Main Conference page: http://www.acat.me.uk/event/890/
Please note that times and contents may be subject to change
Once you have booked to attend the Conference, please select to attend one workshop on each day (if applicable).
Please return to your ACAT home page to access the link to book workshops.
Wednesday 20th September 14:00 - 16:00
1 Steve Potter, Rabhya Dewshi, Lee Crothers, Marie-Anne Bernardy, Lucy Cutler, and Ivona Amleh ~ ‘Innovations in writing the reformulation letter: Side by side, off the map, bit by bit, from a template’ (Chair: Liz McCormick)
2 Louise McCutcheon and Emma Burke ~ ‘Applying a developmental perspective to CAT with complex problems in young people’
Thursday 21st September 13.30 - 15:00
1 Liz Fawkes and Dawn Bennett - 'A glimpse into 40 sessions: Use of self and challenges to the therapist’s sense of self in working with powerful enactments with clients who have had a raw deal in life’‘
2 Deirdre Haslam - ‘Working with, and resolving impasses and ruptures in the therapeutic relationship’
3 Esther Gimeno - ‘Threats of therapeutic rupture: The “Ghosts” of the therapist’
4 Vikki Ryall - 'A pragmatic approach to including families in CAT therapy using the SSFC model’
5 Alison Jenaway and Carol Gregory - ‘Let’s get physical – getting physical symptoms on the CAT diagram’
6 Vicky Petratou - ‘Feeling stuck in a powerless, ‘victim’-like self-state, how can creative CAT help with embracing the pain and exploring more dialogically useful ways of interacting?’
7 Nicola Crook - ‘Landing in another country with CAT: Use of the model in nurturing self-care’ || Matti Kurronen - 'TRE (Tension, Stress & Trauma Release Exercise) for Psychotherapists and Clients' ~ comfortable clothing recommended (NB two workshops will be presented within this one session)
8 Tim Sheard - ‘How do we relate to our bodies in CAT: Positively included, taken for granted or thrown to the dogs?’
Friday 22nd September 13:30 - 15:00
1 Jay Dudley - ‘Bridging the relational space - towards a new beginning’
2 Ann Treesa Rafi - ‘Cognitive Analytic Therapy for the wise old ‘Dadaji’* in India’ || Eleftheria Zampouridou - 'Recovering from substance abuse: The CAT effectiveness of Building Relapse Prevention and Life Skills' || Päivi Räisänen - 'Applying CAT to a father of three with substance and sexual addiction problems’ (NB three workshops will be presented within this one session)
3 Eeva Joki - ‘The power and dark shadows of leaders’ || Rita Toli - 'Applying CAT in a Greek primary school' (NB two workshops will be presented within this one session)
4 Louise Elwell - ’Reformulating Emptiness: how may we work actively with states of emptiness, desolation and boredom?’
5 Kerry Manson, Marisol Cavieres and Sunil Lad - ‘Developing a CAT understanding of Anti-social Personality Disorder (ASPD): Eliciting key reciprocal roles’
6 Jennifer O’Brien and Fritha Melville - ‘Using experiential and creative approaches to contextualise workplace stress and support self-care practices for helping professions’
7 Paul Johanson and Sara Casado - ‘Loving the unlovable: CAT, compassion and working with people who commit sexual crime’
With apologies, please note that Christina Hardy's workshop has been withdrawn: Envy: Green-eyed Monster or Desire for Equality. If you have booked to attend this workshop, it will be possible to change your choice via your personal home page as before.
Wednesday, 20th September 2017 | 14:00 – 16:00
1. Steve Potter (UK), Rabhya Dewshi (UK), Lee Crothers (Australia), Marie-Anne Bernardy (France), Lucy Cutler (Jersey), and Ivona Amleh (Palestine)
‘Innovations in writing the reformulation letter: Side by side, off the map, bit by bit, from a template’
An international group of contributors will showcase and explore their innovations in the use of writing in reformulation and invite participants to try them out. Those taking part can join us in a practice-based international research group to further evaluate innovations in reformulation writing.
Rabhya Dewshi is a clinical psychologist and CAT practitioner based in Oxford, and working with adults and children, in a variety of contexts including schools and courts, and using a variety of models including CAT informed writing.
Marie-Anne Bernardy-Arbuz is a clinical psychologist and psychotherapist, working in an outpatient clinic attached to the department of psychiatry for children and adolescents at Robert Debré Children’s Hospital in Paris. She is interested in the parent/child relationship.
Ivona Amleh is a psychiatrist and a CAT enthusiast. She works in Bethlehem, Palestine and finds different modes of therapeutic writing a potent medium for encounter and change.
Lee Crothers is a CAT therapist based in Melbourne Australia and is Director of In Dialogue.
Steve Potter is a CAT psychotherapist and is based in London. He is involved in using mapping and writing as a part of a continuous co-creative therapeutic process.
Lucy Cutler is a clinical psychologist working in Jersey. Lucy's presentation will be 'words for childhood need'.
