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

Abstract

ObjectiveThere has been growing interest in the use of cognitive analytic therapy (CAT) with those facing experiences of psychosis. However, there is little research on how CAT is best applied to working with psychosis. This study aimed to identify what the key aspects of CAT for psychosis are or whether this approach requires adaptation when applied to those with experiences of psychosis, drawing on expert opinion.MethodAn adapted Delphi methodology was used. Items were generated during an initial workshop (N = 24) and then rated for agreement or importance via an online survey by a sample of experts with experience of CAT and working clinically with psychosis (N = 14).ResultsFollowing two rounds of ratings, consensus was reached on most items. Additional comments emphasized the need to be flexible with regard to the varying needs of individual clients.ConclusionsResults highlight the specific relational understanding of psychosis provided by CAT as one of the key elements of this approach. Responses emphasized the need for some level of adaptation to work with psychosis, including greater flexibility with regard to the treatment frame.Practitioner Points When working with experiences of psychosis, aspects of the CAT model, such as session length, pacing, and duration of therapy, are open to change and may require modification.When working with experiences of psychosis, narrative reformulation letters and sequential diagrammatic reformulation (SDR) remain essential to the therapy.This Delphi methodology study essentially relies on opinion. Further empirical research could test assumptions about the most important or therapeutically effective components of CAT in psychosis.CAT is still not widely used in the context of psychosis limiting the pool of experts available for the current sample.

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“…); or (4) expert opinion elicitation (employed in psychology; Taylor et al. ), which can be used to formulate priors in Bayesian analyses (Murray et al. ).…”

“…In situations where synthesis of conflicting data sources results in model failure (e.g., unrealistic and/or unidentifiable parameter estimates, lack of model convergence, estimates biased towards the most datarich source), ecologists may consider borrowing methods from other fields to resolve discrepancies. Such methods include (1) data weighting (done in fisheries stock assessments; Francis 2011); (2) data subsetting and thinning (a geospatial technique, Freschi et al 2014); (3) data supplementing (done in the social sciences; Foster et al 2016); or (4) expert opinion elicitation (employed in psychology; Taylor et al 2017), which can be used to formulate priors in Bayesian analyses (Murray et al 2009).…”

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“…However, this meant there was less control over the timing and format of the therapy provided. There is currently no evidence‐based guidance on the necessary length of CAT when working with psychosis, although a recent Delphi study emphasizes the need for flexibility (Taylor, Jones, Huntley, & Seddon, ). Consequently, therapists were free to contract for however many sessions they felt were necessary based on their clinical judgement.…”

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“…The Delphi technique is considered an excellent tool for obtaining consensus from a group of experts in a wide range of fields, such as applied psychology and psychotheraphy [60], the impact assessment of public policies [61], or strategy implementation for sustainable development [62], among others.…”