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Relational peer groups and the strength of the working alliance in Inter Regional Advanced Psychotherapy Training [IRRAPT] Programme: a qualitative study

Rob Lam, Louise Yorke, Amanda Copeland, Dorota Cronin, Vivienne Hopkins, 2019. Relational peer groups and the strength of the working alliance in Inter Regional Advanced Psychotherapy Training [IRRAPT] Programme: a qualitative study. Reformulation, Winter, pp.25-34.

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Abstract

The training journey towards becoming a CAT psychotherapist through the Inter-regional Advanced Psychotherapy Training [IRRAPT] programme is explored, identifying process challenges in evaluating the relational group training experience through measuring the strength of the working alliance of trainees towards their peer group. We describe the investigation into the unique aspects of IRRAPT training; a therapeutic journey as much as a therapy training journey where the collective impact of situated knowing on personal and professional development by evaluating the contributions of the strength of the working alliance between trainees in the unique lived in learning participation of the residential group. We describe outcome measures in psychotherapy training using a CAT derived relational measure [CAT-RAM] piloted with a training cohort. Preliminary indications of positive relational growth outcomes are explored in relation to CAT’s integrative theory of relational learning.

Introduction

IRRAPT is a unique psycho-therapy training experience: at the time of writing, literature research has not identified this kind of [Self to Group] permutation of group learning in the United Kingdom however, discrete elements such as group supervision and learning through the group in formal group analytic and psychotherapy trainings are common. There is limited research on trainee evaluation of outcome measures from diverse psychotherapy trainings.

Literature research reveals thematic emergence from qualitative research on group learning processes demonstrating anticipations of old patterns of behaviour that stem from early family experiences, as growth of awareness in training. These are often unconscious but influence the group (Ogren, et al., 2001). Bion’s contributions of group processes and understanding of the group itself as the psychotherapeutic container has been assimilated and generalised across contemporary time limited psychotherapies for clients. The three levels of the relational container [Containing-Contained] within group structures has been well described and implemented in forms of group psychoanalysis [Bion,W. 1970] without specific attention for training psychotherapists or with outcome evaluations.

The immersive demands of the private and professional self in a lived in residential setting, cyclically revisited during the spiral training of trainee development (a trainee learns more each time a subject, or event boundary is revisited), enables recognition, revisiting and reforming of self as the inextricably Winnicottian trainee, for whom there is no trainer* [Winnicott, 1960). In IRRAPT, the trainers are the others: the formal trainers and the peer group of trainees as enabling Others. The symbiotic potential relationship of the Self and Other in changing permutations of groups with different membership of the same cohort is a multi-faceted layering of small satellite groups within the [Peer Group]. Relational skills of a trainee are required to move in and out of groups, reforming self-identity through different modes of iterative group participation and belonging.

Here, we describe this relational training domain as a form of “swimming between the chronotopes” [Potter S, 2020 publication scheduled] of the small groups within the IRRAPT training which enables a reconstitution of a flexible CAT psychotherapy identity which can push therapy where it moves and hold the relational centre at the heart of training. CAT mapping of relational dances between the Self and the Group(s) as dyadic agents, recognises the Rule of the Thirds: there is always a context in which relational dances occur. The Self learning through the Other; through being, participating, sharing together and being alongside one another throughout the training is examined specifically in relation to the outcome measures for the dialogic aspects of trainee growth through the external non-residential [Seminar Groups] and the overall residential [Peer Group] experience. Credit towards trainee growth through supervision is not dismissed, however caution in generating hypotheses which overstate the value of group supervision in psychotherapy should be acknowledged: for clinical technical problems are rarely brought into a group learning setting whilst emotional, counter-transferential blocks are (Altfeld, 1999).

We wonder if exploration with experienced others better facilitates clinical and personal growth over and beyond cognitive [declarative memory driven] learning processes. This premise challenges the accepted view that supervision per se results in more effective clinicians which is termed “a myth” [Bickman 1999]. The paucity of peer-reviewed articles validates this supervision myth view (Bambling and King, 2000).

