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ACAT Annual Conference and AGM :: The Relational Present | Skills in Dialogue
25th January 2008 to 26th January 2008

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Friday: 09.00 - 18.00
Saturday: 09.00 - 17.00
Venue: University of East London, Docklands Campus, University Way, London, E16 2RD

Learning about and experiencing new ideas from CAT and other relational therapies to promote dialogue and acquire new skills.

Keynote Speakers:

Friday morning, 25 January, 2008:
Prof Charlie Lewis
The Relational Self:  What can we learn from “Theory of Mind”?

Prof Charlie Lewis

Biography: Charlie is Professor of Family and Developmental Psychology at Lancaster University. His two main areas of theoretical interest involve the roles of fathers in families and young children’s social-cognitive development. On the latter issue he has spent much of the past fifteen years developing an account of social understanding that is based upon our grasp of interactions and particularly language. These were published, with Jeremy Carpendale, in a Behavioral and Brain Sciences target article in 2004 and How Children Develop Social Understanding (Blackwell, 2006). He is starting work on a second edition of that book and a more general text about the relational nature of social knowledge.

Abstract: How do we understand ourselves and others as intentional agents? Psychologists and others return repeatedly to this question and much current debate has been very active, under the banner of ‘theory of mind’. In keeping with many previous debates, there have been heated controversies between very different theoretical positions. I will outline these influential perspectives, some evidence which makes each of these problematic and the current state of play in the field. The main problem with these positions is that they are individualistic and see relations between people as being the product of internally driven skills. I will argue, in contrast, that social interactions drive social understanding, drawing upon the developmental accounts of Piaget, G. H. Mead and Vygotsky, but also on analyses of language following Wittgenstein. It is the conjunction of these theoretical positions that allows us to interpret the burgeoning research on ‘theory of mind’ in development and in groups known to experience severe social interactional problems. This research has focused increasingly upon the origins of these skills in infancy and early childhood. I will review these studies in terms of the competing theories, concluding that social understanding is a slowly unfolding process in which the combined contributions of innate predispositions, interactional landmarks early communication can be seen.

Saturday morning, 26 January, 2008:
Prof Philip Thomas and Dr Paul Sullivan
A linked presentation of two papers drawing on a dialogic understanding of work with ‘Peg’ over a twelve year period

Prof Philip Thomas
Narrative and the Moral Meanings of Psychosis

Philip Thomas is Professor in the Institute for Philosophy, Diversity & Mental Health in the University of Central Lancashire, and also chair of Sharing Voices Bradford, a community development project working with Bradford's culturally diverse communities. He worked for over twenty years in the NHS as a consultant psychiatrist, but now works exclusively in the community and as a writer and academic. He is a leading voice in the Critical Psychiatry dialogue, and with Patrick Bracken, he has co-written the excellent and challenging book: Post-Psychiatry: Mental Health in a Post-Modern World, published by Oxford University Press.

Brief Abstract:
It is now widely accepted that over the last 30 years, psychiatry has become increasingly dominated by approaches to diagnosis that stress nosology and categorisation.  Other, vitally important and historic features of diagnosis that deal with the individual's perspective, have been neglected. This paper draws attention to the broader, moral aspects of diagnosis, which are largely understood through our actions (patient and psychiatrist) as moral agents. It presents a jointly authored account by patient and psychiatrist of work that took place over a twelve year period. Prof Thomas will demonstrate the importance of narrative in day to day psychiatric practice, and how narrative foregrounds the meaningfulness of psychotic experiences, and in doing so facilitates the person's own recovery processes. It also draws attention to the value of long-term work, and work-at-a-distance, in building and developing the trust and intimacy necessary to enable narrative.

Dr Paul Sullivan
Dialoguing with voices in the mind

Dr Paul Sullivan is a lecturer of Social Psychology in the University of Bradford.  He is particularly interested in the links between the individual and the social - and their fracturing - from a phenomenological point of view.

Brief abstract:
In this talk, Dr Sullivan will reflect on Peg’s experiences of hearing voices, as reported by Professor Thomas, using Bakhtin’s ideas around dialogism and voice.  In particular, he will examine how Bakhtin’s understanding of voice, understood as a point of view, relates to two wider distinctions in his phenomenology: ‘Authority-Carnival’ and ‘Spirit-Soul’ (relationship to self and relationship to others).  He will argue that these distinctions help to make sense of Peg’s experiences and draw attention to the role of outside others in helping her find/create her own genuine voice.  He will also look at how Peg’s dialogues extend our notions of internalisation in psychology.

