The development of a change model of “exits” during cognitive analytic therapy for the treatment of depression

Abstract

eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Objectives: 'Exits' in cognitive analytic therapy (CAT) are methods that change unhelpful patterns or roles during the final 'revision' phase of the therapy. How exits are conceived and achieved is currently poorly understood. This study therefore focused on the revision stage of CAT to explore and define how change is accomplished. Methods:Qualitative content analysis studied transcripts of sessions six and seven of a protocol delivered eight-session CAT for the treatment of depression. Eight participants met the study inclusion criteria and therefore sixteen sessions were available for analysis. Results:The exit model developed contained three distinct (but interacting) phases; (1) developing an observing self via therapist input or client self-reflection, (2) breaking out of old patterns by creating new roles and procedures and (3) utilisation of a range of methods to support and maintain change. Levels of inter-rater reliability for the exit categories making up the model were good.Conclusions: The revision stage of CAT emerged as a complex and dynamic process involving three interacting stages. Further research is indicated to understand how exits relate to durability of change and whether change processes differ according to presenting problem. Key Practitioner Messages: Exit work in CAT is a dynamic process that requires progression through stages of insight, active change and consolidation. Development of an 'observing self' is an important foundation stone for change and CAT therapists need to work within the client's zone of proximal development. A number of processes appear important in facilitating change such as attending to the process and feelings of change. Cognitive analytic therapy (CAT) is an integrative therapy that draws on personal construct (Kelly, 1955) and object relations theory (Ryle, 1985), and is based on the principle that mental representations of self, others and the world are developmentally formed by early interactions with significant others (Ryle & Kerr, 2002). CAT assimilates associated psychoanalytic and cognitive methods to offer a transdiagnostic, time-limited and relational approach to facilitating therapeutic change (Ryle & Kerr, 2002). The model therefore anticipates that the client will relate to the therapist as they did with significant others in their ...

Clients' experience of change: An exploration of the influence of reformulation tools in cognitive analytic therapy

“…Participants' accounts suggest that it is the meaning of the SDR experience that affects whether the diagrammatic reformulation process is important in bringing about change. For some participants, key moments in the therapy involved the use of the SDR to explore enactments in the therapeutic relationship, a finding replicated in Sandhu et al's (2017) paper. The different experiences of mapping described by participants (both overwhelming and useful) point towards an important clinical implication: It is essential to regularly check understanding, work slowly, use clients' own language, and consider using a simplified diagram.…”

“…In a number of the above studies, clients identified a process of gaining insight as important in their experience of change. A recent examination of change processes in CAT found that insight, in particular, the development of an “observing self,” is fundamental to the process of change (Sandhu, Kellett, & Hardy, ). However, the mechanism by which CAT tools lead to improved insight and how this relates to observable outcomes is still unclear.…”

Evaluation of a Mobile App to Enhance Relational Awareness and Change During Cognitive Analytic Therapy: Mixed Methods Case Series (Preprint)

“…We have learnt from this study that the recognition and revision phases of CAT can be supported using mobile technology to support patients practicing relational awareness. Such awareness has previously been illustrated to be the plinth upon which change occurs [25]. Any efforts to make relational awareness tools more accessible and less obtrusive to patients between sessions and also more time efficient for therapists within sessions are at a premium.…”

“…CAT uses a 3-phase approach: (1) an initial "reformulation" stage during which target problems and target problem procedures are summarized in narrative and diagrammatic reformulations, (2) a middle "recognition" stage facilitating self and relational awareness, and (3) a final "revision" stage that is focused on change. Therapeutic change during CAT is founded on effective relational awareness [25].…”

Blending Cognitive Analytic Therapy With a Digital Support Tool: Mixed Methods Study Involving a User-Centered Design of a Prototype App (Preprint)

“…This position has much in common with the "self-as-context" process of acceptance and commitment therapy [8]. There is evidence that outcome in CAT is heavily dependent on the patient being able to occupy the "observing eye" position, as from this position of awareness, change is then possible [9].…”