2. Louise McCutcheon and Emma Burke
‘Applying a developmental perspective to CAT with complex problems in young people’
Adolescence and young adulthood is a “demographically crowded phase of life” with change occurring across a wide range of domains. Increasingly CAT is being used effectively with young people, but many clinicians feel they need to modify how they deliver CAT to suit these clients. We know that some clinicians delay the reformulation letter or simplify their diagrams, but how do they know what to do and when to do it? In this workshop, we will consider how the use of a developmental model might help us to reflect on how and why we might modify and adapt our CAT for the young individuals we are working with. In particular, we will focus on keeping collaboration at the forefront to engage young people, and to explore what might be a ‘good enough’ therapy experience.
By the end of this workshop, participants will have: considered how a developmental framework might assist them in offering CAT to young people; considered what aspects of ‘traditional’ CAT might need adapting; have some ideas about how they might adapt their work to better meet the needs of young people.
Louise McCutcheon is a clinical psychologist who jointly founded the HYPE programme, a CAT-informed early intervention programme for BPD at Orygen Youth Health in Melbourne Australia. She is a CAT practitioner, supervisor, and trainer, and developed the Australian CAT training programmes in Melbourne. She is also the founding chair of ANZACAT. Louise presents the work of the HYPE programme nationally and internationally, and works with adolescent and youth mental health services to develop CAT-based early intervention programmes around the world.
Emma Burke is the coordinator of the HYPE programme at Orygen Youth Health. She is a CAT practitioner and supervisor, and has been using CAT with young people with complex problems and their families for the past 10 years.
Thursday, 21st September 2017 | 13:30 – 15:00
1. Liz Fawkes and Dawn Bennett
‘A glimpse into 40 sessions: Use of self and challenges to the therapist’s sense of self in working with powerful enactments with clients who have had a raw deal in life’
This workshop is dedicated to and celebrates the work of Tony Ryle. He supervised the CAT therapy delivered by Liz and was active in Dawn’s research on a CAT model of enactment resolution.
Accessible accounts of the process of psychotherapy combining different perspectives are rare. The workshop gives glimpses into a 40 session Cognitive Analytic Therapy (CAT) with a woman with multiple problems who met the diagnostic criteria for Borderline Personality Disorder. Audio of the case material illustrates the challenges for client and therapist. Liz as therapist and Dawn as researcher aim to put flesh on the framework of the enactment resolution model that was developed with Tony. We hear his voice in the supervision of this therapy and in the guidance the model offers when working with powerful enactments in the therapeutic relationship. The workshop considers what CAT has to say about being authentically present in our work, yet not ‘rescuing’ and whether we can walk that fine line. It examines what CAT therapists ‘do’ and how we use the tools and the model to get our bearings when tested personally. We hope the workshop helps you to examine the integration of model with our own stance and personal style so that we can offer a meaningful connection in a relatively short therapy
• The first enactment will be used to set the scene
• Dawn will present an overview of the enactment resolution model and point out what she thought Liz as therapist did to manage this
• Further illustrations of key moments from the therapy will be presented by therapist and researcher as we extract some key moments in sustaining an alliance to allow change
• We will invite your reflections as to whether this is what Tony intended CAT to be
• Bennett, D., Parry, G. & Ryle, A. (2006); ‘Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: A task analysis. Psychology and Psychotherapy: Theory, Research and Practice’, 79, 395-418
• Liz Fawkes & Val Fretten (2017); ‘The use of the CAT model in the supervision of CAT therapists working with borderline personality disorder. In Cognitive Analytic Supervision: A relational Approach’, Ed Deborah Pickvance
Liz Fawkes is a CAT Psychotherapist, Supervisor and Trainer, and Clinical Lead for CAT in Somerset Partnership NHS Foundation Trust. She is Course Co-Director for the Somerset CAT Practitioner Training, and teaches on the DClin Psych CAT module in Exeter, as well as offering ad hoc CAT training days on other courses. She has recently taken up the role of Chair of ACAT Training Committee. She has long enjoyed working with people with a personality disorder, both in CAT and formerly leading a front-line personality disorder service, and recently took a step down from a senior management role in order to concentrate on CAT again. She co-wrote the chapter in the new CAT Supervision book with Val Fretten, based on work supervised by Tony Ryle. CAT Lead - Somerset
Dawn Bennett is a Consultant Clinical Psychologist, Lancashire Care NHS Foundation Trust. She is an ACAT accredited CAT psychotherapist, trainer and supervisor and Course Co-Ordinator for the CAT North course and Vice Chair of ACAT Training Committee. She is actively involved in CAT training and supervision and particularly values the CAT model for how it allows us to work with process issues. Her doctoral research was on formulation, alliance threats and therapist competence in CAT for borderline personality disorder. Her subsequent research developed a CAT competency measure (C-CAT). She rated this therapy on C-CAT in an NHS study of the efficacy of CAT in usual practice.
2. Deirdre Haslam
‘Working with, and resolving impasses and ruptures in the therapeutic relationship’
I will begin by providing an example from my own practice regarding impasses and ruptures and how I addressed these. I will then invite participants to reflect on this before suggesting ways to resolve such ruptures and breakdowns in the future. Together we will formulate a set of suggestions for future practice.
Learning outcomes: learning from practice; formulating strategies for future practice.
