Dr. Kerry Manson, Consultant Clinical Psychologist, presented 'Delivering CAT in a Prison Setting'. Kerry manages a Primary Care Psychological Service in a large, local Victorian prison, using a stepped care model of service delivery which offers low intensity interventions on the wings, counselling, CBT and CAT. Kerry provides CAT at Step Four. She tends to see prisoners with personality issues, type II trauma and anger problems. Despite the complexity of this client group CAT is demonstrating effectiveness. Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is used as an outcome measure for all clients within the service. An analysis of 29 completed CAT cases found that the average pre-therapy score mean was 1.86 (clinically significant) and the average post therapy score mean was 1.17 (non clinically significant). Although Kerry’s service focuses primarily on the 'psychology of distress' rather than 'the psychology of offending' there is an unavoidable cross-over at times and the CAT formulation is essential for holding in mind both the abusing and abused aspects of the individual. There was also a discussion regarding the necessity of simplifying CAT formulations in this setting and seeking advice from our CBT colleagues and colleagues working with people with Learning Disabilities in order to do this. Using CAT to manage wider systemic issues when dealing with difficult dynamics in a prison setting was also discussed.
Dr. Tanya Petersen, Clinical Psychologist, Ashworth High Secure Services, followed with a presentation entitled "CAT on a Neuropsychological Ward: an Integrative Approach to Cognitive Neuro-rehabilitation". The presentation described the use of CAT as a systemic and consultational model with nursing staff and the clinical team in the neuro-cognitive service at Ashworth. Tanya considered how the principles of CAT are applicable to a cognitive rehabilitation approach. The primary focus of cognitive rehabilitation does not necessarily capture the individuals’ personal history and therefore the individuals’ personal narratives may be lost. CAT provides an understanding of "challenging" behaviours and cognitive deficits within the context of an individual's life and associated adverse experiences. CAT considers the intra-psychic and relational aspects of behaviour, effectively adding a “third dimension” to our understanding of presenting difficulties. The cognitive rehabilitation model is used as a ward approach at Ashworth. With this in mind, Tanya explored how the process of CAT formulation within this context is relevant. The collaborative nature of developing a diagrammatic reformulation enables staff to develop their understanding of formulation while retaining a sense of ownership and inclusion throughout the process. Sharing of CAT formulations allows for a safe, non-threatening and non-judgemental discussion of reciprocal roles with staff, and of how these may be re-enacted between patients and staff. Moreover, the “wider clinical picture” provided by systemic diagrammatic reformulation allows for easier generation of exits by teams. To illustrate the use of CAT in a neuro-cognitive setting, Tanya presented a case example.
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