereby a single case experimental design has been conducted with patients, during which TPs are intensively collected over the duration of the phases of CAT.  This presentation will present a synthesis of that evidence base and evaluation of the size of the effect of CAT in terms of reducing TPs.  A multilevel meta-analysis of N=30 single case experimental designs will be reported across a wide variety of clinical presentations. This will synthesize the effect size in terms of non-overlap of TPs between reformulation and recognition/revision phases of CAT.  The results will be discussed in terms of the lessons learnt in terms of the key role of recognition and revision of TPs during CAT.

Biography

Mel Simmonds-Buckley works as a researcher at the University of Sheffield and has contributed two previous CAT meta-analyses (effectiveness and acceptability).  Chris Gaskell is a clinical psychologist working in the NHS and Stephen Kellett also works in the NHS as a CAT psychotherapist

5.20pm – 5.40pm

Research Presentation - 'A grounded theory of cognitive analytic reflective practice (RP-CAT) within secure children’s services'
Sasha Priddy, Shonagh Goodall and Stephen Kellett

Whilst CAT is being increasing used as an indirect intervention, there is no evidence of how this approach is used during reflective practice groups.  This study sought to develop a process model for this approach in secure children’s homes.  After ethical permissions were granted, 24 participants based in 4 staff teams in a single home, attended four RP-CAT group sessions over a 1-year period. Sessions were audio recorded, transcribed, checked for CAT adherence and analysed using grounded theory.  Theoretical sampling was achieved via conducting focus groups with teams informed by the emergent categories and using sessional measures of group cohesion and helpfulness to confirm theoretical saturation. The presentation will present a grounded theory of how RP-CAT works.  The results will highlight how a better understanding of reciprocity in staff enables the dynamics of effective care to be more consistently enabled.   

Biography

Sasha is a Clinical Psychologist who works in adult acute inpatient setting and uses CAT in that context.

5.50pm – 6.00pm

Research Presentation - 'Relational approach to treating self-harm (RelATe): Update on a feasibility randomised control trial of CAT for self-harm’
Zerena Airnes, Peter Taylor and Stephen Kellett

The RelATe project is the first National Institute of Health Research (NIHR) funded clinical trial of CAT. In this project, patients in the community that have actively self-harmed three times in the previous year are randomized to either 8-session CAT or treatment as usual (TAU) and are then followed up at 12 and 18 weeks. As the trial is a feasibility study, the primary outcome is ability to recruit and retain participants in both arms of the trial.  This presentation will therefore feedback the recruitment targets and progress during the study and will report the overall CONSORT diagram.  Additionally, the presentation will describe the 8-session approach and share the protocol for this focused and brief CAT approach to self-harm.

Biography

Zerena Airnes is a CAT therapist who works in the NHS and she has been a therapist on the trial. Peter Taylor is a senior lecturer at the University of Manchester and Stephen Kellett works in the NHS as a CAT psychotherapist. Peter and Stephen are the co-joint chief investigators on the trial

Saturday 20^th July

12.05pm – 12.25pm

Research Presentation - 'Cognitive analytic guided self-help (CAT-GSH) for depression; initial evidence of effectiveness'
Rebecca Kelly, Mel Simmonds-Buckley & Stephen Kellett

In NHS Talking Therapies services (formerly IAPT) there is a need to develop other models to the treatment as usual cognitive-behavioural approaches used at Step 2.  CAT-GSH for anxiety has recently been developed and gone through rigorous evaluation.  CAT therapists have often commented on why there is not a depression version and therefore this project concerns the development and evaluation of CAT-GSH for depression, with a focus on gathering feedback of the patient experience of the intervention.  This presentation will outline the results therefore from a parallel mixed methods evaluation.  After ethical approvals were in place, N=11 patients were recruited and treated with CAT-GSH for depression by N=4 psychological wellbeing practitioners.  This is a 6 (35-minute) session intervention using a structured workbook and follows the reformulation, recognition and revision structure of CAT.  The results will report on clinical competency, sessional outcomes on the IAPT minimum dataset, RCSC rates and dropout rates.  These will be integrated with qualitative interview themes from PWPs and patients. Results will be discussed in terms of the need to innovate CAT for it to be an offer in Talking Therapies services and the need for better evidence. 

Biography

Rebecca Kelly is a final year Trainee Clinical Psychologist studying at the University of Sheffield. She has dedicated the past three years to developing and piloting a CAT-informed guided self-help manual as part of her thesis. Her other areas of interest include using a CAT-informed approach to understand and alleviate distress in older adults and people with Dementia.

12.25pm – 12.45pm

Research Presentation -  'Investigating the feasibility and acceptability of reintegrating repertory grids back into reformulation and termination letters'
Stephen Kellett, Amy Squire, John Bristow, Oliver Wilkinson, Chris Gaskell & Mark Evans

Completing repertory grids to enable reformulation has fallen out of practice in CAT.  This study therefore sought to explore the acceptability and feasibility of reintegrating dyad grids back into CAT practice.  Ethical permissions were granted to implement a mixed methods design.  Seven patients with complex emotional difficulties were treated by four CAT therapists in a tertiary psychotherapy service using the 24-session model.  Dyad grids were intended to inform narrative reformulation letters and goodbye letters.  Patients completed the Clinical Outcomes in Routine Evaluation 10 (CORE-10) and the Helpful Aspects of Therapy (HAT) measures at each session.  Patients and therapists were interviewed regarding their experiences of using grids.  The feasibility and acceptability results will be presented, and the practical lessons learnt from the project will be shared.

Biography

This project was very much a team effort.  Amy, Oliver and Mark are psychiatrists and Chris, John and Steve are clinical psychologists.  All are interested in furthering the evidence base for CAT.