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CAT Skills Training in Mental Health Settings

Freshwater, K. and Kerr, I., 2006. CAT Skills Training in Mental Health Settings. Reformulation, Summer, pp.17-18.

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Some of the background to a project in Sheffield which developed and delivered a skills level package and which has been delivered to all sector community mental health teams in Sheffield in the context of a larger trial of treatments for personality disorders (outlined on the School of Health and Related Research (SchARR) web site at the University of Sheffield) has already been described in Reformulation (de Normanville and Kerr 2003). It has also been more extensively written up and evaluated for publication elsewhere (Donnison et al and Kerr et al) and will not be repeated here. This package has also been more formally accredited by ACAT as a skills level training which may be delivered around a core format as authorised by the training committee (see Training Committee minutes May 2005). This apparently largely successful and welcome training initiative and comparable ones elsewhere (e.g. in Lancashire led by Dawn Bennett) has led to further interest in delivering and developing similar packages in other contexts.

Experience of attempting to develop and deliver this type of training to colleagues in the Tees, Esk, and Wear Valleys NHS Trust (TEWV) was summarised and presented by Kate Freshwater. The aims of this project had been to increase the psychological skills of secondary care mental health staff and to support staff in their challenging work with “complex/BPD” clients. It was hoped that staff would be able to use the CAT model as a framework to develop their skills of psychological formulation: - to identify and describe the RRPs of clients and to limit/avoid collusion or reciprocation.

Over the past two years, the CAT Service of TEWV has delivered nine such trainings (entitled “CAT & complex people”) to staff teams including crisis teams, CMHTs, an eating disorders team, and a team for people with a PD diagnosis.

The teaching consisted of two days (or four half days – according to team preference), with the offer of follow-up monthly CAT-informed supervision/case discussion which was taken-up by three teams. Small-scale evaluation indicated that the majority of staff expected to make use of CAT in their clinical practice and 89 percent wished to learn more about CAT. More qualitative feedback reported changes following the training including:

Clinical Practice: improved understanding of and communication with clients, better preventative work due to CAT aiding prediction of behaviour patterns and the possible consequences of intervention, better management and reflection when closing down contact at discharge, using diagrams with clients, using the concept of “exits” with clients who are stuck which enabled a sense that more interventions were possible.

Staff’s thinking about clients and their relationship with them: using the concept of “reciprocal roles” when discussing clients in hand-over, more understanding of own (often difficult) feelings towards clients, increased awareness of the concept of “unmanageable feelings”, diagrams helping to clarify confusion and identify where staff are on the map.

Team Functioning: Using CAT terminology when communicating with other team members – more of a “shared language”, CAT enabled a more consistent approach and closer communication between team members, increased awareness of how the team and other services may fit onto clients’ diagrams.

This experience of working with the teams has been most rewarding for the CAT Practitioners of TEWV, some team members now attend a weekly supervision group on a CAT case and two staff are currently applying for practitioner training. It is noteworthy that the majority of staff seemed able to grasp the concepts and skills taught e.g. Many were able to reflect upon their own counter transference responses despite this being unfamiliar or alien to their “objective”/professional training. However, the trainers were also struck by staff who had no/or a limited account of the client’s early years/personal history – indicating a possible need for future training in assessment from a more social psycho-developmental perspective. Drop-out from monthly team supervision became a difficulty with two teams. Reasons given included pressures of job roles such as workload, crises and staffing problems overriding supervision, monthly meetings being too infrequent to maintain, staff preference for other therapeutic models, and various pressures on staff to train in CBT including managerial interpretation of the NICE Guidelines and the staff’s personal development need to attend accredited courses.

The trainers also felt some anxiety as to whether managers or the staff themselves may regard the training as a short-cut to practising CAT therapy, despite clarity over its aims. To date they are aware of only one staff member declaring to be a “CAT therapist” following the training, and this individual may well have made this claim even without their input!

The CAT staff of TEWV are hoping to move towards extending the training to a similar model to Sheffield, seeking accreditation by ACAT, and completing a more robust evaluation. It is hoped that this will add clarity to the aims and function of the training, increase managerial support to enable staff to commit to training and supervision, and meet the accredited training/developmental needs of some staff.

The animated and engaged discussion by many participants at the workshop seemed to indicate considerable interest amongst various colleagues from diverse settings to become involved in running such trainings and a need for them. However one clear problem appeared to be that of persuading colleagues and managers of the usefulness of such trainings and in consequence of the need for formal evaluation of such trainings and their impact and subsequent publication along with that more generally of further formal CAT research. It did seem clear that participants felt that to become actively involved in such trainings and in helping develop more therapeutically and interpersonally literate generic services could be both timely and rewarding.

Kate Freshwater
Consultant Clinical Psychologist and CAT Practitioner in Middlesbrough.

Ian Kerr
Consultant Psychiatrist and Psychotherapist in Sheffield.

References

De Normanville, J. and Kerr, I.B. (2003). Initial experiences of a CAT skills level training in a CMHT. Reformulation, 18; 25-27. (Available through www.acat.me.uk ).
Donnison, J, Warnock-Parkes,E., Thompson, A.R., Kerr, I.B., Turpin, G. and Turner, J. An evaluation of the impact of a brief ‘skills level’ training course in cognitive analytic therapy (CAT) with multidisciplinary community mental health team (CMHT) staff (submitted).
Kerr, I.B., Parry, G.D., Pickvance, D., and Turner, J. A cognitive analytic therapy (CAT)-based skills level training in working with ‘difficult’ and personality-disordered patients for generic community mental health team workers: rationale and description of training package (submitted).
NB Copies of papers currently submitted for publication may obtained in due course to those interested from IK. 

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Freshwater, K. and Kerr, I., 2006. CAT Skills Training in Mental Health Settings. Reformulation, Summer, pp.17-18.

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