Working creatively with complexity: the very nature of the presentation invites being creative with the material. I will make reference between theory and practice by reference to the former when providing material from my own practice and subsequently by inviting participants to reflect on their own practice in relation to theory.
The presentation will begin with my making use of my own clinical material, before inviting participants to reflect on their own practice before coming up with a set of strategies for future practice.
Using experiential exercises participants in small groups will reflect on their own experiences of ruptures to the therapeutic relationship with the aim of being able to apply this learning in their own clinical work.
Deirdre Haslam has been a member of ACAT since its inauguration. She has, in the past, been a workshop presenter and has also been a supervisor on a number of the trainings provided by ACAT. At present she both works as a CAT practitioner in private practice as well as offering supervision both to trainees and also the members of ACAT.
3. Esther Gimeno
‘Threats of therapeutic rupture: The “Ghosts” of the therapist’
Although threats to therapeutic rupture are an inherent part of working with difficult patients, there are certain types of patients whose resolution is especially difficult. This is the case of working with personality disorders or trauma patients.
We propose different situations and real cases of threat to therapeutic ruptures and roles with which you can collude frequently in therapy.
The aims of this workshop are:
• To discuss the main roles with which it is easy to collude in each type of patient (illustrating with real cases and diagrams).
• To bring specific techniques to avoid colluding and take distance or regulate ourselves.
• To discuss ways to treat with the patient and explain it, when collusion has been done.
Link between theory and practice will be considered through the employment of diagrammatic reformulations to illustrate the collusions. Reference to clinical material will be made by presenting and discussing real cases and situations.
Esther Gimeno Castro: General Health Psychologist; CAT Skills Training Level.
4. Vikki Ryall
‘A pragmatic approach to including families in CAT therapy using the SSFC model’
Family inclusion is accepted as a key element of an effective response to people experiencing mental health difficulties. Family support is protective generally and during a person’s care it can improve their engagement in treatment. Further, there is strong evidence that family interventions can lead to improved outcomes for the person. Despite the importance of family to a person’s well-being, there are significant barriers to their routine inclusion in mental health care, and so the full potential of family involvement is often not realised. One such barrier has been the lack of integrated and effective models that support the inclusion of family and align with effective individual treatment model/s.
The routinely involvement of families in CAT therapy with young people has been a priority across public mental health, primary care (headspace) and private practice. In 2016 whilst attending Single Session Family Consultation (SSFC) training sessions repeatedly; the alignment of SSFC with CAT became increasingly evident. Further, the practical support the SSFC framework could offer as a way of improving what families are offered seemed strikingly doable.
In this workshop I will outline the SSFC framework, discuss it’s alignment with CAT, describe how I have come to routinely incorporate SSFC into my CAT therapies, provide several case examples to demonstrate the integration, and offer some initial reflections on what CAT might offer SSFC and vice versa.
Vikki Ryall joined headspace, the (Australian) National Youth Mental Health Foundation in 2009. She is an accredited mental health social worker who is trained in a range of different therapies. Vikki was part of the inaugural CAT training in Australia in 2003 and is now a CAT supervisor and member of the ANZACAT executive. Vikki is enthusiastic about the value of CAT psychotherapy in her work with young people. She is keen to extend the use of CAT in working with young people through other modalities such as consultation, and online and family work. Vikki has extensive experience in management and clinical leadership in youth mental health organisations and has worked in youth mental health for most of her 20-year career. Vikki has extensive clinical experience with young people who are difficult to engage, high risk and present with complex needs in public mental health, primary care (headspace) and private practice. Vikki has published articles about high risk young people and presented at conferences in this area.
5. Alison Jenaway and Carol Gregory
‘Let’s get physical – getting physical symptoms on the CAT diagram’
In this workshop, we will be thinking about how physical symptoms and psychological issues interact and exploring different ways in which they can be included in the CAT reformulation process, and in particular placed on the CAT diagram so that they are available for reflection rather than seen as a fixed problem.
We will present a relational model of physical health issues (both medically explained and unexplained) and briefly describe a few of our own cases to illustrate the different ways in which physical symptoms can appear on the map. We will then present a case in more detail, and encourage participants to create a CAT diagram in small groups which includes the patient’s physical problems.
Alison Jenaway is a consultant psychiatrist in medical psychotherapy in the liaison psychiatry department of Addenbrooke’s hospital. She uses CAT with patients referred from the physical health teams with both explained, and unexplained, physical health problems.
Carol Gregory is a consultant psychiatrist and is trained in both CAT therapy and psychodynamic therapy.
Alison and Carol work closely together, and have been exploring the use of CAT as a reflecting tool for physical health staff.
6. Vicky Petratou
‘Feeling stuck in a powerless, ‘victim’-like self-state, how can creative CAT help with embracing the pain and exploring more dialogically useful ways of interacting?’
In this workshop we will explore the use of creative means to help our clients gain perspective and freedom from habitual ‘victim’-like self-states which limit their potential for moving towards making more proactive choices in life.
