Cognitive analytic therapy at 30

Ryle, Anthony; Kellett, Stephen; Hepple, Jason; Calvert, Rachel

doi:10.1192/apt.bp.113.011817

Cited by 38 publications

(51 citation statements)

References 43 publications

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“…Outcome research demonstrates the effectiveness of cognitive analytic therapy (CAT) for a range of presenting problems (Calvert & Kellett, ; Ryle, Kellett, Hepple, & Calvert, ). Understanding why CAT works and what brings about the changes, as with other therapeutic approaches, is less well evidenced (Kazdin, ; Norcross & Wampold, ).…”

Section: Introductionmentioning

confidence: 99%

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

Tyrer

Masterson

2018

Clin Psychology and Psychoth

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Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small‐N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self‐Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation‐10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT‐specific tools.

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Section: Introductionmentioning

confidence: 99%

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

Tyrer

Masterson

2018

Clin Psychology and Psychoth

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“…There is a small but developing evidence base for CAT for complex clinical populations (Calvert & Kellett, ), with a weighted mean effect size across CAT outcome studies of d + = 0.83 (Ryle, Kellett, Hepple, & Calvert, ). However, how these effect sizes are achieved (i.e., how change is brought about) during CAT is currently poorly understood (Calvert & Kellett, ).…”

Section: Introductionmentioning

confidence: 99%

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

Sandhu

Kellett

Hardy

2017

Clin Psychology and Psychoth

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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 ...

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“…Ryle et al . () noted that a key feature of CAT is rapid reformulation and speculated that this may be a key factor contributing to the low dropout rates observed across CAT outcome studies. Acceptability of treatment is particularly pertinent for survivors who often endure ongoing marginalization and adversity, which can then markedly limit their capacity to effectively engage with services (Fisher et al ., ).…”

Section: Discussionmentioning

confidence: 99%

“…Research is needed to determine the optimum GCAT treatment duration for survivors with significant interpersonal difficulties. As group delivery of CAT is increasingly popular (Ryle et al ., ), a measure of group treatment fidelity is needed to mirror the competency measure developed for use with individual CAT (CCAT; Bennett & Parry, ). Findings were limited to female survivors, and future studies should prioritize investigating outcomes for male survivors; a much neglected clinical and research population (O'Leary & Gould, ).…”

Section: Discussionmentioning

confidence: 99%

“…In summary, a wealth of evidence confirms the negative, long‐term psychological impact of CSA and yet relevant outcome research remains in its empirical infancy. GCAT is a treatment approach currently unsupported by a robust evidence base, despite the recent call to produce evidence for group CAT delivery (Ryle, Kellett, Hepple, & Calvert, ). This study aimed to evaluate the outcomes of GCAT in routine clinical practice for female CSA survivors, through investigating differences between outcomes during treatment versus wait time.…”

Section: Introductionmentioning

confidence: 99%

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Group cognitive analytic therapy for female survivors of childhood sexual abuse

Calvert

Kellett

Hagan

2015

British J Clinic Psychol

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Objectives The effectiveness of cognitive analytic therapy delivered in groups has been under‐researched considering the popularity of the approach. This study sought to investigate the effectiveness of 24 sessions of group cognitive analytic therapy (GCAT) delivered in routine practice for female survivors of childhood sexual abuse (CSA). Methods In a longitudinal cohort design, N = 157 patients were treated with 24 sessions of GCAT. Validated outcome measures were administered at assessment, pre‐GCAT, and post‐GCAT. This enabled rates of reliable and clinically significant change to be compared between wait time and active group treatment. The uncontrolled treatment effect size was then benchmarked against outcomes from matched studies. Results On the primary outcome measure, GCAT facilitated a moderate effect size of 0.34 with 11% of patients completing treatment meeting ‘recovery’ criteria. The dropout rate was 19%. Significant improvements in interpersonal functioning, anxiety, and well‐being occurred during GCAT in comparison with wait time on secondary outcome measures. Conclusions Group cognitive analytic therapy appears a promising intervention for adult female CSA survivors, with further controlled evaluation indicated. Practitioner points Group cognitive analytic therapy appears a promising and acceptable intervention for female CSA survivors experiencing high levels of psychological distress. Long‐term follow‐up studies are required with CSA survivors to index the clinical durability of GCAT. A GCAT treatment fidelity measure needs to be developed and evaluated.

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Cognitive analytic therapy at 30

Cited by 38 publications

References 43 publications

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

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

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

Group cognitive analytic therapy for female survivors of childhood sexual abuse

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