Nicola Kimber-Rogal and Louise Yorke, 2016. Letter from the Editors. Reformulation, Summer, pp.3-4.
Welcome to Reformulation number 46. If the weather is no clue for you when you receive it, we can let you know that this is the Summer Edition of 2016. The thought of Summer can bring images of growth and bounty to mind. As editors we believe that this edition is full of articles that reflect how CAT continues to grow and to mature as a therapy. However, although published in the warmth of Summer these articles have largely been conceived and written in the depths of Winter. During that period The Five Year Forward View for Mental Health, a report from the Mental Health Task Force to the NHS in England (February 2006) was published. This vision of health services, although focusing on the mental health economy in England, is relevant to all mental health practitioners in terms of the themes it addresses. The document opens by reminding us how “half of all mental health conditions have developed by the age of 14, rising to 75 percent by the age of 24” and notes how childhood difficulties can often progress, “those with persistent disruptive and aggressive behaviour are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and twenty times more likely to end up in prison..[and adds, to our collective national shame] Yet most children and young people get no support”. According to the report, mental health difficulties both affect and are poorly treated in adults, including mothers, people with physical health conditions, persons living in poor housing conditions and veterans of the armed forces and concludes that the outlook is similarly bleak for older persons; the report notes “One in five older people living in the community and 40 per cent of older people living in care homes are affected by depression”.
The Five Year Forward View of Mental Health (Feb 2016) document certainly highlights the imperative to address mental health difficulties in all sections of society from children and young people to older adults and to do this collaboratively, working with persons, relationships and behaviours rather than a diagnosis. The report also highlights the importance of improving both mental health services and the mental and physical health capital of not only those treated by health services but also for those who provide health services. The themes described in the Five Year Forward report reflect and resonate with themes beyond national and temporal boundaries. It is no surprise therefore that articles in the Summer edition of Reformulation address topics that are consistent with the Five Year Forward report, in the sense that they addresses psychological difficulties in persons across the life-span and take a collaborative and co-construction focused solution to the development of understanding.
Specifically contributors have written articles that show how the CAT model can be used with children, young adults and older adults: Clinical Psychologist Jo Varela explores how a collaborative therapeutic consultation model can be used with children and parents to help them to understand how intergenerational ways of relating can affect dyads and family systems and how they are repeated and may be changed. Jo uses concepts of play therapy and sculpting in this work to good effect. The technique of sculpting is described at the end of her article and, like the Six Part Story Method described in the Winter Edition 2015 (number 45 ) of Reformulation, can be used to develop therapeutic understanding as part of the SDR development. Returning to Reformulation with a second article in his trilogy, Young Persons Psychiatrist Nick Barnes, discusses through exploration of a number of clinical case illustrations, the importance of finding the “space in the middle”, the place where a young person and the therapist can notice, describe, map and understand Exits in the form of constructive and compassionate reciprocal role relationships. Clinical Psychologist Michelle Hamill and a person who has used mental health services, “Rosie” have provided their Reformulation and Goodbye Letters as an illustration of how important CAT can be for older persons and illustrates the need for services to provide therapy for older persons because as “Rosie” says, although it would have been helpful if she had received therapy as a younger person, it is “never too late” to cultivate hope and for a person to develop positive self to self and self to other ways of relating and for their life to thereby be affected by positive change. Alongside these letters, Reformulation has re-published a version of an article by Laura Sutton and Alistair Gaskell from 2009 to emphasize CAT theory and technique while working with older persons.
Psychotherapist Steve Potter and Advance Nurse Practitioner Jane Bradley and colleagues Paula Cox and Jennifer Scott and duo Phyllis Annesley and Lindsay Jones have written articles about different elements of CAT practice. Steve’s article describes for readers how by focusing upon the therapeutic relationship, upon enactments, the process of transferences can quickly develop a therapeutic dialogue even for difficult to engage clients. Steve provides a step by step guide that shows how by noticing what can sometimes appear to be nuance or parts of a therapeutic session that are often ignored in favour of the content, or the ‘dog story’ as he describes, that reciprocal roles and associated procedures can be understood and mapped from the very start of therapy. Jane Bradley and colleagues explore another development in CAT practice, the positive SDR that they have developed and use extensively in different ways as part of their work. This article is particularly illustrative of how, just as good practice in risk assessment recommends identifying strengths the client presents with as well as the risks, that the CAT model can helpful identify positive reciprocal roles from the start of therapy and not only be an element of the Revision part of therapy. In this article it is described how CAT can be flexibly, creatively and contextually extended in similar but individualized ways by different practitioners to suit their personal styles and clinical populations. In their article Phyllis Annesley and Lindsay Jones have documented the development of their CAT informed model of reflective practice. They have developed and used this model in a forensic inpatient setting and set out the model and how it works in practice so that readers can consider how such a model could be used in their service for consultation and or reflective practice. Such reflective ways of working bring us back again to the Five Year Forward View of Mental Health document and its emphasis on the importance of increasing knowledge, skills and wellbeing in the healthcare workforce.
Although this editorial focuses upon CAT across the life-span, the concept of life-span can be considered not only in terms of age but the stages of the life history of ways to train and practice Cognitive Analytic Therapy. To provide a review of the training developments in CAT and on the number of options for training from introductory to psychotherapy and supervisor training courses Clinical Psychologist Dawn Bennett, Vice Chair of the ACAT training committee has provided an update article. This article informs us on developments between ACAT and Clinical Psychology Training programmes, a process that is likely to require additional supervisors to be trained.
We hope that you enjoy this Summer 2016 edition of Reformulation. The aim is for this edition to be printed and at your doorsteps before the 23rd Annual CAT Conference that this year will be held at Exeter University from 23rd to 25th of June. We look forward to seeing you at the conference. The Annual Conferences provides a great opportunity for learning and networking and is another means of CPD. If the 23rd Conference is anything like previous CAT conferences, there will be many interesting sessions and workshops to attend. These elements of the conference will reviewed in the CPD section the next edition of Reformulation, along with more articles describing the creative development of theory and practice of Cognitive Analytic Therapy.
A Hopeful Sequential Diagrammatic Reformulation – Four Years On
Jane Bradley, Paula Cox and Jennifer Scott, 2016. A Hopeful Sequential Diagrammatic Reformulation – Four Years On. Reformulation, Summer, pp.30-39.
Learning With Young People About Being “In The Middle”
Nick Barnes, 2016. Learning With Young People About Being “In The Middle”. Reformulation, Summer, pp.11-18.
Meeting with Older People as CAT Practitioners: Attending to Neglect
Laura Sutton and Alistair Gaskell, 2016. Meeting with Older People as CAT Practitioners: Attending to Neglect. Reformulation, Summer, pp.22-28.
The 4P’s model: A Cognitive Analytic Therapy (CAT) derived tool to assist individuals and staff groups in their everyday clinical practice with people with complex presentations
Phyllis Annesley and Lindsay Jones, 2016. The 4P’s model: A Cognitive Analytic Therapy (CAT) derived tool to assist individuals and staff groups in their everyday clinical practice with people with complex presentations. Reformulation, Summer, pp.40-43.
Update on ACAT’s Collaboration with Doctorate Courses in Clinical Psychology
Dawn Bennett, ACAT Vice Chair of Training Committee, 2016. Update on ACAT’s Collaboration with Doctorate Courses in Clinical Psychology. Reformulation, Summer, pp.44-45.
“Playing” with CAT - Using a CAT Informed Approach with Young Children and their Families
Jo Varela, 2016. “Playing” with CAT - Using a CAT Informed Approach with Young Children and their Families. Reformulation, Summer, pp.6-10.
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