The current paper aimed to ascertain MDT staff ’s experiences of a two- day introductory training to CAT. This training was specifically designed for MDT staff working in inpatient services for women with a diagnosis of personality disorder. Traditional models of professional mental health training often do not incorporate a relational framework for understanding client difficulties and so CAT can provide a way of conceptualising some of the most challenging aspects of mental health work (i.e., interpersonal dynamics) using an accessible and transdiagnostic framework (Kerr et al., 2007). There is a growing body of evidence suggesting CAT can also have a positive impact on stress, burnout and therapeutic confidence, leading to more positive relationships with both clients and colleagues and the overall functioning of an MDT (Caruso et al., 2013).

The results of the thematic analysis suggested the training was well- received by MDT staff taking part and the positive impact and anticipated benefits of the training were in line with that of previous research. From the analysis, the largest theme (120 items of coded data) related to the ‘practical applications of the CAT model’ and from these items three sub-themes were identified: ‘everyday practice’, ‘team function’ and ‘psychological process’. Some respondents indicated they felt the knowledge and understanding they had acquired during the training could help them in their everyday practice. This supports evidence that has shown CAT’s efficacy as a framework for service delivery beyond that of an individual therapy (Shannon et al, 2016). The feedback suggested the CAT model could benefit practice in several ways including providing useful tools for focusing 1:1 discussion (i.e., the use of ‘maps’), increasing confidence and skills in managing difficult interactions and more effective care planning. This finding is also supported by research conducted by Thompson et al. (2008) who found that a ‘skills level’ training in CAT had a positive impact on individual practice/confidence and Caruso et al (2013) who indicated that feelings of individual accomplishment increased following similar training.

The central focus on the understanding and use of SDRs (‘maps’) was a unique feature of the training. It was designed specifically for maps to be a core part of guiding a client’s care in an inpatient service, within the context of ongoing MDT supervision. The results indicated participants felt maps could be beneficial to their practice; they suggested that using maps during one-to-one sessions would help to increase effective dialogue and aid the development of psychologically informed care. Maps were also seen as a potentially helpful tool to facilitate reflection with colleagues, to enable more effective work with clients and more awareness of staff ’s own emotional responses. Additionally, it was suggested that maps could be used to share learning across the team and encourage consistent approaches to practice. The flexibility and use of maps (including within inpatient settings) has been highlighted by Potter (2010); the current evaluation supports the notion that maps can be a tangible and accessible way of facilitating relational understanding within staff teams that supports ‘side by side’ working as opposed to oppositional and conflicting approaches to care, which can exacerbate difficulties (Potter, 2010; Barnes, 2016).

The link between the implementation of CAT training for MDTs and increased team cohesion and functioning has been demonstrated in the literature (Kerr et al, 2007). This may be particularly important when thinking about teams working in inpatient settings as there are more opportunities for difficult and challenging interpersonal experiences for staff (Moore, 2012). The feedback indicated participants were positive about the influence the training could have on the team, with several staff indicating they felt it could allow for a more consistent approach. Participants also thought the shared learning would be helpful when considering how best to respond to challenging situations or difficult interpersonal dynamics as a team. It has been argued the training staff receive in psychologically informed approaches to mental health is limited, as is the support and supervision offered (Kerr et al., 2007). Therefore, training initiatives, such as that outlined in this paper, may be of significant importance when working towards building a relationally skilled workforce.

A number of participants commented on how the training allowed them to develop an increased awareness of themselves and what they bring to their work. It was clear from the evaluation that some participants felt they may respond to clients in a more effective and thoughtful way following the training. This was demonstrated by participants considering strategies such as taking a ‘pause’ before responding to a client, using the map to understand feelings of frustration and reflecting on reciprocal roles. Participants also identified the training could have a positive impact on their therapeutic relationships and on their level of compassion. Previous research has supported the notion that CAT training can have a positive impact on the therapeutic relationship and has argued this is an important finding as the link between quality of the therapeutic relationship and clinical outcome has been clearly demonstrated (Caruso et al, 2013).

The current paper demonstrates face validity and acceptability to staff teams who have the intention to utilise CAT within their work setting as measured at the point of delivery of the training. This work could be extended to include baseline and follow-up data (to assess individual change in staff knowledge and understanding as well as the impact of the training on subsequent working practices). Exploring the impact of this training on staff ’s relationships with clients (particularly levels of compassion and the quality of the therapeutic relationship) would be areas for further consideration. The training was evaluated using a standard service feedback questionnaire. It would be useful to develop this further to ascertain more specific information on how the sub-themes in Theme 1 reflected the mechanisms at work in CAT, by using a more focused questionnaire/interview process.

In conclusion, there is a clear need for inpatient services to develop the skills and knowledge of their staff to attend to the increasingly complex and challenging needs of clients. CAT can provide a helpful and containing way of formulating complex presentations such as personality disorder, while also providing a framework for understanding staff ’s own responses to their work. The impact of such work on client outcome, the therapeutic relationship and the containment of staff needs further research. However, the current evaluation, suggests staff have responded positively to the introduction of CAT principles and their application to personality disorder, and the CAT model could be an acceptable, accessible and meaningful approach to enhance psychological work within inpatient settings.