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Cognitive Analytic Therapy Foundation

Level Certificate

2018

Trainee Handbook

UNIVERSITY OF EXETER | Doctorate in Clinical Psychology – CAT foundation level handbook

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Contents Cognitive Analytic Therapy Foundation Level Certificate ..................................................... 2

Outline of Foundation Certificate in CAT embedded training ............................................... 2

CAT road map ......................................................................................................................... 4

CAT Teaching .......................................................................................................................... 5

Essential reading .................................................................................................................... 6

Assessment ............................................................................................................................ 6

Clinical practice and assessment ........................................................................................... 6

Written assignments .............................................................................................................. 7

Marking .................................................................................................................................. 8

Personal Development ........................................................................................................... 8

The Award .............................................................................................................................. 9

Appendix 1: Foundation Level CAT portfolio ....................................................................... 10

Appendix 2: Marking guidelines for Essay ........................................................................... 27

Appendix 3: Marking guidelines for Clinical Case Report .................................................... 29

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Cognitive Analytic Therapy Foundation Level Certificate

At Exeter we are excited by the new development of offering an embedded Cognitive

Analytic Therapy (CAT) (ACAT accredited) foundation level qualification to trainees. It will

equip trainees with CAT skills and competencies for working with clients in health service

settings. The addition of CAT training to the programme complements the CBT and Systemic

training that are a well-established part of the DClin programme.

CAT brings together cognitive psychotherapies and psychoanalytic approaches into one

integrated, user-friendly and effective therapy. It is a goal/change focused, and time-limited

(16-24 sessions) therapy. CAT at its heart is an empathic, respectful, collaborative, meaning-

making relationship between the client and the therapist within therapeutic boundaries. For

further information see http://www.acat.me.uk/page/about+cat

CAT has recently been accepted as a psychological therapy for use within Improving Access

to Psychological Therapies (IAPT) services for individuals who may present with personality

disorder, with the publication of the CAT competency framework as part of the IAPT Serious

Mental Illness (SMI) framework. Moreover, CAT is proving particularly helpful in secondary

care, where clients / service users have frequently experienced challenging childhoods that

have led to a constellation of problems – a core feature of which can be difficulties in

interpersonal relations. These relational difficulties can often be enacted in therapy and in

teams, and can disrupt treatment, and interactions within care teams. As such, CAT provides

an approach that can contribute to a greater sophistication of understanding and

formulation of clients /service user problems, both within the context of therapy and within

health teams.

Outline of Foundation Certificate in CAT embedded training

The Exeter DClin programme offers a high standard of teaching and clinical placements that

develops the core competencies and skills within trainees. However, clinical psychology is a

broad field and, where possible, the programme seeks to support trainees to pursue their

area(s) of specialisation. Trainees may choose to opt-in to opportunities provided during

training. All trainees on the programme will receive the CAT teaching. Those trainees who

opt-in to do the foundation level CAT will need to complete supervised CAT clinical cases on

placement and assignments outlined below.

Trainees who are interested in pursuing CAT accreditation should discuss this with their

appraiser and clinical tutor. The clinical tutor will seek to arrange the relevant placement

opportunities, but this will be dependent on supervisor availability and trainees learning

needs. CAT placements are most likely to take place in the second and third year of training.

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Jason Hepple is the foundation level course director, however, trainees are encouraged to

contact Nadja Krohnert N.E.Krohnert@exeter.ac.uk if you have any queries relating to CAT

foundation level certificate.

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CAT road map

All trainees receive 11 days teaching and 4 locality packs on CAT

Most of the teaching falls in the second year.

Trainees who do not wish to pursue CAT foundation do not need to do anything else.

Trainees who are interested in gaining CAT foundation accreditation should discuss this with their clinical tutor and appraiser. Trainees will register with ACAT, and will fulfill requirements for accreditation are

outlined below.

During 2nd and 3rd Year trainee to complete.......