Against this dearth of research on training psychotherapy experience and outcomes, the fundamental importance of the strength of a working alliance, beyond the kinds of working alliance, has been impressed upon us in our studies of the generalisability of the psychoanalytic concept of the working alliance, whose author only touches upon the application of the working alliance for training psychotherapists in groups (Bordin, 1979). In contrast for client populations, Yalom’s therapeutic factors have been extensively explored and remain wanting for generalisation for group psychoanalytic therapy trainees (Yalom, 1995). The application of these general therapeutic factors inherent in groups as mechanisms which facilitate change, competes with views that they remain as given requirements for general group conditions for therapeutic shift at the outset (Forsyth, 2010). Neither, in our view, can IRRAPT be reduced to an iteration of the social microcosm as an opportunity for self-development through group process operations which eschew the CAT relational approach.

Groups – small and large - possess intrinsic uniqueness accounted for by group identity alone, which hold potential in determining positive or negative outcomes from groups (Lewin, 1947). The American Group Psychotherapy Association reiterates the tensions between contrasting views: namely that therapeutic shift in a group requires awareness of intrinsic group mechanisms of action for agentic change within its members. In contrast, the overemphasising of group specific mechanisms risk erasing the identity changes of individual participants (American Group Psychotherapy Association, 2007).

Aims

1. Development of Relational Alliance Measure [CAT-RAM]
2. Situating outcome measures within CAT’s relational framework

Are there meaningful relational outcome measures for personal and professional development in relation to the strength of the working alliance between Self and group processes in IRRAPT? For our null hypothesis, we commenced our journey hypothesising that there would be no perceived benefit on personal and professional development; self-awareness; therapeutic knowledge; skills and confidence from the IRRAPT model of psychotherapy training. Personal development of relational skills and therapeutic knowledge derived from interpersonal learning are mediating effects of this working alliance between trainee and the IRRAPT groups in the Vygotskian model of socio-constructivism (Vygotsky, 1978). This qualitative research does not seek to establish nor challenge the validity of the extant conflicting views and empirical qualitative research on client populations. Neither does it seek to extrapolate psychotherapy outcomes from client populations to trainee psychotherapists. It seeks to start the first steps in filling the void of personal and professional developmental and relational outcomes for trainees.

The generalisability of the concept of the working alliance reveals limitations as a pan-theoretical construct (Horvath and Luborsky, 1993). Bordin’s emphasis on the fundamental privileging of the working alliance between teacher and student holds much appeal for its fidelity towards the Vygotskian model of the Self enabled through the Zone of Proximal Development (Vygotsky, 1978). Critical commentary on the heterogeneity and pan-theoretical basis of the working alliance has not yet been voiced in the literature. As such, Bordin’s view of the working alliance in relation to the Zone of Proximal Development outcomes for trainees has been emphasised as relevant to us as CAT researchers. We aim to unpack whether trainee experiences reflect this Vygotskian link to the strength of the therapeutic alliance.

Methodology

We explored the three factor structure specified - Task, Goals and Bonds required for the strength of the working alliance (Bordin, 1979). Our process growth in relation to CAT training drew on dialogue from the larger research group processes within the IRRAPT [Peer Group] for development, revision and critical feedback prior to commencing a final blueprint for redefining the strength of the trainee’s working alliance in a situated training process. Bordin’s widely accepted model holds sufficiently for our purposes. Throughout this research, we have monitored our own relationship and procedures situated within this research. The research process itself forms a part of this enquiry of the strength of the working alliance in relation to CAT practice.

Authenticity, Trust, Collaboration and Confidence were arrived at as specific CAT related themes for trainees measuring the strength of the working alliance with the wider training cohort through a recursive dialogic process within our research group and then with the wider [Peer Group]. The similarities with Bordin’s three factor structure can be seen through our derivation of a new relational alliance measure [CAT-RAM] which addresses specifically, the strength of the working alliance within the zone of proximal development of the group processes, drawing on extant knowledge and self-supervisory processes.

CAT-RAM identifies formative reciprocal role repertoires for trainees in the situated training chronotope. Trainees learn to swim the chronotopes of the [Seminar Groups] outside of Holland House [the chronotope] and the multi-faceted rotating groups within the residential [Peer Groups]. This swimming-negotiated process of spiral relational growth and learning, we have identified as unique to IRRAPT training. It is not described in current UKCP psychotherapy trainings. Does this swimming add anything to the strength of the working alliance between relational dyads, such as the trainee and the wider group?