Friday morning, 25 January, 2008
CAT Synthesis

Jason Hepple and Annalee Curran
The Relational Present in CAT – Enactment, Entrapment and Encounter

Biography
Jason Hepple is a Fellow of the Royal College of Psychiatrists and a CAT psychotherapist working in Somerset. Annalee Curran is a CAT therapist and supervisor and is one of the founders of CAT.

Brief Abstract
An awareness of ‘what is going on in the room’ seems to be one of the skills that develops as a therapist matures. Relational awareness and description has always been central to the CAT model and encapsulated as reciprocal roles, which in turn become subject to dialogue in the therapy relationship as mediating signs in both prose and diagrammatic reformulations of the narrative.  

Awareness of enactments of reciprocal role-plays in the therapy relationship and the bringing of these into the dialogue is a core skill of a CAT therapist; avoiding collusion and  introducing the ‘observing eye’ of conscious reflection. Using illustrative material and clients’ own reflections, the presenters aim to add two extensions of the CAT concept of enactment. Entrapment encapsulates the enactment unseen – often reflecting a neglecting:neglected area of the clents’ story – an unconscious collusion or perhaps projective identification between client and therapist. Overcoming these allows the therapy relationship to move to a place where a ‘real’ contact can be made between the whole persons of the client and therapist within the boundaries of the therapy. These encounters may be central to the process of change and transformation both in and following a therapy experience.

Workshops:

Friday Workshop: 15.00 and 16.30
1 Eva Burns-Lundgren and Mark Walker
Title: In Dialogue with the Body in CAT

Biography
Eva is a Consultant CAT Psychotherapist and Oxford CAT Course Director. She has a background in social work in adult mental health and qualified as a CAT Psychotherapist 11 years ago. Eva has recently been involved in running CAT workshops on this topic with Margaret Landale, Body Psychotherapist.
Mark's background is as a Clinical Nurse Specialist working in the NHS. He is a CAT Practitioner and Supervisor and also teaches Taichi and Qugong. Through experience in this area, he has developed an interest in working with the breath, movement and focusing as therapeutic interventions to facilitate mindfulness and identify embodied responses.

Learning objective
At the end of the workshop I will be better able to pay attention to and make use of what the body tries to communicate in therapy.

Brief description
The workshop will use interactive exercises in a playful atmosphere to help therapists stay with and focus on the present moment in CAT therapy sessions. We will work on how to recognise, ‘accurately describe’ and jointly reflect on bodily signs and communications.

Friday Workshop: 15.00
2 Liz McCormick
Title: How to enjoy writing a prose reformulation!

Biography
Liz McCormick has been in private practice as a psychotherapist for over twenty five years. She is a founder member of ACAT, a trainer, supervisor and the author of a number of self-help books including Change For The Better.

Learning objective
By the end of the workshop I will have explored different ways of putting together the initial patient material into accurately described but relaxed and communicative form.

Brief description
This workshop will offer practical exercises to a) help lessen any fear or rigidity around writing and b) loosen the soil of creativity in each participant. Our aim is for a shared new reciprocal role: Expressing joyfully in relation to joyfully expressed! Participants are invited to bring patient material to reformulate.

Friday Workshop: 15.00 and 16.30
3 Norma Anderson Maple
Title: Group relations in CAT terms

Biography
Norma is a Psychotherapist and Group Analyst and a founder member of ACAT, formerly at Guy’s and subsequently Consultant Adult Psychotherapist at HeatherwoodHospital and now in private practice. She has developed an interest in combining CAT tools and skills together with group psychotherapy practice over a number of years and has experimented with various formats both in the NHS and now in private practice.  She has written (with Ian Simpson) about CAT and Groups as well as facilitated workshops on this topic in Finland and, more recently, Greece.

Learning objective
At the end of the workshop, the participants will have explored how relational interactions in therapy groups can be thought about in CAT terms by the group conductor and group members alike and described as written Reciprocal Role Procedures.  These can then be challenged and modified within the group space and thus influence change in relationships outside the therapy room.