Clinical

4 supervised CAT cases ( 2 of at least 16 sessions, and 2 of at least 8 sessions) - supervised by a CAT accredited supervisor

2 CAT-specific ‘appraisals’ carried out by CAT accredited supervisor (one of these 'appraisals' can be submitted at an observation for clinical assignment)

Academic

1 essay (2,500- 3,000 words)

1 case-study (4,000 words)

Reflective

Personal development session (organised and paid for by trainee)

Year 3 trainee submit their application to ACAT for Foundation level CAT

Post qualifying trainees can apply to do an additional year (includes teaching days, 16 session personal CAT therapy, 4 additional clients and some written work) to gain the CAT practitioner

accreditation

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CAT Teaching

CAT teaching is delivered over three years. Most of the CAT teaching falls in year 2nd and 3rd

year.

Preliminary teaching:

Case Formulation - A Two day introduction (including CAT formulation)

An existing part of the D.Clin.Psych course giving an introduction to comparative

formulation from the perspective of different psychological therapies.

Cat-Specific teaching:

Day 1: An Introduction to CAT – Locality Study Day

Day 2: CAT as a focused and relational model

Day 3: Reformulation – prose and diagrammatic

Day 4: Unmanageable feelings and unmet need

Day 5: RRs, RR Re-enactments in the therapy relationship and use of self

Day 6: Developing the Observing Eye and facilitating recognition and revision

Day 7: Introduction to Borderline Personality Disorder

Day 8: The Dialogical Self in CAT

Day 9: Managing a time-limited therapy - 8, 16, 24 session CATs – when, why and how?

Day 10: Evidence-based practice and change – Locality Study Day

Day 11: Endings in therapy and the course

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Essential reading

Ryle A, Kellett S, Hepple J and Calvert R (2014) Cognitive Analytic Therapy (CAT) at Thirty.

Advances in Psychiatric Treatment 20, 258-268.

Bennett D, Parry G (2004) A measure of psychotherapeutic competence derived from

Cognitive Analytic Therapy. Psychotherapy Research 14: 176-192.

Kellett S, Bennett D, Ryle A, Thake A (2013) Cognitive analytic therapy for borderline

personality disorder: Therapist competence and therapeutic effectiveness in routine

practice. Clinical Psychology and Psychotherapy 20: 216-225.

Assessment

The CAT foundation is assessed in three domains; clinical, written assignments and a

personal development element.

All evidence is to be recorded on the foundation level CAT portfolio (see appendix 1).

Clinical practice and assessment

4 supervised CAT cases

A least 2 of the four cases must be at least 16 sessions in duration (two may be 8 session

cases). Insofar as it is possible, trainees will be encouraged to accumulate a range of clinical

experience in terms of pathology, gender, age, ethnicity, socio-economic group. A complete

CAT case is one in which all three CAT tools have been developed and shared (prose

reformulation, SDR and goodbye letter).

Cases must be supervised by an ACAT accredited supervisor. Supervision is weekly other

than for annual leave. Time will be allocated with, on average, a minimum 15 minutes

weekly per client, but with flexibility in the allocation according to client and trainee need.

Trainees are encouraged to keep a supervision log that can be signed by the supervisor.

2 CAT- clinical appraisals

The purpose of the CAT appraisal (see portfolio, appendix 1) is threefold: firstly and

primarily it provides a means whereby the trainee and the supervisor can talk about the

process of supervision, agree about areas of progress or difficulty in CAT and agree areas to

concentrate on in the future. Secondly, it will give the supervisor feedback on how they

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supervise and how they could supervise more effectively. Thirdly, it provides the basis for

the CAT supervisor’s report.

The CAT clinical appraisal is separate, and an addition to, the placements supervisors’

assessment (Clinical Competence Goals and Evaluations Form and the Portfolio of Clinical

Experience). It is the main placement supervisor’s assessment which determines whether or

not a trainee is deemed competent in clinical practice on the Doctorate in Clinical

Psychology. However, one of the CAT appraisals can be submitted as one of the

observations for the clinical paperwork hand in.

Written assignments

The foundation course requires two pieces of written work.