As a relatively small cohort, we acknowledge that more effective learning in smaller groups has been reported with marked emphasis on valuing of learning from peer to peer (Bennett et al 2002). We adapted the process of identifying patterns of semantic and latent themes arising from the respondent qualitative data in line with a six point model of thematic analysis (Braun & Clarke, 2006) through CAT’s dialogism in view of critiques of thematic analysis.

These express caution with selecting themes using thematic analysis according to the personality of researchers and likewise with grounded analysis approaches in which the personal styles of researches contribute personal processes to the data preparation (Madill, Jordan et al 2000).

In our process work, we acknowledged the risk of confounding a thematic analysis by offering a structured theme of the working alliance as a self-rated questionnaire. Instead, we have developed a relative measure through a relative five point Likert Scale measuring our agreed criteria for our relational alliance measure [CAT-RAM] (Appendix 1). A score of zero was assigned for undecided/no perceived rated change outcomes, ranging to a maximum perceived benefit (or adverse outcome) of plus or minus two points per trainee response for the quality of self-rated agreement outcomes which were subsequently aggregated for the training cohort. Free text for a qualitative data analysis was agreed in framing reciprocal role measures and outcomes; identification of procedures and self-states with enlisting of potential exits as trainee relational alliance measures across the residential group experience [CAT-RAM] specifically in relation to the CAT model of reciprocal roles through revisiting the chosen six point thematic analysis model. This version of qualitative CAT research remains attractive for us on account of the epistemological neutrality and non-yoking with particular theoretically limited perspectives (Maguire and Delahunt, 2017).

CAT-RAM is a brief anonymised self-questionnaire model for evaluating trainee relational alliance measures: in line with the nature of brief intensive short-term foundations for the working alliance with clients. Its suitability for self-respondents training in psychotherapy as a pilot study drew specifically on technological processes of purposefully blinding the researchers to respondent material through the use of internet application. Anonymised electronic data entry and collection of the CAT-RAM self-reported questionnaire were deposited at the end of residential weeks at the 3rd residential training week up until the 5th residential training week in the final year. No digital unsealing of the results was undertaken due to the potentially negative responses or feedback which could adversely contaminate researchers own responses and agreed as an appropriate method to generate freedoms for authenticity and honest responses without confounding the research data.

The cumulative results across data points were electronically hibernated without access or analysis until well after the final endpoint data collection, just prior to the 6th final residential week in the training cycle prior to a preliminary presentation of data. All data collection points were then assessed by two researchers to draw on the frequency of semantic themes. The process was repeated at a later time by a different pairing of researchers for the inter-rater reliability rate of 100% achieved by weighting of frequency, verbal explorations and dialogue on assaying of the thematic weight until consensus across the final two assessors became unanimous through negotiated resolution.

Results

Part 1 Strength of the working alliance in the four factor structure of our [CAT-RAM] tool is expressed in Tabulature in Diagrams 1 – 4.

Collated feedback for Authenticity, Collaboration, Trust and Confidence rated by the trainee cohort during the progression of training. For reference – a zero baseline represents no significant change or benefit from relating with [Peer Groups] valued by trainees which = No Change or seminar groups. A maximum theoretical score of 2.0 indicates the strongest possible score for the strength of the working alliance.

All four factors demonstrate increasing strength across the training cohort. Trust across the cohort is rated across residential [Peer Groups] and external Seminar Groups to match by end-point analysis. Personal experiences of [Group Impact] show gains surpassing the effect from the [Seminar Group]. The greatest effect shift is recorded in Confidence with a change of +0.6 and Authenticity (+0.5) derived from the [Group Impact] experience. [Peer Group] size effects outweigh [Residential Groups] however confidence intervals have not been calculated. The lowest contributing shift is identified in non-residential [Seminar Groups] where confidence is recorded with a net change of +0.1 on the relative scale of -2.0 to +2.0.

