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Introductory CAT Workshops: Helpful Guidelines

Boa, C., 2002. Introductory CAT Workshops: Helpful Guidelines. Reformulation, ACAT News Spring, p.x.

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I have been asked if there are any helpful tips or guidelines I could suggest to trainers proposing to run their first CAT Introductory Workshops.

While I am happy to say what I have found helpful, it is important that each of us finds our own style. I believe that training, like therapy, is a sensitive interaction between participants, and it’s important to find a collaborative pace and language, rather than sticking rigidly to a prescribed format.

Having said that however, perhaps some things are ‘prescriptive’. The first of these is to re-iterate throughout the training that "nothing therapeutic happens in CAT –(or any other therapy for that matter) - without establishing a working relationship" Almost as important is the second essential – "keep it simple". By the time we are ready to be trainers we are so familiar with CAT concepts and language that we cannot imagine how confusing it all is for those hearing it for the first time. Even with fairly sophisticated participants who may work all the time with psychological concepts and who would be considered psychologically minded, it is helpful to return several times during the initial period to explanation of terms used, preferably with slight variation or illustrative anecdote, but mainly so that trainees can ‘rehearse’ and internalise the learning in digestible bits, or bytes!

For this purpose, at the outset I give trainees a handout listing abbreviations, starting with the PP (presenting problem) through TP’s (Target Problems) and TPP’s (Target Problem Procedures) to goodbye letters. Going through them briefly at this early stage gives a useful of sort of shape to the training and the concepts and practice of CAT.

Lots of hand outs. As many as expenses will allow. Trainees can then make their own notes on the relevant handout rather than have to write down everything you say leaving you presenting to hidden faces and furious scribbling. I have found that whatever is put up on the overhead projector leads to a request for handouts, and because of expense – in money terms as well as in consideration of trees, - I try to deflect excessive demand. Sometimes there is access to a photocopier in which eventuality trainees are welcome to arrange for copying additional material – except sensitive case material.

My preferred training style is for lots of interaction, with fellow trainers, if we have them, as well as with participants, so that everyone experiences the training as a ‘collaborative activity’ rather than being talked ‘at’. I invite interjections or questions, especially because if what I am describing is not clear to the questioner then it is perhaps helpful for others to have clarification. There is always a danger of course that one may encourage the ‘delinquent’ participant but I have found it a risk worth taking.

In my view there is no substitute for experiential training. Therefore I design the training programme with as many ‘slots’ for small group practice as time will allow. In the first group I may present a case and ask participants to think about it using CAT ideas such as reciprocal roles, which I will already have outlined without expecting depth of understanding at first hearing. Use of a flip chart is helpful to write up as many ideas and suggestions as are presented, and I will then try to draw up a sort of SDR to be compared, when we re-convene into the larger teaching group, with the SDR used in the case. Almost always it is gratifying – indeed a relief! - to see how near their suggestions have come to the actual SDR.

In subsequent group practice trainees are asked to present one of their own cases, either completed or ongoing and we look at it in the same way – always encouraging group participation so that every one feels involved and engaged in the process.

A reminder at this point of the training where intense excitement may have been generated is of the contract for confidentiality and respect for any client material that is brought into the training. This would repeat what will have been said at the beginning of the training when I make a point of stating that there may be confidentiality issues which need to be observed, and when I ask if any participant feels they cannot contract such confidentiality that they let us know at that point. Also in the introduction I usually ask for some allowance to be made for socio-political errors, such as medical labelling or gender confusions, because although sensitive to and respectful of these issues, under the pressure of limited time to convey CAT theory and practice it is possible mistakes may be made. I do, however, make a point of referring throughout the training to the importance of cultural environment and context. Having raised this area myself I don’t recall ever having been challenged. Although such sensitive issues may lead to a potentially useful discussion, they can take up an awful lot of time, and may split the training group into unmanageable factions.

It has been my experience that in most CAT Introductory workshops there is an initial enthusiasm and almost an excitement to absorb the ideas and practice methods. However as invariably with idealisation there comes a sudden backlash and one or two of the group begin to express angry resistance. It can catch a new trainer by surprise and again may threaten group cohesiveness and undermine the good work so far. However, as in therapy it is to be welcomed as a most useful turning point. It appears to be a ‘procedure’ whereby curiosity and positive interest have been awakened and suddenly the trainee experiences a floundering self-doubt and disloyalty to their previous training and familiar model of therapy. It is useful because at this point if, rather than becoming defensive or confrontational, the doubts and difficulties are picked up and held reflectively by the trainers, it is possible to recapitulate CAT concepts and to place them within an integrative frame.

It is often at this stage that CAT can be referred to as a "safe first intervention"; for some a complete therapy in itself and for others a helpful way of assessing whether patients can use a psychological approach to their difficulties. Selection criteria, research, various time limits in relation to agencies, the importance of contracting and ending; the ‘nuts and bolts’ of CAT are better assimilated at this ‘fractured’ stage, than during the earlier positive transference stage. There is a tangible shift in an ‘adult’ response to the didactic content of the training and eventually a returning warmth and receptivity to CAT as a potentially helpful model of therapy.

CAT is most rewarding to teach. The shortage of trainers has so far somewhat constrained the availability of this form of therapy to a wider population. While there are a growing number of formal CAT training courses it is my view that there is an unlimited pool of health care workers who would welcome and could greatly benefit from a knowledge and use of CAT concepts and practice methods.

Let’s get training!

Cherry Boa

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Full Reference

Boa, C., 2002. Introductory CAT Workshops: Helpful Guidelines. Reformulation, ACAT News Spring, p.x.

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