Essay – (2,500 and 3,000 word limit)

Title: “What are the theories underpinning CAT’s understanding of reformulation?

Illustrate your answer with reference to your experience of writing a reformulation letter”

The essay focuses on the trainees reflection on the process of writing, and the contents of, a

‘Reformulation Letter’ that the trainee has written to a client / patient.

See marking guideline (see appendix 2)

This essay is so closely linked to therapeutic work with a client that we would encourage

trainees to include this into their placement activity.

The recommended submission date would be June / July of second year.

Case-study (4,000 word limit).

The case study needs to outline the whole course of a CAT therapy. To qualify as a written

case study the three CAT tools must be present: the reformulation letter, sequential

diagram(s) and the goodbye letter. Case studies need to be of a 16 session (or longer

duration) CAT

The recommended submission date would be third year, when the trainee will have had the

opportunity to integrate the teaching with their clinical practice. See marking guideline (see

appendix 3). (Trainees may submit the CAT case study as one of the four clinical practice

reports (CPRs), and this will be marked according to the DClin CPR (CAT.

All assignments must adhere to programme guidelines including confidentiality and consent,

and be written to APA format.

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Marking

Submission dates: Please contact Nadja Krohnert to agree submissions deadlines. In order to

plan for ACAT markers work load, it is likely that submission dates will fall on Monday

second week of June (Year 2 or Year 3), and Monday of second week in March (Year 3).

Assignments to be submitted through DClinPsy Clinical Psychology (DClinPsy@exeter.ac.uk).

Assessments will be marked by ACAT markers and according to ACAT guidelines. Exeter and

ACAT have agreed shared marking guidelines for the case study / Clinical Case Report.

Assignments will be marked and given a mark of distinction / merit / pass / borderline

(requires resubmission) / fail. This is an outright fail with no resubmission of this same piece

of work. A specific % mark is not assigned but the categories are anchored to a % range as

follows:

Distinction (70% and above)

Merit (60 - 69%)

Pass (50 – 59%)

Borderline / Refer (40% - 49%)

Fail (<40%) This is an outright fail with no resubmission of this same piece of work

Personal Development

One personal development session on the use of self in clinical work.

This session would usually be conducted on a one to one basis by a CAT psychotherapist or

practitioner independent of the course. Please see Information on personal development. This

session will be confidential and not shared with course supervisors and trainers other than

the fact that it has been completed. This would be organised, and paid for, by the trainee.

Personal CAT therapy (16 sessions) is not a requirement of the CAT Foundation course.

This session would usually be conducted on a one to one basis by a CAT psychotherapist or

practitioner independent of the course, with the aim of exploring what it is ‘they bring to

work’. The starting point for this experience is often through reflecting upon the use of self

in relation to a clinical case or scenario. It gives participants not only some flavour of what it

is like ‘at the receiving end’, but also shows that work in this area of mental health inevitably

involves personal reactions and requires an openness to discussion of these issues in

supervision. It is stressed that this is not therapy but simply an opportunity to explore these

issues in confidence. The personal reformulation experience is well developed and focuses

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upon the shared mapping out of patterns, roles and coping strategies that have most

bearing on professional practice. The format will typically be one of two forms

An extended single session of 2.5 hours with an introductory hour or so of

exploration and discussion, based ideally on completion of the psychotherapy file,

followed by a break and then an attempt at and/or a brief written reformulation.

A two hour session with a follow-up session at an agreed interval.

The Award

On successful completion of the Foundation Level course the candidate will submit an ACAT

accreditation form detailing satisfactory completion of all components. This would be

organised by the trainee. As ACAT trainees need to remain an ACAT member until

accreditation those trainees completing the CAT portfolio after the three years of

professional training will be personally responsible for maintaining their ACAT membership

and fee. This is at present a cost of £87 per year, payable from October to October. ACAT

Exam Board meets three times a year and will agree the award – the One Year Foundation

Level Certificate in Cognitive Analytic Therapy accredited by ACAT.