Brief description
This workshop will introduce and discuss material from a CAT Group currently operating. This group has been described as a “fast, open group” with the speed and maturity of the group ascribed to the use of CAT tools to enhance containment and vitality. The workshop is also intended to provide a forum for discussion of the various formats of CAT integration with group psychotherapy. Thus conference participants who are currently running (or have run) CAT groups will be particularly welcome.

Friday Workshop: 15.00 and 16.30
4 Rachel Pollard
Title: Bakhtin’s ‘outsideness’ and ‘surplus of vision’

Biography
Rachel is a CAT psychotherapist in private practice. She has been practising CAT since 1996 and has previously worked as a counsellor in higher education and as a psychotherapist in the NHS. Her core professional background is in social work. She has been interested in Bakhtin for several years and wrote her doctoral thesis on the use of Bakhtin in Cognitive Analytic Therapy theory.

Learning objective
At the end of this workshop I will have a basic understanding of Bakhtin’s concepts of ‘outsideness’ and the ‘surplus of vision’ and of some ways in which these could be used to think about and evaluate therapeutic interventions that either strengthen or challenge the therapeutic alliance.

Brief description
Despite the advent of the camera and others ways in which we try to capture images of ourselves, we can never see ourselves as others see us. Similarly we can never see other people as they experience themselves. Bakhtin referred to this radical difference that each individual has in relation to every other individual as outsideness and the unique perspective that this allows us as a surplus of vision that enables us to see and know things about the other person that they cannot see and know for themselves. How therapists use their surplus and the extent and nature of the surplus they have varies according to training, professional background and personal inclination and can have a significant impact on the interventions they make and the nature of the therapeutic relationship. This workshop will explore these ideas using some experiential work and with reference to case material.

Friday Workshop: 15.00 and 16.30
5 Kathie Hostick
Title: At the end of the workshop I will have an understanding of the Parent interview as a technique for impasse resolution.

Biography
Kathie is a Certified Transactional Analyst (CTA), and a Provisional Teaching and Supervising Transactional Analyst (PTSTA). Kathie has a private psychotherapy practice in Hull and is the director of the Ellesmere Centre for Psychotherapy and Training where she runs a psychotherapy training programme. Kathie also works as a psychotherapist within the NHS and has 25 years experience in mental health. She specialises in working with clients diagnosed as having a personality disorder from a developmental and relational perspective.

Learning objective
By the end of the workshop I will have learned about the Ego States model and have some understanding of the 'Parent Interview' technique.

Brief description
As therapists we often experience a sense of 'stuckness' in our clients whilst they wait for the parental projection to change. They often ask questions from a Child ego state such as 'Why did you never love me?' 'Why was I never good enough?' They have a Child belief that the 'parent' will respond with something different and stay waiting and hopeful for this, therefore not pro-actively making changes in themselves.

A Parent interview is a specific technique that is used in conjunction with two chair work. It enables the client to acquire a sense of their parents’ perspective on life. Often this not only provides them with some insight into the questions they ask from a child place, but can also invite sensitivity to their parents’ experience. In this workshop we will briefly look at the underlying reasons for the impasse, observe a short demonstration of a Parent interview and practice the technique.

Friday Workshop: 15.00 and 16.30
6 Maggy Ruppert, Zoe Birchnall, Carole Bruton, Steve Christianson
Title: Enhancing Group Therapy by using CAT tools - a Qualitative Study of a 16-week Group Therapy bringing together Yalom and CAT.

Biography
Maggie is a Consultant Clinical Psychologist, Zoe, Carole and Steve are Nurse Therapists at Waveney Mental Health Partnership Trust.

Learning objective
We have felt enthused and inspired by the experiment and we hope the session will inspire others to try this way of working and to perhaps share other innovative ways of using CAT.

Brief description
We invited six people in a secondary mental health service to take part in an experimental group where we attempted to integrate CAT tools within a group psychotherapy (Yalom style). Paramount was that it was a group therapy not CAT within a group.  This session will show how the experiment unfolded, and what it was like for facilitators and participants alike – including: a live demonstration of being in such a group - subject to sufficient volunteers! We will present the diagrams, group reformulation and ending letters as well as feedback participants gave us in a post-therapy focus group which was taped and transcribed.

Friday Workshop: 15.00 and 16.30
7 Jackie Preston and Sonja Spranger
Title: Incorporating Creative Ideas into CAT: views and experiences from working with adolescents.