A common problematic relational pattern that we are often challenged with in therapy is the dilemma: ‘either you are with me (as an ideal other who can read my needs and meet my needs perfectly) or against me (my enemy, someone deserving punishment and alienation)’. Many of our patients with complex psychopathology, who have experienced repeated harsh and/or narrow problematic reciprocal relationships, are often highly attached to their victimized self-states. Frequently such self-states are fuelled by a sense of injustice, betrayal, entitlement and a difficulty in noticing the problematic impact of their interpersonal reactions. Building and maintaining trust in therapy is a common and often painful challenge. How can we creatively work with such states in CAT to promote freedom to engage with more choices in life?
We will also address specific difficulties when working with the angry/hungry/needy victim self-states that problematic dilemmas can often foster. We will explore relevant philosophical and mythological concepts on fortune, love and failure, review clinical cases, and engage in experiential activities (using art, movement and/or role-playing techniques) to shape ways of working creatively to help our clients identify and promote dialogue between their partially dissociated, self-states.
Vicky Petratou is a Cognitive Analytic Psychotherapist, supervisor, trainer and a drama therapist. She has been practicing CAT for more than 20 years. She works as a Psychotherapist and Clinical Supervisor in private practice and for the NHS (at the Munro Clinic, Guy’s Hospital, London). She is a tutor and a marker for the IRRAPT Cognitive Analytic Psychotherapy Course and the St Thomas’ Practitioner Course. Originally, she comes from Greece, has a background in psychology and physical theatre, and is interested in exploring how philosophy, mythology, embodied playfulness, and artistic expression can enrich the practice and theory of CAT.
7a Nicola Crook
‘Landing in another country with CAT: use of the model in nurturing self-care when integrating into a new job and country, New Zealand ‘
Arriving in New Zealand from the UK has been one big adventure! It has bought many a new experience in both my professional and private life. These have been both exciting and liberating whilst also sometimes highly challenging. Adapting to a new job as a Clinical Psychologist has required working with new systems, practices and structures, cultural differences and working relationships. This in itself has been testing at times, whilst also managing personal problems, especially when your usual supports are no longer within the same time zone! I aim to share with you how my own experiences of using CAT tools, namely letter writing and mapping, have served as an anchor for me when feeling lost at sea. I intend sharing my personal journey as to how these have contributed to my own self-care when negotiating unchartered waters. The workshop aims to give participants a ‘mini’ experience of using these tools.
Nicola Crook is a UK trained Clinical Psychologist and CAT Practitioner with experience of working in an Adult Community Mental Health Team in the UK National Health Service (NHS). She has experience of working for the Mental Health, Addictions & Intellectual disability Service 3DHB in Wellington, New Zealand. She has worked within the Adult Community Mental Health Team here and is currently working for the Regional Personality Disorder Service (RPDS). She has experience of using CAT both individually and in group settings. Nicola has worked mainly with people presenting with severe and enduring mental health needs, including personality disorder. She has become increasingly interested in the application of compassion (CFT; Paul Gilbert) to her clinical work. Nicola completed her post graduate diploma in Cognitive Analytic Therapy in the UK in 2013.
7b Matti Kurronen
‘TRE (Tension, Stress & Trauma Release Exercise) for Psychotherapists and Clients ‘
TRE® is an innovative series of exercises that assist the body in releasing deep muscular patterns of stress, tension and trauma.
It safely activates a natural reflex mechanism of shaking or vibrating that releases muscular tension, calming down the nervous system. The body is encouraged to return back to a state of balance.
For psychotherapists, the implicit part of the work often goes unnoticed. The toll of the work shows in tiredness and tension. At worst, the sense of meaningfulness in work fades and family life suffers. Many psychotherapists in Finland have really taken to TRE. They use it regularly as a tension reliever.
In this workshop, the participants get to experience how a TRE exercise works and get something concrete that they can take into their repertoire of self-care:
• how psychotherapists can promote client’s trauma work
• how psychotherapists can take care of one’s welfare
• demonstration of exercise in which participants take part
Comfortable clothing recommended
Matti Kurronen has been a CAT Psychotherapist for ten years, work and organisation psychologist, lecturer at the University of Applied Science (social work), and FINCAT president.
8. Tim Sheard
‘How do we relate to our bodies in CAT: Positively included, taken for granted or thrown to the dogs?’
In this workshop we will give attention to how we relate to our bodies and with our bodies in CAT. In sessions with a client do we identify with our body as a relational subject, see ‘it’ as an object, as some kind of servant, or ignore it? Put in CAT language do we experience our relationship with our bodily selves as self-to-self or as if self-to-other? Does this matter, is this relevant to CAT? It is suggested that it can be vital when working with stuck or difficult therapeutic process, particularly with those suffering from developmental relational trauma (‘borderline’ or ’PD’). We will begin to explore our bodily experiences when working with challenging process and how core problematic reciprocal roles may be experienced on a bodily level as ‘embodied counter-transference’. If this experience is marginalized or ignored then it can become a form of collusive reciprocation that will harm not only the therapeutic process but also lead to a bodily burdening of the therapist. On the other hand if we can creatively include our capacity to relate and attune through embodiment then this can support a freeing up of the therapeutic relationship and creative engagement with unmanageable experience.
This workshop will focus on beginning to map out the landscape of:
• Our relationship with our therapeutic bodies
• How much our bodies may be implicated in our work, particularly with developmental trauma
• How we may be carrying an unrecognized burden through our bodies
We will begin to look at the possibility of a more creative inclusion of our embodied relational capacity in CAT, but there will not be time to introduce positive embodiment skills that can be developed to address these issues.
