Developing a competence framework for Cognitive Analytic Therapy

One of the ways in which psychotherapies are adopted in the NHS is through the publication of competence frameworks.  These are formal documents, available online, which set out in clear, lay language what practitioners need to know and what skills they must acquire to practise a particular therapy. The reason it’s in lay language is because it is not primarily for the adherents of the method but for the outsiders: the service commissioners, managers, funders, service users and the interested general public.  The adoption of CBT into IAPT was accompanied by such a competence framework, commissioned from University College London by the IAPT programme, and others followed. 

ACAT decided that it would be politic for CAT to have its own Framework alongside CBT, psychoanalytic and psychodynamic therapy, systemic therapy, humanistic therapy, interpersonal psychotherapy, dynamic interpersonal therapy, and counselling for depression.  As CAT is so widely practised in the NHS, and indeed was a child of the NHS, we wanted to ensure it continued to flourish in that context. 

 

How was the framework produced?

The development of the framework was overseen by an Expert Reference Group (ERG), composed of researchers, trainers and therapists (Dawn Bennett, Elizabeth Fawkes, Jason Hepple, Stephen Kellett, Ian Kerr, Glenys Parry and Anthony Roth).  With the exception of Professor Tony Roth, who contributed expertise in the framework development method, all were experienced cognitive analytic psychotherapists, trainers and supervisors, with relevant experience in NHS management, health services research, IAPT, CAT research, and course accreditation.

A full description of how we identified the psychological knowledge and skills (competences) required to practise CAT, decided how to structure these competences into domains, accessible to their intended audience and distinguished between generic competences applicable to all good therapies and CAT-specific domains of competence is described in a published paper (Parry, Bennett, Kellett and Roth, 2000).  We needed to match and mirror the structure of the competences already developed for CBT, psychodynamic and humanistic therapies through a method described in the paper.

This paper Developing a competence framework for cognitive analytic therapy is available https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/papt.12306

There is also a chapter in the forthcoming CAT Handbook.

 

How are the competences structured?

CAT has a three-part structure (Reformulation, Recognition and Revision) and after considerable debate on how we may list CAT competences this structure allowed greatest clarity.   The CAT-specific competences were grouped into:

  1. Knowledge of the basic principles of CAT and rationale for therapy
  2. Reformulation and engagement phase:
    • Knowledge of reformulation in CAT
    • Engaging the client to reach a shared reformulation
  3. Recognition and revision phases:
    • Knowledge of working at change in CAT
    • Facilitating change in CAT
    • Working with the time-limited nature of CAT
  4. CAT-specific meta-competences.

A list of competences is hard for the user of the framework to structure, especially if they are unfamiliar with the field.  The framework therefore sets out a ‘map’ of competence headings which identifies all the areas of knowledge and skill, organises them into domains and helps to show the ways that the different sets of competences inter-relate, particularly over the course of a therapy.  Each competence statement needs to be concise and comprehensible on its own, so the text enables users to understand what is needed without extensive cross-reference elsewhere.

 

How to access it

The framework and specific competences are designed to be viewed online:

On this page you will find the map, then clicking on any domain opens up the list of competences for that domain.  In addition, there is a guide for clinicians and commissioners which describes each of the domains and the principles which guided the development of the framework.  There is also a description of CAT for service users - a non-technical description of what service users can expect from a therapist if they are offered a CAT intervention. This is also on the public engagement site What Is Cognitive Analytic Therapy? - All About CAT (acat.org.uk)

 

The place of clinical judgement

The framework describes the various techniques and activities which need to be integrated in order to carry out CAT effectively and also for the therapist to be aligned with theory, evidence and best practice.  The map contains a blend of generic, specific and meta psychotherapeutic competences.  CAT-specific domains of competence are underpinned by the reformulation, recognition and revision structure of the therapy and also a list of CAT-specific meta competences.  These set out the ‘overarching’ competences of CAT therapists that are relevant across a wide range of clinical settings, that facilitate adaptation and flexibility on the part of the therapist, and which entail the use of clinical judgement. 

CAT Therapists will vary in their knowledge and skills across the framework and it doesn’t say that a CAT therapist must practice all the competences in order to be competent.  The framework says ‘this is CAT’, it defines us as psychological therapists.

 

How does it differ to the Competence in CAT Measure (CCAT)? (Bennett & Parry, 2004)

The framework describes but does not measure the extent of someone’s competence.  The CCAT is a measure of therapeutic competence in CAT.  It is explicitly concerned with delivery of CAT and whether a therapy session meets a criterion for ‘satisfactory CAT’.  The score can say whether a therapist is more or less competent.  We have used the measure in research to say if CAT was delivered and in training contexts to support development

 

References

Bennett, D. & Parry, G. (2004). A measure of psychotherapeutic competence derived from Cognitive Analytic Therapy. Psychotherapy Research 14(2), 176-192.

Parry, G; Bennett, D; Roth, AD & Kellett, S; (2020) Developing a competence framework for cognitive analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice 10.1111/papt.12306.) at the following link: https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/papt.12306

Roth, A. D., & Pilling, S. (2008). Using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36(2), 129-147.  

 

March 2020; updated August 2021

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