The West Midlands CAT Practitioners Course 2009-2011

Darongkamas, J., Griffiths, Dr T., Williams, O., 2010. The West Midlands CAT Practitioners Course 2009-2011. Reformulation, Winter, pp.41-44.


Abstract

The journey so far of the development of CAT in the West Midlands, culminating with an intake of 15 trainees (all NHS staff) on to a fully funded Practitioner course in 2009, is presented here. We wish to thank ACAT and colleagues for their help in enabling the course to be up and running in such a short time.

A brief history of CAT in the W. Midlands is given along with background to the funding obtained. We describe the procedure for raising the profile of CAT, generating enough interest and providing a Region-wide set of introductory workshops (to confer eligibility for interested staff to apply for selection on to the course). The task could not have been accomplished without the “core” group of dedicated CATs in the Midland Special interest group (MCAT).

Colleagues interested in such developments for their own Trusts and/or Region are welcomed to contact us.

A Brief History of CAT in the Midlands

There are relatively few CAT therapists in the West Midlands. Over the years, there have been two practitioner courses held within the region. One was in 1994-1995 run by Dilys Davies from Nuneaton, accompanied by Norma Maple and later Philippa Gardner. This course had had an intake of 12 trainees, four of whom went on to complete the CAT Psychotherapy level Training in London.

The other Midlands Practitioner Training was in Shropshire in 2001-2003 run by Sally Gray from Southampton (who came up to do the training days) and by Dr Tina Griffiths, CAT Psychotherapist and Consultant Psychiatrist who co-trained and provided the supervision and reading seminars etc. This course had 6 trainees, one of whom went on to the IRRAPT Training.

Alongside the Shropshire development, the Midlands CAT group “MCAT” had been formed in the late 1990s by Val Crowley and Mark Walker. Over the years they had put on a number of two day introductory workshops, promoting CAT in the West Midlands, mainly from the Birmingham area. There was a shared understanding that there was a wish for a Practitioner Course in the Midlands which would happen “one day”. This idea had been around so long it had almost become an idealised fantasy/longed-for myth (as we were acutely aware of there not being enough core people to be able to run such a course). The number of people coming to the bi-monthly MCAT meetings grew slowly over the years, until it was apparent that a critical mass was just about reached to enable a regional course to take place.

Funding

Meanwhile CAT had been mentioned in the NICE Guidelines for Eating Disorders. More had been published on CAT but the evidence-base was still not as extensive as that of other therapies. However, those practicing CAT were aware of the potential gains that could be achieved by clients using this approach. At a Regional Event showcasing the early development of Improving Access to Psychological Therapies (IAPT), Jurai Darongkamas found herself extolling the virtues of CAT over lunch to colleagues, including those working in the NHS at a Regional Level. It was fortuitous that another member of MCAT was also present at the same meeting and backed up the positive view of patients’ outcomes through using CAT. At the same time, Tina Griffiths had contact with the Regional Workforce Development Team as a member of the IAPT implementation team in Shropshire and was also extolling the virtues of CAT.

Several months later, Val Crowley put in a proposal to her Trust to run a two-day Introductory Workshop. This was something that had happened before in previous years and no further thought was given to this request. Unbeknown to Val, managers in her Trust forwarded the proposal to the Regional Workforce Deanery in the hope of getting some of the funding through that regional pot for their Trust. The Workforce Deanery fortunately realised that there seemed to be a number of professionals in the area who were interested in CAT and then contacted Jurai to discuss the possibility of a regionally coordinated response.

The Workforce deanery was keen to develop a range of therapies to complement CBT, which was being rapidly expanded through IAPT, and saw the potential for CAT training, especially with the support offered through ACAT. The idea then quickly grew to help mental health professionals in the West Midlands Region achieve a qualification in CAT which would allow them to practice CAT within their core professions.

At a subsequent MCAT Meeting (in June 2008), we had to decide quickly if it was feasible to run a West Midlands training. At the time we were thinking of an autumn 2010 start date. One of the limiting factors was the number of accredited supervisors in the region. That meeting was characterized by dialogical tension between those who had worked in the NHS for some time and were used to things developing slowly and those who worried that IAPT monies would not be available on an ongoing basis and that we had to “bite the bullet” there and then by putting in a bid as soon as possible. There was a mixture of feelings in the room, ranging from intense excitement to more cautious wariness and a desire to reflect and think things through carefully.

Shortly after the meeting, it became clear that we had to submit a bid for a course to start in September 2009 otherwise it was likely the money would no longer be available. We realised this was cutting it very fine indeed, especially from the point of view of getting enough accredited supervisors but also with the sheer organisational task ahead. Our bid was finally accepted in mid December 2008.

Between then and September 2009 we had to arrange Introductory Workshops at five locations across the West Midlands and then advertise, recruit and interview, as well as set up the course.