The workshop is largely experiential, with some theory included as we go along. Strong fluency in English is therefore not required.
Tim Sheard is a CAT psychotherapist working in the UK and offering workshops and short trainings in integrating embodiment into CAT. A paper in the summer 2017 edition of Reformulation outlines this approach in more detail.
Friday, 22nd September 2017 | 13:30 – 15:00
1. Jay Dudley
‘Bridging the relational space - towards a new beginning’
The workshop is aimed at those working with complex personality disordered patients, eating disorders, and OCD.
‘A word is a bridge thrown between another and myself’ (Voloshinov)
I will explore the sense of ‘materiality’ (Leiman) inherent in this statement. Ruptures and enactments will be understood in the context of the ‘dialogic tension’ between ideas and beliefs that hold ‘me’ from ‘not me’ and hinder change.
Bakhtin’s premise that ‘the word wants to be heard’ will be explored alongside his idea that this is possible only where the other (therapist) adopts a position of ‘responsive understanding’.
These ideas will be set against an early environment of ‘missing parental provision’ (I will give a brief overview of CAT’s Object Relational frame through the lens of Winnicott, Balint, and Fairbairn).
Ideas surrounding the emergence of a ‘false self’ construction (CAT’s compensatory position) or a ‘something rather than nothing’ survival/defence will be explored using clinical material from 2 cases (one chronically OCD and one BPD) to explore in detail with CAT maps.
I will argue that the tensions between familiar RR’s that ‘demand’ our loyalty or allegiance, and the fragility of an unknown ‘new beginning’ are where change is forged.
CAT Exits: A ‘new beginning’ (Balint) may occur if the therapeutic relationship is located in the language and gesture of ‘responsive understanding’ (Bakhtin). For change, in the form of new ideas, beliefs or internalised ‘good objects’, to be sufficiently ‘internally persuasive’ (Burkitt and Sullivan), we need to understand the underlying processes that can help to hold and contain. I will develop an original metaphor of a ‘keystone’ to help understand this in more detail and offer some connections between the ‘two-sided nature of words’ and ‘meaning bridges’ (William Stiles; Stephen Mitchell). My aim is to bring a fresh focus and deeper understanding to exits.
Jay Dudley is a CAT Psychotherapist and Supervisor, and previous Trainer and Course Co-Director for Somerset CAT Practitioner Training. He has presented CAT case vignette at the Royal College of Psychiatrists Conference (2015). Jay is presenter for two one-day workshops for CAT South West, and visiting Trainer on the Exeter DClinPsych CAT Training. He is currently working as Principal Adult Psychotherapist, Personality Disorder Service, Devon Partnership NHS Trust, and is in private practice.
2. ICATA Masterclass: case presentations from around the world.
2a Ann Treesa Rafi
‘Cognitive Analytic Therapy for the wise old ‘Dadaji’* in India’
Cognitive Analytic Therapy (CAT) is a relatively new psychotherapy model that was founded by Dr Tony Ryle in the early 1980s. It was introduced in India in 2011 and the Indian Association for CAT was launched in 2012. The ICAT is still in its early stages and is being established in Bangalore. CAT provides a therapy model that views the self as both socially constructed and also a part of the social environment. A relational model such as CAT enables the therapist to work creatively, integrating both cultural and religious values into one’s work where by the client is viewed from a holistic perspective.
This paper outlines the progress of a client, who presented with the issues of alcohol use and excessive watching of pornographic material. It elucidates the application of CAT by identifying reciprocal roles, procedural sequences and mapping exits over a 16-session CAT. The current case was in a culture where elders are considered the wisest and the head of the family. Advice is sought from them on issues that include intra-family conflict and their decision is the final one. In this case the client, an elderly gentleman aged 75, was seeking therapy from a female counsellor who was much younger which would be considered rather unusual in this culture. The paper also highlights the changing client-therapist relationship over the course of therapy.
Cultural struggles around the use of pornography by an elder and overcoming one’s own challenges and prejudices as a therapist, learning to position oneself in a more compassionate role both for the therapist and client is highlighted through this presentation.
(*Grandfather in Hindi)
Ann Treesa Rafi, M.Phil, M.Sc. (Counselling psychology) is an Assistant Professor of Psychological counselling at Sampurna Montfort College. She is involved in training students in counselling psychology and also works as a counsellor in the Montfort Counselling Centre. She has conducted various training programmes and workshops on topics like communication, relationships, stress management etc. She is interested in the inclusion of cultural symbols in therapy to make it more culturally-sensitive.
Ann has been using Cognitive Analytic Therapy extensively in her clinical work adapting the model further to fit well with the Indian Society and culture. She has an interest in understanding how relational procedures can be presented symptomatically as addictions and abusive behaviours. She has presented at various conferences in India and is a member of the Indian Association for Cognitive Analytic Therapy.
2b Eleftheria Zampouridou
‘Recovering from substance abuse: The CAT effectiveness of building relapse prevention and life skills’
Beyond the detox and stabilization phases of any addiction treatment program, are the crucial practices that address the individual’s needs to sustain abstinence and recovery efforts once treatment coming to an end.