Diagrams 1- 4 [Zero baseline = No Change or no perceived benefit Maximum self-rated change perceived change potential = 2.0]

Legend: Authenticity, Collaboration, Trust and Confidence collated by the training cohort. [Impact of Peer Group]: data collated from trainees’ perspectives of benefits of residential experience of [Peer Groups]. Group Impact: Trainees’s perspective of how the wider [Peer Group] progress. External [Seminar Group]: Trainees’ views of impact on how the non-residential [Seminar groups] contribute.

Results

Part II CAT-RAM Analysis

At the first point of data collection, positive reciprocal roles in relation to the container function of IRRAPT dominated the themes. 4 respondents identified embracing IRRAPT whilst exploring, feeling accepted and feeling heard as trainees on a new training experience, reflecting facets of general group therapy experience.

Four respondents identified co-construction of relational growth seeding at the first point in data collection, with major latent themes of personal growth through personal zones of proximal development in the group. Of the 10 responses, major semantic themes focus centripetally on identity through belonging; interpersonal nourishment and growth in the peer group cast as possessing trust, feeling connected, feeling safe; collaborating and sharing with others in attending to the rhythms and pacing across the IRRAPT journey.

Diagram 5 (Residential 3)

The third major thematic using our model, identified solidarity with one another in taking the on the road chronotope (threat has a long history of taking place on the road – from Oedipus Rex, Ulysses, Red Riding Hood) into the IRRAPT journey.

In Diagram 5, the conversion of feeling anxiously threatened reciprocal role linked procedures at the start of the training journey, is an adjustment challenge which is overcome through group support evidenced through other reported data (not shown): patience, reflective capacity and awareness given through wording of feeling intimacy, bonds and encouragement from the peer group.

The affect tensions arise in relation to self-mediating demands and changes in relation to conflict with the emerging professional self as a latent thematic.

Diagram 6 (Residential 4)

By the second point of data collection, the theme of stumbling converts into semantic themes of the course getting harder. The semantic theme of pacing, in tune rhythm and learning new Helpers’ Dance is cast as an orchestration towards vitality. Synchronicity with challenges to our own Zone of Proximal Development is palpable in this middle phase of training where owning of personal and group processes are defined with genuine possibility of existential encounter.

Diagram 7 (Residential 5)

Differences in identity within the group is marked by an overlap of semantic themes with personal values in identity with those of the group. Unpacking the theme of mimetic rivalry – of instinctual feeling - is worked through as respect and acceptance of differ-ence by double voiced discourse in the middle of training, supporting the address of the personal agent and that of the group simultaneously.

By the end-point [diagram 7] of data collection, this on the road chronotope identifies pacing; being in tune with a secure base gained through IRRAPT in order to pluck up courage to try new and different ways of relating to one another: a sense of authoring our own journeys where mimetic rivalry is converted into tolerable competitiveness. The Zone of Proximal Development is revealed across all data points as a strong theme for trainees. Across all data collection the latent theme ofOtherness – valuing the Other [Peer Group] through the individual and group Zones of Proximal Development, as enabled through dialogic processes of orchestrating vitality through ownership (agentic and collectively), towards genuine I-thou relating and outward growing. These dialogic moments move beyond the general group processes of instilling Hope.

Integration of this chimeric trainee who swims in the chronotope of Holland House, enables the double voiced discourse to integrate this conflict towards a resolution directed toward hopefulness and acknowledged outgrowth of a new identity by the final data collection point.

The identified reciprocal roles which have been founded serendipitously do conform to group processes: identified by respondents as [Accepting] – [Accepted], [Understanding] – [Understood]; [Validating] – [Supported]; [Respecting] –[Respected] which carry across all data collection points to end-point. The latent thematic identified here, correlates with the containing and secure base of the [Peer Group] and the situated context of Holland House.

Trainees were further able to identify safe as well as productive self-states. Proposed exits identified an array of strategies: interpersonal authenticity through sharing vulnerability and connectedness with one another; closer bonds and celebrating growing and learning together through feeling understood and supported by like-minded. Social focus in relation to professional networking development was offered and also contrasts with self-growth to hold one’s own confidence and identification of change required from within than without.