Conference

At the same time as thinking of a course starting in September 2010, we had been discussing the possibility of organising a conference as an MCAT group. The aim of putting on this conference was to increase the profile of CAT to people in the West Midlands generally and to the Trusts in the West Midlands (one of which we hoped would eventually host the CAT Practitioner Course). Originally, the timetable was to have the Conference and to then put on the series of workshops. Due to the timescale suddenly being brought forward by a year, this was not possible. So, the conference then became a place to promote MCAT in the national picture and to give something back to MCAT members who had been working hard to promote CAT in the region for some time. We wanted speakers of national repute; Elizabeth Wilde- McCormick and Annalee Curran kindly agreed to deliver a day entitled “Creative Ways of Working with Cognitive Analytic Therapy” which was enjoyed by 40 attendees from the region and also from further afield, as far away as Aberdeen. We had excellent feedback from the day. We would like to thank the South Staffordshire and Shropshire Healthcare NHS Foundation Trust for underwriting this Conference at the time (even though it eventually made a small profit). Neil Carr OBE (Chief Executive) was due to give the opening address but when he was unable to attend, he kindly donated lunch for all the attendees! The positive feedback from the conference helped boost morale within the MCAT members and to “recharge our batteries”.

Introductory Workshops

Despite the extensive use of e-mail, it seemed there were no particular distribution lists to capture key groups who could be in a position to apply for the Introductory Workshops and the CAT Practitioner Course, but we worked hard to promote it to as many potentially interested staff groups as possible. Despite practical difficulties in co-coordinating dates, times and locations, we arranged 6 workshops across the regions which were well attended by over 150 people from a variety of professional backgrounds.

Using a standardised workshop evaluation form, all 6 workshops received very positive feedback.

Key Organisational Components

Shortly prior to all of this taking place, Shropshire Mental Health Trust merged with South Staffordshire and Jurai Darongkamas, Tina Griffiths and Adrian Newell found themselves working for the same Trust. After discussions within MCAT, it was felt that this Trust might become the natural host to the West Midlands Training. Jurai and Tina approached various managers with this in mind and put in a business case, eventually reaching an agreement. Although Val Crowley had had enormous input in the development of MCAT and the promotion of CAT within the region (including numerous Introductory Workshops, a Skills Training and input on Clinical Psychology Training courses in the region), the lure of retirement was strong. We agreed that Tina, who had previous experience with the Shropshire training, should be the Course Director with Jurai as the Assistant Director.

We are indebted to the ACAT Training Committee for helping us to get the course up and running so that we were in a position to get the course ratified by both ACAT and Sheffield Hallam University (SHU). We are grateful to members of the Training Committee, particularly Sarah Littlejohn (chair), Dawn Bennett and Steve Potter for dealing promptly with our many enquiries, helping us setting up the course curriculum, giving us permission to use the ACAT North course administrative materials and to John Sloper and Susan Van Baars for their support.

Recruitment

As well as recruiting CAT therapists to take on roles of tutors, seminar leaders, supervisors, etc, we had to make contact with potential personal therapists, away from the core course staff group. We advertised as widely as possible to potential trainees, making extensive use of e-mail, endeavouring to ensure that we included all who had attended recent and previous workshops.

We aimed to have 15 places on the course. We felt this was a manageable group size but it was also dictated by the number of supervisors available, the proposed level of funding and the room space we planned to use for training days.

In order that potential trainees and managers appreciated the level of commitment to the course that would be required, we also attached a document to the application for managers to sign, clearly outlining the different components of the course and the number of hours that would be required on average per week for each trainee. We had contact with a number of clinicians who were interested in applying but whose managers or Trusts would not allow them to apply due to the estimated time commitment. Others were in the middle of changing jobs and had to negotiate with new managers, even two managers if they were in split posts. There were many and varied queries and much e-mail communication around that time!

The application process was largely conducted via e-mail with hard copies of applications being used for the interview process. Fortunately we had thought of setting up a specific CAT Course e-mail at NHS.net that both Course Directors could access to respond to such queries separately from their usual e-mail inbox. It became apparent that the interest in the course was very high. We held a central selection day, going through all the applications and offering interviews to those who fitted the selection criteria. We held interviews over a number of days, with two MCAT people and a service user on each interview panel. Although we had a reserve list, all 15 candidates who were offered a place, accepted. There are 9 Clinical Psychologists, 1 Counseling Psychologist, 2 Mental Health Nurses, 1 Psychiatrist, 1 Art Therapist and 1 Social Worker.

It was decided to hold the training days in Cannock at Jurai’s work base as this was more central, nearer the motorway and had the convenience of some secretarial support there.

During day one of the course, trainees were asked to fill in a pre-training course questionnaire. It allowed an insight into their expectations of the course and what they wanted to achieve from attending the course. This covered topics such as personal and professional development and service improvements.

The feedback from the trainees was analysed and put into themes. Many of the trainees felt they wanted to improve their skills and competencies by ‘developing expertise and knowledge of CAT to apply in the workplace’ and ‘to be more competent as a therapist’. The trainees also highlighted a desire to develop personally through the course, whether this involved direct interaction with service users (‘I hope to feel more confident in my own understanding of clients’) or to work more specifically on their therapeutic role (‘to work with my own feelings and reactions in therapy’).