The CAT approach: in order to Enhancing Motivation for Change in Substance Abuse Treatment, to provide incentives for individual to remain abstinent, to understand and modify his attitudes and behaviours related to drug abuse, to develop balance and alternative ways of coping with stressful circumstances, to focus on ways of making better future choices.
Dr Eleftheria Zampouridou is a Consultant Psychiatrist - CAT Psychotherapist, Head of Kavala Substitution Treatment Unit, Greek Organisation against Drugs (ΟΚΑΝΑ)
2c Päivi Räisänen
‘Applying CAT to a father of three with substance and sexual addiction problems’
In this paper, making reference to recorded transcripts of the work, I highlight the successes and challenges of using Cognitive Analytic Therapy to help a married father of three who presented with sexual and substance addiction problems. In addition the paper explores the utility of using CAT in a family consultation service as part of a systemic approach to helping families in difficulty.
Psychologist Päivi Räisänen has been working for Family Counselling since 2010. The topic of her master`s thesis was about personality psychology. She had double academic credits in her degree and has undertaken comprehensive courses in, for example, neuropsychology, personality, and in mental health psychology. She has been working as a psychotherapist since completing her CAT studies at Helsinki University, 2013 - 2016.
3a Eeva Joki
‘The power and dark shadows of leaders’
Does power over other people change our inner dynamic? If it does – how? And does power change a person’s habitual ways of relating to other people?
We look into questions of power at work but also into the dark shadows of some personalities when they gain more power – eg narcissistic, antisocial and demanding leaders. What happens to their inner dynamic and interaction? And what happens to the people around? How can we understand the dynamic of the workplace?
How can CAT’s concepts add value to understanding some common behaviour and relating patterns of leaders? Here we look at Anthony Ryle’s concepts of reciprocal roles, reciprocal role procedures, separate self-states and splits. We also apply Mikael Leiman’s concepts of unbearable position, risk position, wanted position and protective position.
Let’s also look at the research of Professor Robertson and other psychological researches in power, DSM-5 Criteria and Professor Kets de Vries’ famous thoughts on dark side leadership.
We go through some cases from workplaces, some public examples and biographies. Together we’ll consider some situations that come across during workplace counselling and in therapy.
Eeva Joki focuses on leadership advisory services and executive search on senior-level roles in Heidrick & Struggles' Helsinki office. She has over 15 years’ of experience in management consulting and a broad experience in assessing individuals for various positions including top management of large multinational companies.
Eeva holds an MSc in Psychology and has received certifications of consultancy and coaching. She is a CAT Psychotherapist.
3b Rita Toli
‘Applying CAT in a Greek primary school: How reciprocal roles can minimise power battles between parents and teachers and inform direct child work’
CAT can be a useful way of working in contexts other than 1:1 psychotherapy considering the evidence from outreach teams (Kellet, Wilbram, Davis & Hardy, 2014) and community mental health teams (Carradice, 2012). Therapeutic work in a primary school can be challenging as there are often conflicting viewpoints regarding the difficulties and needs of the child. These need to be addressed before any interventions are offered. The use of therapeutic skills and an understanding of the family’s reciprocal roles can promote positive and effective communication.
In this workshop we will have an overview of how CAT can be used in non-clinical settings. We will then look at a case from the primary school including the initial concerns, the power issues that arose between the parents and the school, and how I tried to deal with them. We will identify RRs from a video from ‘Frozen’ and the description of my sessions with the student. Finally, we will discuss the interventions used so far and ways to move forward in the next school year.
Rita Toli, Clinical Psychologist, qualified at Sheffield University in 2014. She now lives in Athens and works in a private primary school. She also practices CAT psychotherapy with adults in a private practice.
4. Louise Elwell
‘Reformulating Emptiness: how may we work actively with states of emptiness, desolation and boredom?’
Many of our clients experience states of mind in which they feel empty, also alone, or desolate, as well are bored and disengaged. This may be either a detached state, a state that is more obvious when depressed, or a background state of mind, influencing one’s whole experience. The work on this state may prove to be very important, very central, in a therapy, or simply a part of the whole jigsaw. But how should we work with this, or should we simply be hopeful that this sense of emptiness will somehow be filled by the experience and work of therapy, and the therapeutic relationship? Moreover how should we think about this state, in terms of its history in the client’s life and how it is held intra-psychically?
I have been interested in these questions for a while and have come to feel that in spite of the nervousness we may have about making this state more central to the therapy, that it may be essential to do so in many cases. If we do not, we risk overlooking a key driving dynamic in the mind of the client. The state may be directly influencing certain distracting behaviours. Or it may simply be a place that feels so cut-off and alone that he/she has never shared this with anyone before, and never expects to – adding to feelings of loneliness and desolation - and so it may be easily overlooked. In fact there are many reasons that it may easily be overlooked or avoided in the work.
I hope in the workshop to share what I have learnt about reformulating and working with this area with some of my clients and also some of my thinking so far about this area, the work in progress. The issues raised by it are in some ways subtle but I think extremely important. The starting point for the workshop is the therapeutic and technical aspects, but of course the experience of emptiness touches on philosophical and religious concepts which may be seen as germane for some people in thinking about this. I will plan this workshop so that there is plenty of time for thought and sharing between ourselves.