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Appendix 1: Foundation Level CAT portfolio

This Portfolio collates the minimum required evidence to support an application for foundation level accreditation in Cognitive Analytic Therapy (CAT) required for the Association for Cognitive Analytic Therapy (ACAT) accreditation at Foundation level. It is your responsibility to complete this portfolio, throughout the 3 years of training, add to it as necessary before submission to ACAT and to ensure that the portfolio is signed off by ACAT accredited supervisors as appropriate. To demonstrate competencies in CAT-informed theory and practice - a range of generic, and CAT competencies, must be attained at a satisfactory level, or above, as evidenced by the ACAT Core Competencies Framework. The required competencies will be acquired through a combination of; supervised practice on clinical placement (to include appraisals of clinical skills), course teaching, self-study, a personal CAT reformulation and academic assignments. The requirements are:

Four CAT cases supervised by an accredited ACAT supervisor. Two of these must be at least 16 sessions long. All will show your use of the CAT tools; prose reformulation, diagrammatic reformulation (SDR) and a goodbye letter. Each case has to be discussed in supervision for 15 mins per week (except when there is annual leave), preferably in a small group format.

A personal CAT reformulation session (to be self-organised and self-funded).

Two clinical appraisals of clinical skills undertaken by the ACAT accredited supervisor. A short report on the trainee’s performance from the supervisor when they end contact and a short report of the trainee’s experience of supervision at the same time.

Attend at least 90% of CAT teaching.

A CAT case study (4, 000 words long) and a CAT clinical essay of (2,500 – 3,000 words) marked by ACAT markers. You have up to one year after graduation to complete your portfolio and submit it to ACAT for accreditation.

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Clinical Component

CLINICAL COMPONENT: Completed therapy cases

Case summary and number of completed clinical sessions. Number of supervision sessions. Details of placement and specialty where case was undertaken.

Supervisor’s signature, name and ACAT accredited status

Date

CAT CASE ONE

CAT CASE TWO

CAT CASE THREE

CAT CASE FOUR

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Written Assignment

ACADEMIC COMPONENT TITLE ACAT MARKER NAME AND SIGNATURE

Date and outcome

CAT Case Study

CAT Essay

“What are the theories underpinning CAT’s understanding of reformulation? Illustrate your answer with reference to your experience of writing a reformulation letter”

Personal Development

EXPERIENTIAL COMPONENT Evidence: number of hours personal learning / reflection / therapy (minimum of 1 session)

CAT Personal Reformulation Practitioner name & signature

Dates

Personal Reformulation

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Teaching

CAT TEACHING TOPIC

Name of Presenter & Date

CAT locality study Day 1 An Introduction to CAT – (Locality Study Day)

CAT TEACHING Day 2 CAT as a focused and relational model

CAT TEACHING Day 3 Reformulation – prose and diagrammatic

CAT TEACHING Day 4 Unmanageable feelings and unmet need

CAT TEACHING DAY 5

RRs, RR Re-enactments in the therapy relationship and use of self

CAT TEACHING DAY 6

Developing the Observing Eye and facilitating recognition and revision

CAT TEACHING DAY 7

Introduction to Borderline Personality Disorder

CAT TEACHING DAY 8

The Dialogical Self in CAT

CAT TEACHING DAY 9

Managing a time-limited therapy - 8, 16, 24 session CATs – when, why and how?

CAT locality study DAY 10

Evidence-based practice and change – (Locality Study Day)

CAT TEACHING DAY 11

Endings in therapy and the course

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Optional CAT learning

The log below enables you to record any additional CAT teaching, activity or clinical experiences that has not been captured above.

Completion of this log is not a requirement for the attainment of core CAT competencies but it does provide an opportunity to acknowledge

any broader experience of CAT theory and practice gained during the three years of clinical training.

CLIENT SPECIFIC CAT TEACHING AND OTHER CAT TEACHING/CONFERENCES ETC

TOPIC Name of presenter ACAT qualifications Dates and hours Comments

LOG OF ADDITIONAL EXPERIENCE OF CAT THEORY AND PRACTICE

Evidence Relevant supervisor or clinical tutor’s signature and name

Date

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ACAT core competencies framework – supervisor appraisal

Trainees wishing to pursue CAT foundation certificate must complete two CAT clinical appraisals with CAT accredited supervisor. All of the below sections must be only signed off by an ACAT accredited supervisor.

