Patras programme presentations in detail

The following details are those sent by the presenters at the 2015 Patras conference.

Presentation: How do you feel? Integrating Embodied Awareness into CAT

We build our relational intelligence when we are more aware of our feelings and how they arise, helping us to navigate our relational world more smoothly. Emotions are embodied processes and our bodies move through states of arousal and relative calm, in and out of regulation and dysregulation. In a plenary presentation I would like to describe my early results in integrating biofeedback measures into a CAT therapy, using technology and embodied awareness techniques as a supplement to mapping, to help my client develop the felt sense of their emotional world and their capacity to regulate this more helpfully in their everyday life. The plenary will include biofeedback outcome measures alongside video material of client work. The workshop will focus on the skills of interweaving CAT therapeutic interventions with embodied work, and include demonstrations and experiential learning.

Presenter: Caroline Dower is an Integrative and CAT Psychotherapist, working in a Gastroenterology service in the NHS in Durham, UK and in private practice as a psychotherapist, supervisor and trainer. She has a strong interest in the integration of embodied methodologies into CAT and is beginning research into the application of these approaches to autonomic nervous system dysregulation and physical health.

Plenary presentation followed by workshop experiential session.

 

 

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Presentation: CAT for Apparently Unusual Experiences

This workshop will explore how CAT can be used to help people with unusual experiences commonly labelled as psychosis or Schizophrenia. We will draw on case material to illustrate how we have attempted to adapt the standard CAT approach for this client group. There will also be consideration of how the CAT model of psychosis fits with more recent developments in the field, such as voice dialogue, trauma models and the recovery model.

Presenters:  Ranil and Alex are both Clinical Psychologists and CAT Practitioners working in Early Intervention in Psychosis Services in the UK.

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“Mapping for Mentors”

This workshop aims to explore the use of CAT tools – and in particular the use of mapping – to assist mentors / peer mentors in their understanding and supporting of young people’s needs in order that a more relational understanding of development can inform opportunities for change.  In recent years there has been a huge call for more and more mentoring and peer mentoring programmes – particularly for young people. This call comes from many different areas, and often driven by different agendas, but it is clearly one of the “in vogue” interventions for young people. However, what is also apparent is that there is a vast array of interpretations of what is meant by mentoring/peer mentoring, what it should look like and where it should be delivered.

Over the last couple of years I have been involved in the development of 3 different peer mentoring programmes for young people within different settings, and have come to conclusion that CAT could have a very clear contribution to this way of working and supporting young people.

The peer mentoring programmes have involved:
1. Time 2 Talk – this has been a project developed within a school in Tottenham offering a Whole School Approach to promoting emotional wellbeing and challenging mental health stigma. The project was born out of a tragic death of student outside the school gates and has evolved into the development of a peer mentoring training within the school that seeks to support students specifically on issues of emotional wellbeing.

2. More than Mentors – this is programme has been developed in Newham, involving an extensive network of agencies and services, seeking to develop an evidence based peer mentoring programme, delivered by 6th form students for young people aged 12 – 14yrs from across the borough of Newham. The focus of this work has been specifically to explore the possibility that this type of intervention can contribute to the building of resilience within the young people of Newham

3. The Haringey Peer Mentoring Forum – lastly, this model of mentoring has taken an “experts by experience” (experts perhaps by having been through the care system, or having been involved with mental health services) approach to thinking about support for young people, with the design and delivery aimed to be much more focused within the community, and working within specific estates/neighbourhoods of Tottenham. Given the difficulties with young people feeling that the only options available to them are gangs and gang culture within some areas of Tottenham then this type of peer mentoring support requires careful management of risk. Hence when one thinks about exits, one is also thinking about the impact of that exit upon the wider system – either in or out of the gang.

All 3 peer mentoring programmes have tried to develop models of practice and delivery that fit with their environments and the needs of the young people they are seeking to support. But all have a positive youth development underpinning that informs their methodology, whilst the essence of working alongside and exploring issues in collaboration with the mentees is very much at the core of the practice.
All 3 of the above projects have sort to explore the impact of the peer mentoring not only on the mentee, but also on the mentor. The learning gathered from both the training offered to the mentors, as well as the experience of working alongside another, is a hugely enriching experience for the mentor and offers further beneficial outcomes from this type of intervention.

But given the perspective of working alongside and collaboration, combined with a relational understanding of self and one’s development, I am strongly of the view that many of the CAT skills – such as Mapping – and its underlying theory have, potentially, a significant role to play in the field of mentoring/ peer mentoring. This role would be in both training and delivery – but it would need to be age and developmentally appropriate. We don’t want to create a team of junior CAT therapists – mentoring is not about offering therapy. However, just as we offer mapping and contextual reformulation to wider agencies and networks, I feel this is something that we can seek to offer through mentoring programmes, and something that CAT could provide in quite a unique way. I welcome colleagues’ thoughts and views about how far we could use the model of CAT to work within the mentoring relationship.

Presenter: Nick Barnes is a Young people’s Psychiatrist who works predominantly within an Adolescent Outreach Team in North London, working with young people with significant mental health need such as psychosis, severe depression and suicide prevention. He has been particularly keen in finding ways of engaging young people and their families in therapeutic work that is meaningful and accessible to the local population. Appreciating that there are many barriers to accessing support and care, Nick has sought to use the psychological and developmental understanding that is offered by Cognitive Analytic Therapy in a number of creative ways (such as through football or creative media) to try and ensure that support is offered that can enable opportunities for change for many of those young people and their families that would simply never be able to access an established mental health service, for whatever the reasons. For it is addressing this unmet need that particularly interests Nick, and drives much of his work. There are many young people and families who are described as “hard to reach”, but for whom it often more about being “hard to engage”. By making use of the “relational mental health” perspective that CAT offers, Nick is seeking to offer interventions and support that can allow for an easier access, enabling a more scaffolded approach to engagement.