Discussion

Group learning is not without challenges: negative group dynamics can be amplified within a group residential setting. Our shared cohorts’ experience was of some anticipating conflict at the beginning of the course, in line with Bion’s three levels of containers within groups [Bion, 1970]. The construction of this research required two research sessions, thus missing the valuable earlier data of Residential weeks 1 and 2 which may have captured this. On the collated data our consensus recognised minimal negative interpersonal dynamics impacted on the group as a whole over the 2 year training cycle.

Living and training in a group refuses the boundary between personal life and professional life: the interactive self to self-growth through this embodiment of the private Self and the professional Self reach a new internal dialogue. We draw on Situated Knowledges (Haraway, 1988) which expresses an enquiry of research through situated witnessing. This approach has unmasked the doctrines of research in order to free allusions towards objectivity through imitations of professional colonising empirical methods outside of our disciplines as primarily clinicians, in order to attain accounts of embodied truths given in the relational field of being in the group; learning with the group and through group. This is a thoroughly Vygotskian premise, lived out in ascertaining our working alliance hypothesis. We feel situated knowing in CAT embodiment theory goes beyond feminist critiques. Our situated witnessing of this community of voices in the [Peer Group], has been facilitated by recursive exploration in the chronotopic on the road journey of relational therapy which we undertake in the topographical space of Holland House over two years. This is an event boundary – a time and space warp threshold where something happens. – as the “Bionic container” – the Third in which we are positioned in our relationship of trainee to trainer - thinking and dialogic relationships unfold. Event boundaries are portents of powerful shifts in perception of time and space and can function to divide continuous experience into discrete units for structuring for localised brain functions [Swallow et al, 2009].

Research into episodic memory encoding and updating, complements situated knowledges whereupon attention and concentration (cognitive); memory (autobiographical, relational, declarative etc.) and control pointing towards future authorship (agentic potential to relate) are all reinforcements of episodic memory in Holland House as a lived event boundary where unique time and place position the relational training stage in the re-visitations of the spiral learning cycle. We hypothesise that relational object discovery through the Zone of Proximal Development of swimming through the chronotopes of the satellite groups within the [Peer Group], yields a situated and embodied knowledge of both personal and professional lives, which are presented integrally – that is - as non-dissociated and non-encapsulated dimensions of psychotherapy training at the threshold of an event boundary where forms of memory, including goal directed relational activities such as the establishment of trust, bonding, collaboration and expressions of authenticity of the self in group situations, offer a potential yield of outcomes which embed as meaningful relational memory events in our personal and professional journeys as trainees.

The direction of the process of result for us has changed from the original modest design: the results of CAT-RAM surprised us in refuting the null hypothesis and demonstrating how the function of the [Container-Contained] reciprocal roles in trainee relations to the wider [Peer Group] have unfolded a marked strengthening of the working alliance with one another. Perceptibly (although unknown whether statistically significant), is the impact of the external non-residential groups which are valued by trainees yet demonstrate a more modest feedback response in impact (Diagrams 1-4). Yet net contribution towards sustaining the working alliance during training is collated. The latent themes identify consonance with the theme of rhythmicity: of taking steps in this journeying chronotope of training.

Limitations

The nodal time points of thematic data collection took place during the 3rd – 5th weeks of the 6 weeks of residential training over a two year cycle. We have explored the significance of semantic and latent meaning in relation to the loss of the early time point as the originators of this novel research and development of a prototype relational outcome measure [CAT-RAM] which can be applied to training cohorts in future with a view to addressing these limitations and replicating a more robust study, building on this point address to working alliance theory and practice in order to tease its blossom from a CAT specific dialogic model.

Conceivably, the positive trends and shifts over the time frame in the thematic data have been assumed to extrapolate uniformly. This view can be tested in future cohorts of IRRAPT trainees who are able to move forward with the stored repository of process method of CAT peer group enabling research into the strength of the working alliance in IRRAPT. We recommend tests of statistical significance for future studies, not conducted here in view of our small cohort sample. Our forebears in previous IRRAPT trainings also hold a rich repository of views which remain untapped. We hold reservation in application of [CAT-RAM] for practitioner trainings which have no chronotopic equivalence in relation to swimming with chronotopes, a relatively novel concept as applied to training in situated witnessing, ripe for application.

