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Report from the Third CAT and LD Conference, in London

Baines, G., 2014. Report from the Third CAT and LD Conference, in London. Reformulation, Summer, pp.13-15.

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Whilst walking to Goldsmith’s College, University of London, on the morning of Saturday 15th March, I noticed my excitement at the thought of having the opportunity to meet many of those who share a common interest with me, the application of Cognitive Analytic Therapy (CAT) to aid those who have been diagnosed with an Intellectual Disability (ID).

In addition, it was a chance to celebrate the recent publication and launch of the first book, to my knowledge, that focused exclusively on this topic, titled ‘Cognitive Analytic Therapy for People with Intellectual Disabilities and their Carers’.

Having found my seat amongst the 40 or so people that came to the conference from all over the country, including a young man who would identify himself as a user of learning disability services, we were also joined by a small number of international speakers and attendees, one from Finland, and a trio from Italy. Thanks to the diversity in the audience that had assembled, I became aware of the enduring appeal, and inclusive nature of CAT that allows it to traverse sociocultural and linguistic boundaries.

There was a central theme of human rights running through the conference, as well as a range of presentations. Initially the day began with a presentation by Nicola Murphy. She described how she had set up and ran a CAT group for offenders. Nicola skilfully gave me and my fellow attendees a clear framework for how to run CAT groups for people with Intellectual Disabilities. I especially valued Nicola’s anecdotes and the practical tools and adaptations that she used to help socialise their group to CAT ideas, and to cater for groups with mixed cognitive abilities. I have previously fallen prey to the challenges that arise when setting up and running groups. I suspect I’m not the only one. However, I felt more confident and empowered thanks to Nicola’s work, which I too might be able to advocate for similar groups to be run in my own service.

The second presentation of the day was convened by David, a user of intellectual disability services, his CAT therapist Perry, and the psychologist who supported him in the aftermath of finishing therapy. He and his co facilitators spoke about his and their experience of CAT therapy together. Hearing David’s lived experience of CAT seemed to shift how I felt in the conference, from a professional pragmatic state of mind to one which felt more intimate and human. It seemed to me as if I had been invited into his world and that in turn was an honoured guest and witness to his story. I can imagine that many of my fellow attendees felt the same. I felt very privileged to hear how CAT therapy was for David, and I noticed how many others approached him afterward wishing to thank him for his openness and bravery in describing George Baines 14© ACAT Reformulation Summer 2014 Report from the Third CAT and LD Conference, in London his experiences in such a forum.

After a quick teas and coffee break, the atmosphere and feeling of the conference changed dramatically again as Beth Greenhill, Emily Handley, and Kieran Beard asked us to contemplate the fact that those diagnosed with intellectual disabilities are much more likely to die prematurely due to the inequalities accessing physical health care. This continues despite a number of reports and recommendations being published that have attempted to address this inequality. The gravity of these findings was highlighted by one of the facilitators talking from first-hand experience of a close relative with intellectual disability encountering such a breakdown in physical healthcare. I was struck by my feeling of incredulity that emerged on hearing the speaker’s personal account. At the same time I had a feeling of appreciation for their ability to empathise and have compassion for the difficulties of all those concerned in trying to change this situation, including those who work in physical health services. To help them the speakers had constructed a CAT map and letter. This seemed to be a helpful and facilitative way of talking about and noticing how health inequality can make one feel, whatever your place in the system of care, as well as providing a tool to navigate out of the many traps and snags that you could find yourself in when charged with trying to change this uncomfortable unbearable situation.

After lunch, Jo Valera discussed the history during and after the findings of the Francis report and ‘Transforming care’ paper. Their conclusions pointed to evidence of abusive practices continuing to occur in service provision, and recommended services focus on providing caring, and compassionate care. From her work, however, Jo described the problematic patterns of relating that can occur when trying to move towards this care, particularly when the staff feel challenged. Using the CAT model she formulated some of the dilemmas and snags that can occur when consulting with service providers and when working directly with service users. This presentation helped me to reflect on my role which often leads me to consult with staff working directly with people with learning disabilities. I found myself wondering about their possible lived experience when at work, and the complicated roles and philosophies they are expected to implement in practice with users of services, often with limited training and support.

To complement Jo’s presentation, Hilary Brown discussed the difficulties and confusion that abound in a specific area of support, assessing risk, and whether people can make decisions using the Mental Capacity Act. Hilary observed that the current guidance is limited because it takes a purely cognitive stance on decision making, neglects to consider why people make decisions, and dismisses the role emotion plays in decision making. This observation instantly chimed with my experiences of trying to assess capacity, as if something occluded and hidden but known to me had suddenly been brought to light. She described how the multiple states model in CAT can aid us to understand our motivations when making choices, and how motivations result from the relational context we find ourselves in. She ended her presentation by providing some guidance for how one can support another to make complex decisions.

The penultimate presentation was convened by Valentina Pezza, ably assisted by Marisa Poggioli as a translator for those of us who weren’t fluent Italian speakers. Valentina described the history of her relationship with the CAT model and how she used it to aid her understanding of the team dynamics with which she worked. She showed the attendees how the CAT model can become very meaningful not only as a tool to help clients in distress, but also to help look after ourselves at work. We learnt how it enabled her to understand the problematic patterns of relating that occurred between different professionals, and gave meaning to the feelings that she encountered when relating to her co-workers. Valentina suggested that this understanding seemed to allow her to contain these emotions and in parallel take an observing position so as not to be dragged into the less helpful “dances” that occurred at her work.

The conference ended with Julie Lloyd and Phil Clayton carrying out a live demonstration of CAT mapping using a problematic scenario that related to an Intellectual Disability Service Provider. It was also my turn to present, as I had offered the brief description of a case scenario to be mapped. It involved a young man with intellectual disabilities whose personal problems seemed intertwined with the staff team that supported him. As I sat down to present, I noticed how revealing it felt to present one’s clinical work and for it to be witnessed by so many. My initial fears, however, were to prove unfounded as my fellow attendees and I began a dialogue about this case that helped me to clarify my feelings, thoughts, and my future actions and enquiries.

Alas, with this activity finishing I came to the conclusion of the conference and it was time to say goodbye. As with all endings, I was left with a mixture of feelings, something I notice again as I ponder how to end this article. Perhaps, at this point, it seems appropriate to say thank you to all who came along and co-created a thoughtful, compassionate and curious space and dialogue. It was a pleasure to explore CAT and its use for people with Intellectual Disabilities with you all.

I’d like to mention a special thanks to all those who spoke and presented that day, particularly Julie Lloyd who helped co-ordinate the whole event and Herb Blumberg from Goldsmith’s University for helping host the event and keeping us all well fed and oiled! I hope to meet again in similar circumstances sometime soon in the future.

I am a Clinical psychologist in Training at the University of Exeter, and I work as a Psychologist in a Learning Disability Team in Poole and East Dorset for Dorset Healthcare University NHS Foundation Trust.

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My e-mails:

gwb203@exeter.ac.uk

george.baines@dchft.nhs.uk

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Baines, G., 2014. Report from the Third CAT and LD Conference, in London. Reformulation, Summer, pp.13-15.

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