CLINICAL APPRAISAL

Appraisal 1 Supervisor’s name, signature and ACAT accreditation status

Date

Supervisor feedback

Developmental actions

Trainee reflections on supervisor and supervision group

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Appraisal 2 Supervisor’s signature, name ACAT accreditation status

Date

Supervisor feedback

Developmental actions

Trainee reflections on supervisor and supervision group

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By the end of training on the programme, trainees are required to have scored at a satisfactory level, or above, on all of the below competencies in order to satisfactorily fulfil the competencies required.

Needs attention Satisfactory Excellent

1_________2_________3________4________5

GENERAL PSYCHOTHERAPEUTIC COMPETENCIES

Competencies Rating at appraisal 1

Rating at appraisal 2

Ability to conduct an assessment interview

Ability to form and maintain a therapeutic alliance with the client

Ability to negotiate and agree a contract with the client

Sensitivity to the context of the therapy (for example, awareness of cultural differences or impact of therapy on outside relationships)

Ability to form and maintain a therapeutic relationship with the client

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Ability to assess and review when necessary the appropriateness of intervening (to include whether to offer psychotherapy and when to prematurely terminate a therapy contract)

Ability to understand the implications of and work with clients presenting with diverse pathology and a range of difficulties

Ability to relate psychotherapy theory to practice (CAT and other relevant psychotherapy theories)

Supervisor: please complete comments on trainees competencies for this round of the appraisal process

Appraisal 1:

Appraisal 2:

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ABILITY TO USE SUPERVISION APPROPRIATELY

Competencies Rating at appraisal 1

Rating at appraisal 2

Ability to contribute to the supervision process

Ability to present case material clearly and succinctly

Ability to establish a working relationship with supervisor (to include ability to reflect on difficulties in relationship)

Ability to reflect on own contribution to therapeutic process

Ability to be open to, and recognise, own contribution to therapeutic process

Ability to openly address own contribution to therapeutic process

Supervisor: please complete comments on trainees competencies for this round of the appraisal process

Appraisal 1:

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Appraisal 2:

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GENERAL PROFESSIONAL ABILITIES AND COMPETENCIES

Competencies Rating at appraisal 1

Rating at appraisal 2

Ability to recognise, and maintain, appropriate professional relationships with clients, peers, teams and colleagues.

Sensitivity to the confidential nature of client information.

Ability to recognise limits of professional competence and willingness to seek help.

Written and verbal ability to communicate appropriately with other professionals.

Supervisor: please complete comments on trainees competencies for this round of the appraisal process

Appraisal 1:

Appraisal 2:

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CAT SPECIFIC ABILITIES AND COMPETENCIES

CAT specific competencies Rating at appraisal 1

Rating at appraisal 2

Ability to formulate (prose and diagrammatic reformulations)

Able to engage the client in the process of reformulation in early sessions

Identification of TPs & TPPs

Identification of RRPs

Prose reformulation e.g. accuracy, style, presentation, collaboration

SDR/SSSD – e.g. accuracy, style, presentation, collaboration

Ability to balance the range CAT tasks while also establishing, and maintaining, a therapeutic alliance/relationship

Ability to use CAT reformulatory tools to work with TPPs/RRPs emerging in client's life

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Recognition of TPPs/RRPs in 'outside' events (identified in narratives)

Work with client to revise TPPs/RRPs in 'outside' events

Recognition of re-enactment of TPPs/RRPs within therapeutic relationship (transference, counter -transference)

Ability to resolve threats to therapeutic alliance due to above (e.g. how this is acknowledged, explored and negotiated; use of CAT tools to aid client’s understanding; non-reciprocation)

Ability to work collaboratively within the client’s zone of proximal development

Facilitating recognition and revision and between-sessions therapeutic work

Ability to consider, or develop, complementary techniques as appropriate e.g. creative therapies, use of pictorial representation, metaphor etc