Louise Elwell has a professional background in psychiatric nursing and trained in psychodynamic and group analytic psychotherapy at the Warneford Hospital, Oxford, and in CAT at Guy’s Hospital, where she was in the first cohort of the UKCP/MSc training. Louise now works at the Cardinal Clinic and in Oxford, seeing individuals, facilitating groups, and as a trainer and supervisor.
5. Kerry Manson, Sunil Lad and Marisol Cavieres
‘Developing a CAT understanding of Anti-social Personality Disorder (ASPD): Eliciting key reciprocal roles’
It is generally recognised that individuals with ASPD are difficult to work with; those who meet criteria rarely seek treatment as well as many services being reluctant to work with this group. When people do attend there is often poor engagement and difficulty in establishing a therapeutic relationship, yet they can pose significant risk to others including the public.
We are interested in developing a CAT model for understanding the relational difficulties of men in prison with an ASPD diagnosis/traits, by identifying key reciprocal roles and common themes pertinent to this client group; what it means for our client group, and those attempting to engage with them. Whilst our interest has sprung from our clinical background in working with men with an ASPD presentation in both prison and forensic settings, this workshop is open to people who have had experience of working with this client group in a variety of settings (such as mental health, drug and alcohol, homeless services) are welcome to attend. We will assume that workshop participants are already familiar with this population.
The purpose of the workshop is to share our initial model with an expectation that this can be developed further through sharing of ideas and clinical experience to contribute to the development of this model. The facilitators will provide a brief overview of the model using a PowerPoint presentation and clinical vignettes, to identify key ideas, and to encourage further dialogue through small group work and discussion.
This workshops is based on an article written by the workshop facilitators, ‘Developing a CAT understanding of Anti-Social Personality Disorder (ASPD)’, published in the Summer 2017 issue of Reformulation.
Kerry Manson is a CAT Practitioner and Supervisor in independent practice in Liverpool. Previously she worked as a Consultant Clinical Psychologist managing a therapy service and delivering CAT in a prison setting. She has also worked in a Personality Disorder Unit based within a prison.
Sunil Lad is a Counselling Psychologist, he works in a number of prison mental health teams and Community Offender Health Services within Northamptonshire Healthcare Foundation Trust, and is ACAT accredited in CAT skills.
Marisol Cavieres is a CAT practitioner in independent practice, accredited supervisor and trainer with CAT North, and co-director of the national CAT skills case management course: working with complex clients. She is based in Wiltshire. Previously she worked as a consultant clinical psychologist within a community forensic team in Auckland, New Zealand, and has had various posts within adult mental health specialty in North West England and New Zealand.
6. Jennifer O’Brien and Fritha Melville
‘Using experiential and creative approaches to contextualise workplace stress and support self-care practices for helping professions’
Most of us in the helping professions are familiar with the demands of complex clients, team, organisational and systemic stressors. The complexity of these demands can evoke powerful emotional reactions, such as, feeling inadequate, minimised and powerless that if left unaddressed will impact on our wellbeing. The literature indicates that high workplace stress is associated with high staff turnover, sickness and absence, decreased work satisfaction and team dysfunction which ultimately impact on the clients we work with (Scanlan & Still 2013; Sprang, et al. 2011). “Self-care” is a term used to describe the practice of utilising strategies and approaches to managing, maintaining and decreasing workplace stress. Individual and organisational approaches to self-care have been protective in reducing workplace stress, burnout and turnover (Haarhoff, et al 2015; Spence, et al 2015).
Applying cognitive analytic therapy to indirect work such as contextual reformulations, supervision and training, team and service assessments are now well established (Carradice, 2004; Walsh 1996). This workshop will experientially explore the contextual factors contributing to work place stress and self-care through a CAT informed relational lens. CAT advocates for a creative approach to understanding and revising target problems and procedures and utilising arts and creative modalities are another set of tools that can allow participants to engage and express themselves through non-verbal modalities (Lett, 1993). The intention is for participants to engage in experiential activities that combine the CAT framework and art therapy practices in order to understand work place stress and self-care and identify practical self-care exits.