Relational commentary

Dialogue during the second training year occurred outside of the IRRAPT residential weeks: it was striking and noticeable how the group experience, yielded inertia; a loss of enthusiasm, being out of rhythm within the research group due to training demands as well as the uncharted destination of this research. Demoralisation in relation to the project was identified in relation to reciprocal roles of [Detaching] to feeling [Detached], [Being Preoccupied] to [Being Unavailable]. These are kinds of reciprocal roles which affect the working alliance for us in clinical work; in training and in research, across the board. For CAT researchers, monitoring and holding in check whether these impinge on the strength of the working alliance requires address for living research. Our accelerated pace of research implementation and collation of data, in reciprocation to the final residential training week structured the efforts and rhythmic jogging alongside one another as researchers i.e. the strength of the working alliance in undertaking this piece of research. The exits in relation to these unhelpful individual reciprocal roles, has been interpreted in relation to the strength of the working alliance of the wider research group – in being able to pull this project together through the strengths of the group itself. As researchers, we too have been noticing and acknowledging faltering steps – failing to get in tune – related to vitality (of this research project) and linked to voicing within the group. At times, as individual researchers, we have needed resuscitation and bringing our research into working alliance back to life. This is off-set by the choral support of the wider training cohort in enabling us to move beyond our unhelpful reciprocal roles incurred during the process of this research. In retrospect, we can identify these negative reciprocal role procedures of [Dismissing] to [Dismissed] efforts for research writing; [Neglecting] to [Neglected]; [Overwhelming] to feeling [Dejected] and [Blocking] to feeling [Blocked] as indicative of obstacles along our journeying Zone of Proximal Development. The reflections and dialogue together have led us to recognise a salutary lesson on how to learn to strive to get in rhythm in a concerted effort alongside one another, drawing on the strengths of the group, to support the faltering steps which we have all undertaken – stumbling - as stumbling yet picking one another up towards the creative birth of a paper, hatched through the embodied love of our trainers towards us.

Conclusion

We started off not knowing, and sceptical on our training chronotope. Although a limited pilot study, our expectations of the data were low and in line with the general stagnation of qualitative research area of psychotherapies.

In the clinical encounter, we ask the question: what have we not discussed? Or what have we left out? Revisiting the early psychotherapy literature – do our research findings steer us onto a different adventure? The open thematic analysis derived from Bordin’s model of the working alliance, yields a surprising trend and refutation of our null hypothesis: the IRRAPT training develops our strength of working alliance with the [Peer Group] towards conversion and acceptance of initial anxiety and hesitation towards trust, bonding, collaboration and authenticity across all the training cohort. Where Bordin (1979) left off, the CAT-RAM as a relational outcome measure using reciprocal roles identifies a shift towards an emerging dialogic encounter of the “I-thou” within the peer context. Recursive iterations of situated moments are threaded fibres of connectedness with one another, woven into being and becoming as trainees whose identity has immersed and swum with the chronotopic potentials of IRRAPT. Exits derived from the trainees identify an integrative stance drawing both Self to Self change processes and social networking as standard predictions of the working alliance when generalised into the outer world.

Bion’s contribution in understanding individual development through group processes contrasts to the situated witnessed of CAT’s dialogic reworking of the therapeutic alliance using the conceptual framework of the chronotope which covers all regions as an inter-regional training in the UK. In contrast, group analytic trainings are localised regionally fixed and not inter-regional. The dialogic potential in swimming with chronotopes of Self with Others in the satellite sub groups found in IRRAPT’s residential [Peer Group] training is valued as a strong contributing factor towards supporting the Vygotskian CAT model of working alliance in training.
Recommendations

The CAT adapted framework derived from thematic analysis is a novel user-friendly tool [CAT-RAM] which we have developed, is within the Zone of Proximal Developments of trainees. We too have discovered learning from our own formulations, having subsequently revised our preliminary presentation of this research data and findings in Holland House on 2nd October 2019. As integrative and relational therapy trainees, our thematic analysis takes on board the neurobiological developments of contemporary changes in views of human cognition: the Event Horizon Model, recognises how memory functions as event cognitions which vary across individuals and groups (Radvansky, 2017).