The trainees were aware of issues that might hinder their progression after the course and their ability to implement CAT in their workplace. The common ‘barriers’ were funding, time constraints and ‘workload pressures’.

We will not describe this feedback further here as we hope to repeat this “audit” at the end of the course by asking trainees to think about what they have gained from being on the course.

The course needed to be set up very quickly in order for us to secure the funding. We had given some thought to using the training to audit outcomes for the clients seen by trainees. However, we had not had time to discuss in any detail at the MCAT meetings which outcome measures would be useful. Bearing in mind that some trainees had only attended a CAT Introductory Workshop, we thought it would be too premature to ask them to keep outcome measures for the first two clients seen, whilst they are on a training course. However, again we had to make decisions very quickly. On the first training day people rightly pointed out that if, for example, they had been on a CAT skills course already, they would hope to have their first two cases accredited by prior learning, which meant that the first client they were going to see for the training would indeed be their third CAT case! Therefore we decided on the day that we would go ahead with our original idea of using Core 34 (including the Goal Attainment Form) pre- and post-therapy, and the Inventory of Interpersonal Problems (IIP-32). We asked trainees to keep anonymised TTP rating sheets for their clients so that those could be used as another rating measure. We plan to write up this audit when all trainees have completed their cases.

On the first day, trainees, (and the trainers), found it helpful to work through Hilary Beard’s Core Values exercise. In the context of having been busy getting the course ready (on the trainers’ part) and trainees putting in hard work, (preparing their work setting for them to attend the course as well as all the usual pressures connected with working in the NHS), we found this to be very grounding. By thinking about individual core values we were reminded that, at the end of the day, these values are the core building blocks of one human interacting with another (with the aim of helping with the three Rs of course).

Since then, we have been full steam ahead and, at the time of writing, have just completed the second training day of the second year of the course!

The feedback from the first year’s training days shows highly positive ratings both using quantitative and qualitative feedback.
The average ratings obtained across the 10 teaching days in the first year were calculated on 5 questions (regarding perceived relevance (4.73), structure (4.64), teaching methods (4.59), adequacy of materials provided (4.61), amount of learning (4.33). N.B. This was on a 5 point rating scale, 5 being maximally positive.

Examples of other feedback included: “The best bit was ‘the threes’ where one was a client, one a therapist and one an observer”, “Experiential work e.g. task using art materials”, “Really enjoyable and informative”, “I feel like drawing out a 6 and circling this!”, “Everything came together to reinforce how important endings are for us personally and professionally”, “Experiential exercises really helped to bring concepts alive, and more relevant and understandable” and “Great enjoyable day, challenging, but rewarding”. Suggested improvements included: “More examples of ‘good’ goodbye letters and maybe a handout on what needs to be covered”, “More time to reflect on some of the exercises”.

Summary

Despite the amount of work (both predicted and unforeseen), it has been a joy to see the course materialise into being and to be alongside trainees on their CAT journey.

In the climate of today’s NHS, it’s great to have a space for reflection, and to think about quality clinical work with patients. We would encourage others to make links with their Trust’s business, education and finance teams to see if CAT can be introduced more widely to staff at all levels.

Tina Griffiths, Jurai Darongkamas and Olivia Williams

Tina Griffiths has worked in Shropshire for 30 years and as a Consultant Psychiatrist and CAT Psychotherapist in the Department of Psychological Therapies since 1998. She is a CAT trainer and supervisor and was course director for the Shropshire Practitioner Training which she ran with Sally Gray (2001-2003). She is currently Course Director for the West Midlands CAT Practitioner Training. She has extensive experience of working in mental health services and in particular in working with those who have more complex needs. E-mail address: tina.griffiths@nhs.net

Jurai Darongkamas trained as a Consultant Clinical Psychologist in 1990. She completed a Masters in Psychotherapy 1994 and then trained as a CAT Practitioner, Supervisor and Trainer. She works in the NHS in Adult Mental Health as a Consultant Clinical Psychologist (Locality Lead for Seisdon and Cannock Chase, Staffordshire). She has extensive experience of working with those patients whom services find “hard to help”, supervising, teaching and training others and is also an accredited CBT therapist and EMDR Practitioner. Jurai is also an Honorary tutor at the Universities of Birmingham and Staffordshire. University and a Psychologist Specialising in Psychotherapy - Senior Practitioner status (BPS register). Email address: jurai.d@nhs.net

Olivia Williams is currently studying Psychology at Aston University. She worked as an honorary assistant Psychologist in Cannock whilst on her placement year and collated the data summarised above.

Full Reference

Darongkamas, J., Griffiths, Dr T., Williams, O., 2010. The West Midlands CAT Practitioners Course 2009-2011. Reformulation, Winter, pp.41-44.

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