• Engage with expressive modalities such as art, movement and music to explore unhelpful reciprocal roles in the context of stress and professional resilience
• Explore and understand how engaging in a creative process can support professional resilience practices
• Carradice, A. (2004). Applying Cognitive Analytical Therapy to Guide Indirect Working. Reformulation, autumn, 18-23
• Haarhoff, B., Thwaites, R., & Bennett-Levy, J. (2015). Engagement with Self-Practice/Self-Reflection as a Professional Development Activity: The Role of Therapist Beliefs. Australian Psychologist, 50(5), 322-328. doi:10.1111/ap.12152
• Lett, W. (Ed.). (1993). How the arts make a difference in therapy. Melbourne: Australian Dance Council (Victoria) - Ausdance
• Scanlan, J. N., & Still, M. (2013). Job satisfaction, burnout, and turnover intention in occupational therapists working in mental health. Australian Occupational Therapy Journal, 60(5), 310-318
• Spence Laschinger, H. K., Borgogni, L., Consiglio, C., & Read, E. (2015). The effects of authentic leadership, six areas of work life, and occupational coping self-efficacy on new graduate nurses' burnout and mental health: A cross-sectional study. International Journal of Nursing Studies, 52(6)
• Sprang, G., Craig, C., & Clark, J. (2011). Secondary Traumatic Stress and Burnout in Child Welfare Workers: A Comparative Analysis of Occupational Distress across Professional Groups. Child Welfare, 90(6), 149-168
• Walsh, S. (1996) Adapting Cognitive Analytical Therapy to make sense of psychologically harmful work environments. British Journal of Medical Psychology 69, 3-20
Jennifer O’Brien is a clinical Occupational Therapist who works and lectures at the Australian Catholic University and in private practice. She has postgraduate qualification in CAT and creative and art therapies. She has over 15 years’ experience working within the health and community service sector specifically with youth, complex trauma and refugee and asylum seekers. Jennifer has an interest in utilising relational approaches via creative approaches such as through art, movement and music. Utilising various modalities allows access to experiences in a completely different way than language can allow. She utilises these approaches when working with health and community professionals and their organisations to reflect on and improve upon the work. With experience in clinical mental health counselling, training and organisational development, Jennifer has spent the last 5 years specialising in utilising creative modalities in these areas.
Fritha Melville is a senior clinical psychologist with Orygen Youth Health, a public mental health service which works with young people aged 15 to 24 years with a serious mental illness. Fritha has over 15 years of experience working primarily with young people in the health and community sectors, including refugee specific services. Other roles have included working in training and community development contexts. Fritha’s conceptual approach to mental health is based on a holistic framework, which advocates the integration of research, individual and community based interventions. Fritha has been involved in advocating for the needs of people from refugee background both through research and clinical work for over 15 years.
7. Paul Johanson and Sara Casado
‘Loving the unlovable: CAT, compassion and working with people who commit sexual crime’
The talk will address the philosophical and ethical basis of CAT and how this supports and allows a compassionate approach to working with the most marginalised and, in this case, reviled populations.
The relational nature of compassion will be explored, with an emphasis on the therapist’s self-to-self relationship and how practising self-compassion can promote distress tolerance and build resilience, allowing the therapist to remain engaged with patients when strong emotions such as shame, disgust and rage emerge in the therapeutic encounter. There will be an opportunity to experience some practices for developing self-compassion.
A case example of work with a sex offender will illustrate how, in Tony Ryle’s words, the compassionate practice of CAT allows a practitioner “to get close to a patient very quickly in the most important ways”.
Paul Johanson is a trainee CAT Psychotherapist, social worker, and Mindful Self-Compassion teacher. He has worked as a practitioner and team/service manager in criminal justice, substance misuse, serious mental illness, psychological therapies, cancer, and palliative care. He has worked as a strategic leader for the NHS in implementing national programmes in mental health, psychological therapies, and patient experience. He is a long-term practitioner and teacher of compassion and mindfulness meditation and is currently the Buddhist Chaplain at the University of Sussex and the Martlets Hospice in Hove, East Sussex.
Sara Casado is a trainee CAT Psychotherapist, and Consultant Forensic Psychologist working in Forensic Healthcare Services for Kent and Medway NHS Partnership Trust (KMPT). Sara has worked in criminal justice and healthcare settings and currently is the Lead Psychologist for the Medium Secure Units in Maidstone. She also contributes to the PD pathway as Lead for KMPT, working alongside the National Probation Service. She has a longstanding interest in working with people who commit sexual violence and has worked within this field since 2000. Sara is an accredited facilitator of the Thames Valley Sex Offender Programme and is also trained in the SOTSEC-ID Programme (adapted for those who are intellectually impaired). She has adapted her work with people who commit crime, and in particular sexual crime, using the CAT model and is currently undertaking a piece of research in this area considering ‘CAT’s contribution to these mainstream treatment programmes’.
1. Anneke Gielen – ‘Setting up a new programme for early intervention for young people with BPD’
2. Phyllis Annesley and Lindsay Jones – ‘Women’s lives understood through a gendered lens: Recognising and working with social inequalities for women within Cognitive Analytic Therapy’
3. Chloe Sutton – ‘Applying CAT to working systemically with young people in out of home care’
4. Jennifer O’Brien and Fritha Melville – Digital presentation - ‘Working with refugees: a relational framework’
5. Esther Gimeno – ‘The challenge of CAT therapists in training’
6. Victoria Sleight, Claire Newman and Stella Compton Dickinson – Interactive presentation - ‘Discovering creativity within the complexities of an evidence-based model: witnessing and participating in change’
7. Palwinder Athwal-Kooner, Danielle Bream, Tammy Wachter, Victoria Vallentine and Jackie Withers – ‘The effectiveness of CAT informed relational training in a secure forensic hospital’
8. Rhona Brown - Interactive presentation - '#ConnectingToConnected: Can Twitter Aid Our #CATDialogue?'
9. Louise Yorke - 'Relational Discovery - a model of culture change and clinical practice'
(ACAT/ICATA reserve the right to make changes to the advertised programme)
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