We support the view that event cognition, based on the perceptual field of time and space, perforce includes relational aspects of long-term memory (historicity, identity) and chronotopic situated knowing as the developmental matrix of nurturing relational growth of individual therapists. From this research, we have come to conceptualise Situated knowing within a residential training group of IRRAPT where the relational learning happens through swimming with chronotopes. This represents a hitherto unformulated and novel sphere of research.

Finally, the importance of writing in CAT – in relation to CAT’s dialogic approach cannot be overlooked. We have reform-ulated our research through voicing, re-voicing and attending to subtle nuances of theoretical strands which we had not yet appreciated at the outset or by the time of analysing our data in early October 2019 and by sharing and soliciting feedback from our wider community of voices. The contextual writing for the Other: as Vygotskian nascent explorers, openly declare our limitations and weaknesses. This is our striving to be authentic in the process: the unfinalised open playing field which we have explored, grounds IRRAPT training as a firmly relational journey of personal therapist growth which holds a repository of rich potential for integrating wide-ranging influences in order to strengthen the working alliance as training therapists. We believe this is our duty towards our future clients.

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Potter, S. (2020) Swimming with chronotopes (in forthcoming publication Therapy with a Map Spring 2020, Pavillion Books
Radvansky, G.A., Zacks, J. M. (2017) Event boundaries in memory and cognition Current Opinion in Behavioural Sciences Oct; 17:133-140
Swallow K M, Zacks J M, Abrams R A (2009) Event boundaries in perception affect memory encoding and updating Journal of Experimental Psychology General May 138(2): 236
Vygotsky, L. (1978) Mind in Society
Yalom, I (1995) Theory and Practice of Group Psychotherapy Harper Collins Publishers
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*Winnicott, D.W(1960) In reference to: “There is no such thing as a baby…a baby alone doesn’t exist” International Journal of Psychoanalysis, 41:585-595 The Theory of the Parent-Infant Relationship
Appendix: Figure 1: CAT-RAM [Peer Group] version
Dedicated to Hilary Beard & Jason Hepple, IRRAPT psychotherapy trainers at Holland House
Email: reformulation@acat.me.uk
Appendix 2: Notes
(Glossary of helpful terms)
*A chronotope holds particular time and space characteristics as an event in relational life. We only come to know relationships through time and space. This is the context for the IRRAPT studies on working alliance. The original description by Mikhail Bakhtin is given in Forms of Time and Chronotope The Dialogic Imagination, 1981 translated by Holquist pp84-258
*I-thou In his seminal book, Martin Buber cites: “All real living is meeting” is the zenith as seeing the whole person – not in part [such as an I – it] relationship. This form of existential thinking has been embraced in our research as salient as a measure of authenticity. Martin Buber – I and Thou (1971), Simon and Schuster Martino Fine Books reprinted 2010
*Situated Knowledges [Haraway, D 1988) thinking-with one’s own situation in undertaking research, instead of standing outside of the situation. This thought now has far reaching consequences (for example – climate change). In this research, we locate the strength of the working alliance through situated knowing of the chronotope.
*Zone of Proximal Development (Vygotsky, L. 1988, p86) introduced by Lev Vygotsky as "the distance between the actual developmental level as determined by independent problem solving and the level of potential development as determined through problem-solving under adult guidance, or in collaboration with more capable peers", it has far reaching application in all forms of learning.

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IRRAPT 2007-9 Research Projects
McNeill, R., 2009. IRRAPT 2007-9 Research Projects. Reformulation, Winter, p.26.

Research into Supervision
Lawson, C., 2000. Research into Supervision. Reformulation, ACAT News Spring, p.x.

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Clive Turpin, 2019. In Praise and Celebration of IRRAPT. Reformulation, Winter, pp.36-37.

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Turpin, C., Adu-White, D., Barnes, P., Chalmers-Woods, R., Delisser, C., Dudley, J. and Mesbahi, M., 2011. What are the important ingredients of a CAT goodbye letter?. Reformulation, Winter, pp.30-31.

Supervision Requirements across the Organisation
Jevon, M., 2011. Supervision Requirements across the Organisation. Reformulation, Winter, pp.62-63.

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Relational peer groups and the strength of the working alliance in Inter Regional Advanced Psychotherapy Training [IRRAPT] Programme: a qualitative study

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