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‘CAT in Our Time’. 

The workshop is intended to offer an experiential and learning opportunity to think about the concepts of time within therapy and, in particula,r how the social, cultural, psychological concepts of time are  consciously present within CAT.  We acknowledge that thinking about time is an age old and infinitely complex process.  In the workshop we seek to highlight particular concepts, in how they may  impact on the psychotherapeutic process in CAT, alongside an experiential opportunity to consider clinical case material through the lens of time.
many thanks

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Plenary: Using CAT to guide and integrate care and treatment for service users with complex and challenging presentations

This presentation will consider how and why CAT can provide a helpful formulation based framework for services and teams working with complex and challenging clients. It will describe the development of this CAT informed way of working within a secure inpatient context over many years and provide a case example and some outcome data. More detail on some of the specific methods for practical application will be outlined in the workshop ‘Making CAT alive and relevant for care teams working with complex and challenging service users’.

Workshop Title: Making CAT alive and relevant for care teams working with complex and challenging service users

We have been exploring how care staff can access and use CAT understandings in their day to day working with complex and challenging service users. Staff training aside, we have used Reflective Practice sessions, tried making CAT formulations more available to staff teams, and developed the concept of “CAT chats” which uses instant CAT mapping techniques. We have found the Cat model to be a safe and effective way to do this which is accessible by staff and will be using some workshop material to convey these methods.

PresentersJamie Kirkland and Mark Ramm

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Plenary:  CATBiD: A phase one randomised controlled study of Cognitive Analytic Therapy for Bipolar Affective Disorder

Presenter: Dr Mark Evans , Consultant Medical Psychotherapist, Gaskell House , Manchester Mental Health and Social Care NHS Trust

Introduction
Bipolar disorder is a severe and enduring mental disorder with a lifetime prevalence estimated at about 1% for which there is little clear evidence of the efficacy of psychological treatments.

Aims
This pilot project evaluated the acceptability of cognitive analytic therapy(CAT) as a treatment for patients with bipolar disorder as well as various secondary outcomes. The evidence for its efficacy in reducing relapse, service use and symptoms are presented.

Methods
Study design was a randomised controlled trial. Participants in the active treatment arm of the trial received treatment as usual (TAU) plus 24 weekly sessions of CAT followed by four review sessions( at 1, 2, 3 and 6 months post therapy). Participants in the control arm of the trial (TAU) received usual care from their clinical team consisting of psychiatric outpatient appointments and community team support when required.
Primary outcome measures included: total number of CAT sessions completed and acceptability of the therapy using qualitative methodology. Secondary outcome measures include: no of relapses, use of community and inpatient mental health services . and a variety of symptom measures (BDI,MADRS-Depression, Bech Rafaelson Mania Rating scale ,CORE, Personality Structure Questionnaire) and a measure of work and social adjustment (WSAS).
The electronic health record system (AMIGOS ) was used to review number and length of any admissions to inpatient wards, crisis resolution and Home Treatment teams or Assertive Outreach Teams. This record was also used to gauge the number of community team and outpatient appointments.

Results
The results of the acceptability of CAT as a potential treatment for Bipolar disorder together with results from secondary outcome measures will be presented.

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Workshop Title – Using a CAT approach to inform group work (open and closed) with adolescents-within an inpatient setting.

What do you do when you find yourself practising in a setting where service and patient (contextual) constraints and dynamics do not easily allow you to practise CAT in more conventionally recognised CAT ways? One has to then “Cut their coat according to their (contextual) cloth”.

Group work is an important component of inpatient therapeutic input. The main emphasis of this session will be to describe and discuss a (closed) six session CAT informed group work approach developed in this inpatient adolescent setting. Practical examples and clinical material will be used to explore how CAT approaches can be particularly helpful in engaging this often hard to connect with patient group, who may be inpatient for a limited time. I hope it will be an interactive and participative session aimed at sharing ideas and promoting helpful discussion, and having fun! Whilst the topic is inpatient adolescents, many of the ideas are arguably transferable to all types of settings and groups.

Presenter

John’s background is in social work and he practises as a CAT Psychotherapist within the multidisciplinary team at the St Aubyn Centre in Colchester-located in the south east of the United Kingdom. The St Aubyn Centre is a 25-bed Tier 4 NHS inpatient unit working with young people between the ages of 13-17 who are experiencing a significant mental health crisis. Admission to the Centre is usually precipitated by significant self harm or suicidal behaviour, culminating in assessment at an accident and emergency department. Some patients can be quite some distance from their home area.

John has a specific interest in group work, and the application and adaptation of CAT in groups.

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What CAT could offer inpatient psychiatry?

presenter Dr Sarah Cluley

I qualified as a doctor in 1985 and after wandering around various hospitals and specialties I began a career in psychiatry in 1991. Dr Anthony Ryle was supervising junior doctors where I worked and introduced me to CAT for which I am eternally grateful. My specialism was liaison psychiatry where mind and body meet and where there were plenty of opportunities for psychological intervention. I ran a trial of CAT in people with asthma and have trained and supervised staff to use CAT for people who self harm. I retired from the NHS in 2010 since which time I have worked as a tutor at Leeds University and as a private CAT psychotherapist and supervisor. Earlier this year I began supervising inpatient staff who had received a CAT skills training and in this workshop I look at some of the issues in inpatient care today and share my experience of this project.

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