Biography
Jackie Preston is a Consultant Clinical Psychologist and Sonja Spranger is a Clinical Psychologist.  Sonja has been working as a Clinical Psychologist in Child and Adolescent Mental Health Service for 7 years in both a generic CAMHS team and a specialist adolescent service.  Jackie has been working in a specialist adolescent service for 5 years and has recently taken up post in a forensic adolescent unit.  They have both trained on the Dorset CAT Practitioner Course with Liz Fawkes.

Learning objective
At the end of the workshop, I will have had the opportunity to experiment using creative and art based approaches and to consider how these might be a useful addition to my CAT practice.  I will also have an understanding of how CAT can be adapted to meet the needs of an adolescent client group.

Brief description
Our experience of working with CAT has been almost exclusively within an adolescent population.  As part of our work, we have had to think about how to adapt an adult therapy model to young people. One of the ways that we have done this is to use creative ideas and techniques (such as masks and self-portraits) in order to engage young people and bring the concepts of CAT alive in the room.  We hope our experience will not only be of interest to those working with adolescents, but will arouse the curiosity of practitioners working in other fields.

Saturday Workshop: 13.30 and 14.40
1 Linda Harvey
Title: The meaning of silence in the therapeutic relationship

Biography
Linda is a founder member of ACAT and has worked as a counsellor/psychotherapist for the last seventeen years. She trained originally as a nurse at the NOC, Oxford, Barts, London and Guys, London and since becoming interested in CAT has obtained degrees in psychology and counselling psychology and is currently pursuing another Masters in psychoanalytic studies.

Learning objective
At the end of the workshop I will have reviewed my understanding/ handling of the meaning of silence in the therapeutic relationship and considered the implications in CAT.

Brief description
Over the years I have supervised a number of therapists and marked even more process reports. It might seem from this experience that, in CAT, silence hardly ever happens! When alluded to it is too quickly referred to as some aspect of a reciprocal role or as very difficult for the therapist. This workshop is intended as an opportunity to refresh ourselves about silence, maybe from recollections of our own therapy as well as those we conduct and consider whether we feel able to accommodate silence in a brief therapy and welcome it as much as dread it. In groups we will construct SDR’s exploring the client/therapist dyad and reflect on the processes from our personal experience of both.

Saturday Workshop: 13.30 and 14.40
2 Steve Potter
Title: When and how to do diagrams together with the client in the room from scratch!

Biography
Steve Potter is Course Director for CAT North and a practitioner training based in Athens as well as co-leading the IRRAPT training.

Learning objective
By the end of this session participants will have more skills in sitting side by side with the client with paper and pencil and mapping and tracking the cognitive, emotional and relational aspects of the client's experience.

Brief description
So what happens when you feel that (pointing to the diagram)? It seems then you can be here and there at the same time? Shall we link that state to this one? If we don't know about that just now are you happy if we just leave a question mark? So that place there is not just in the past, it is still around, and I guess it happened here a bit with us?

CAT diagrams simultaneously serve many purposes and can be done in many ways. They can get very complex and sometimes feel overwhelming or critical to both client and therapist. This experiential session will be a guided, step by step, journey through the processes of building a diagram with one client in the room together. It will show the skills involved in using the making of a diagram to promote empathy, accurate description, therapeutic structure and alliance. Skills in working with the diagrammatic activity as an enactment magnet will be demonstrated as will its power to be experienced as a new reciprocal role involving compassion, curiosity and mutuality.

Saturday Workshop: 13.30 and 14.40
3 Rose Hughes
Title: Plugging in and letting go. The use of expressive art to support CAT patients to connect with their inner world of feeling and consolidate their sense of self.

Biography
Rose Hughes is a Cognitive Analytic Psychotherapist, CAT supervisor, Art Therapist and Art Therapy supervisor.

Learning objective
To provide an opportunity for workshop participants to experience first hand, through an art therapy type art making activity, how individuals can enter into a sense of flow with their art making and through this feel plugged in, so to speak, and connected to thoughts and feelings which may be less directly available on occasion in the patient / therapist dialogue.

Brief description
In CAT we sometimes wonder what tools to use especially in the middle phase of activity and recognition. This workshop will provide a creative therapeutic space for participants to use art materials followed by discussion. This will help us to ‘plug in’ to ourselves in a different way for a while and also allow for reflection of times when this is just what patients might find additionally therapeutic. No expertise in art making required.

