A qualitative study using online interview methodology to explore the therapist’s experience of endings in CAT, with a particular focus on what makes for a good ending process.

Given the emphasis within the CAT model of the therapeutic value of endings this was deemed an important area to explore. A review of the literature review revealed different theoretical models of endings and the study describes the role of endings within CAT in relation to these models before moving on to consider factors impacting on endings in therapeutic practice. There is a bid within the literature for more qualitative research using in-depth interviews. This qualitative study therefore explored endings in CAT from the perspective of the therapist using online interview methodology, with a particular focus on what makes for a satisfactory ending process. The client’s experience of endings is seen as an area ripe for future investigation.

Eleven participants were involved in the study, recruited from a local mental health care NHS trust and ACAT membership.  The research generated extensive interview data that were subjected to an Inductive Thematic Analysis. Four over-arching themes emerged; ‘Experience of the CAT model in ending’, ‘A good enough ending’, ‘Complex endings’ and ‘Something to go on to’. These themes and related sub-themes are described and illustrated by direct quotation, providing a rich illustration of the therapist’s experience and views on endings in CAT, which are likely to have relevance in the development of thinking and practice.

Several of the themes are discussed further and considered in relation to the literature, including the ‘experience of the model’, which has three strands. Firstly, the role of reformulation in endings, secondly, the time-limited CAT model and related tensions, and thirdly, issues regarding follow ups. ‘Complex endings’ and the notion of the client having ‘something to go on to’ are also discussed, along with a consideration of what makes for a good ending process.

Recommendations are made stemming from the study. These include the importance of a detailed and comprehensive assessment prior to CAT, the potential implementation of workshop and training events to explore issues around endings, the value of supervision and support, and especially after complex endings or client drop out, and further research into more specific aspects of the ending process, including exploration of when therapist’s introduce flexibility and depart from the model, the use of CAT within teams and organisations and, importantly, the client’s perspective with regards to the ending process.

The research, which stems from a personal interest in endings, was conducted in partial fulfilment of the Inter-regional Residential ACAT Psychotherapy Training (IRRAPT) course. It has therefore been written up in dissertation format. I intend shortly to submit a paper summarising the study, findings and recommendations to ‘Reformulation’ for potential publication. In the meantime I would be happy to forward a more detailed summary of the research to those interested.

Dr Julie Wilkinson
Clinical Psychologist and CAT Psychotherapist
For further information:
Please contact: Julie Wilkinson || email: julie.wilkinson10@nhs.net

January 2012

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