Team consultancy using cognitive analytic therapy: a controlled study in assertive outreach

Abstract

Accessible summary Cognitive analytic consultancy involves mapping the dysfunctional procedures and relationships that exist between team and patient using cognitive analytic theory. The study showed no impact on patient outcomes, but a significant organizational impact in terms of team practices and relationships. Cognitive analytic consultancy offers promise in helping in‐patient and community clinical teams manage those patients not suitable for individual or group psychotherapy. Abstract The objective of this study was to evaluate the clinical and organizational efficacy of formulation‐based consultancy to clinical teams using a randomized control trial methodology. Patients in an Assertive Outreach Team (AOT) were randomized into cognitive analytic consultancy (CAC; n = 10) or treatment as usual (TAU; n = 10). CAC consisted of three consultancy sessions with individual team members to formulate and map the dysfunctional roles and procedures adopted by both patient and team. Subsequent changes to practice were then supported via team supervision. Measures of patient and team functioning were taken across four discrete study phases; (1) baseline team training, (2) case consultation, (3) team supervision and (4) 3‐month follow‐up. Team members were additionally interviewed before and following the trial. No differences were evident between CAC and TAU in terms of patient outcomes. However, the climate of the AOT significantly improved longitudinally over the course of the trial, with CAC facilitating enhanced clinical and team practices. The results are discussed in terms of methodological limitations, the advantages/disadvantages of team consultation and the potential for the further development of the CAC model.

Understanding Outcomes in a Randomized Controlled Trial of a Ward‐based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences

“…The process of sharing ideas through formulation also increased the confidence of less experienced staff. The benefits of team formulation on team cohesion are consistent with findings of previous studies investigating staff perspectives on team formulation (Kellett et al., ; Summers, ). Team collaboration was not assessed as an outcome measure in the main trial, but it is an important outcome to include in future trials because research suggests that collaboration has a positive influence on quality of care and team member well‐being (Borrill, West, Shapiro, & Rees, ).…”

“…Consistent with previous studies of team formulation (Kellet et al., ; Summers, ), not all staff members were positive about team formulation or its influence on their practice. Different members of teams clearly respond to organizational interventions, including this team‐based formulation intervention in different ways.…”

“…While quantitative effects on therapeutic relationships were rather narrowly defined in the trial (Berry et al., ), qualitative data described here provided a much more detailed and nuanced picture of changes resulting from the intervention, and how different components of the intervention related to each other and influenced change. Previous studies have explored participants’ experiences of formulation‐based interventions (Kellett et al., ; Summers, ). However, this is the largest qualitative investigation of team formulation to date.…”

“…Findings from small quantitative studies suggest that team formulation can improve staff attitudes toward patients (Berry, Barrowclough, & Wearden, ), reduce problem behaviors (Taylor & Sambrook, ), and enhance team cohesion (Kellett, Wilbram, Davis, & Hardy, ). Qualitative research investigating staff views of team formulations suggests that they improve understanding of the patients’ social context, lead to more creative treatments, and help ensure a more consistent way of working (Kellett et al., ; Summers, ).…”

What are the key elements of cognitive analytic therapy for psychosis? A Delphi study

“…The suggestion of CAT-informed indirect or consultancy-based work also emerged when participants considered the application of CAT to more extreme or florid states of psychosis. This is consistent with recent work evaluating CAT-informed consultancy approaches for those with experiences of psychosis (Kellett, Wilbram, Davis, & Hardy, 2014) and shows that CAT of psychosis need not be limited to one-to-one therapy.…”