Saturday Workshop: 13.30 and 14.40
4 Mary Walsh
Title: CAT and mindfulness: developing the observing self/recognising exits

Biography
Mary Walsh is an experienced Cognitive Analytic Therapist who has been working in the University  of Manchester Counselling Service for a number of years. She is the Coordinator of the Counselling Service groupwork programme.

During the past five years she has offered mindfulness-based groups for staff and students of the university who have presented with symptoms related to depression, stress and anxiety. These interventions are broad-based psychotherapeutic courses/groups that incorporate the key aspects of Cognitive Analytic Therapy (CAT) and mindfulness-based approaches.

Mary currently facilitates three groups per year for students suffering from mild to moderate depression. These groups have 17-22 students in each group; the norm is that there is a less than 10% drop out rate from these groups.

Learning Objective: 
By the end of this experiential workshop, participants will have been introduced to:

• some of the mindfulness practices (both formal and informal) that are offered clinically to a wide range of clients, including those with depression and anxiety
• an exercise looking at what the relational approach of CAT adds to mindfulness therapeutic approaches and how mindfulness–based interventions as a self-regulation approach to emotion management and stress reduction can be integrated with the key concepts of CAT.

Brief Description:
The workshop introduces participants to Mindfulness-Based Cognitive Therapy (MBCT), a treatment that encourages individuals to play an active role in preventing the return of depression by integrating elements of mindfulness-based meditative practice with cognitive therapy.

Saturday Workshop: 13.30 and 14.40
5 Amanda Cassidy
Title: The Masterson Approach to Disorders of the Self - Working with the Disorder of the Self Triad

Biography
We are pleased to welcome Amanda who after gaining a Diploma in Humanistic Counselling in 1994, went on to graduate with a Metanoia MSc in Integrative Psychotherapy (distinction) and then trained with  Judith Pearson and Dr Masterson at the Masterson Institute NY, joining the faculty in 2007.

Learning objective
At the end of the workshop I will begin be able to recognise the expression of Disorder of the Self Triad in my work with clients and be able to think about my response in terms of the Disorder of the Self Triad.

Brief description
In this workshop, Mandy Cassidy will outline how the Disorder of the Self Triad, first identified with ‘so called’ Borderline patients and later extended to Narcissistic and Schizoid patients, manifests in the therapy room. She will illustrate this fully with practical examples from her work. You will then have the opportunity to explore what specific interventions are helpful and why, with each disorder. The main focus will be on the beginning of sessions with patients when the false defensive self is most likely to be presented. How do you work with this in such a way as to allow the Real Self to be expressed?

Saturday Workshop: 13.30 and 14.40
6 Annie Nehmad
Title: The Healthy Self in CAT

Biography
Annie is a founder member of ACAT and a former GP and Women's Health Doctor. Annie runs the CAT service in the City and Hackney. She is also a Solution Focused Therapy Supervisor and Trainer.

Learning objective
At the end of the workshop I will understand the Healthy Self in CAT terms and be aware of ways of eliciting it earlier in therapy.

Brief description
All psychotherapies require some Healthy Self in the client. The sooner we can elicit it and develop it, the more effective therapy will be. This is particularly important in our more challenging or "stuck" clients. The concept of the Healthy Self has not yet been theorised or developed sufficiently in the CAT literature. This is a contribution to this development.

Saturday Workshop: 13.30 and 14.40
7 Dr Alison Jenaway
Title: The Human Givens Fast Trauma and Phobia Cure

Biography
Alison is a Consultant Psychiatrist in Psychotherapy. She works using mainly CAT, and some solution focused therapy, with teenagers leaving care in Cambridgeshire, and with the Liaison Psychiatry Team at Addenbrooke’s Hospital, Cambridge.

Learning objective
At the end of the workshop I will have understood, and observed, the Human Givens ‘Fast Trauma and Phobia Cure’.

Brief description
By the end of the workshop you will know a little more about the Human Givens approach to therapy and how that might fit with the cognitive analytic model.  You will have heard about the Human Givens “Fast Trauma and Phobia Cure” and observed and understood this technique of visualisation under relaxed conditions which is used for treating traumatic flashbacks and phobias (provided someone from the audience volunteers to try it!).  Alison will also describe a case where she has used this technique during a CAT therapy.

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