Facilitating recognition and revision and between-sessions’ therapeutic work

Ability to design, explain/demonstrate tasks/capacity to recognition and revision

Ability to evaluate and relate engagement in recognition and revision to reformulation

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Ability to terminate involvement appropriately

Ability to identify termination issues for clients

Ability to raise and discuss issue of termination at appropriate stage

Ability to produce and invite goodbye letters

Ability to name and contain feelings related to termination

Ability to explain and agree arrangements for follow-up

Ability to monitor change

Use of CAT specific ratings (TPPs etc)

Use of outcome measures and/or service evaluation/audit issues

Supervisor: please complete comments on trainees competencies for this round of the appraisal process

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Appraisal 1:

Appraisal 2:

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Appendix 2: Marking guidelines for Essay

Title: “What are the theories underpinning CAT’s understanding of reformulation? Illustrate your answer with reference to your experience of writing a

reformulation letter”

Using 2,500-3,000 words, reflect on the process of writing, and the contents of, a ‘Reformulation Letter’ you have written to a patient. For the purposes of

this essay you are asked to evaluate and analyse how various theories and therapeutic approaches may have contributed to or informed the understanding

you formed with this patient of his/her sense of self and presenting difficulties, and to reflect on how you expressed this through the creation of the letter.

You are asked to describe what you think is uniquely ‘CAT’ about it, and to identify the personal therapeutic and assessment skills which you used in order

to produce and deliver it in a safe, appropriate and culturally sensitive manner. As well as clarifying for yourself your developing theoretical understanding

of the CAT model and its reformulation tools, this essay also provides an opportunity for you to demonstrate on a more personal level where you are at in

the process of applying this learning. This essay is therefore not simply about giving ‘right’ or ‘wrong’ answers, but rather about sharing with markers in a

reflective manner what you have already discovered and mastered, as well as the things you have struggled with, and which you have therefore identified

as your particular areas for further development.

You are asked to enclose the letter as an Appendix, duly anonymized, which will not be included in the word-count.

Assignments will be marked and given a mark of distinction / merit / pass / borderline (requires resubmission) / fail. This is an outright fail with

no resubmission of this same piece of work. A specific % mark is not assigned but the categories are anchored to a % range as follows:

Distinction (70% and above)

Merit (60 - 69%)

Pass (50 – 59%)

Borderline / Refer (40% - 49%)

Fail (<40%) This is an outright fail with no resubmission of this same piece of work

Marking will be based on criteria outlined below.

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1. Ability to Address the Question/Select Focus of Essay The extent to which this is clearly outlined, specifying your aims or intentions in the essay and your reason/choice of the area. It will consider the clarity of

focus/themes in the introduction and reflected later in the discussion; that material selected is relevant to the issues/question; with reference to key

authorities; that it addresses the question and presents clear arguments.

2. Grasp of theory: Review of Relevant Literature/Knowledge base (if relevant) The extent to which a clear account of the subject area is presented. It will consider how sound and comprehensive your understanding of the subject area

is; the supporting evidence you draw on; that you identify and describe underlying issues

3. Ability to Link Theory to Practice Your ability to integrate material and incorporate it into clinical practice; appropriate and relevant selection of clinically illustrative material which if used,

enhances understanding of theory

4. Capacity to self-reflect, critically evaluate and express personal views The extent to which there is evidence of critical thinking and learning from the work and an awareness of the contribution of the assignment to CAT

practice/theory. Specifically, whether the work analyses, evaluates, criticises and reflects on theories and ideas rather than just describing them; risks,

supports and reflects on own personal viewpoints rather than just stating them, showing some awareness of underlying beliefs; describes and evaluates

conclusions and own learning.

5. Academic Structure and Presentation The extent to which there is a logical structure with good presentation, accurate and identifiable references.

6. Coherence and clarity of presentation The extent to which the assignment answers the question, that the content is relevant to the aims and the conclusions are clearly argued

General comments: This section may include comments on originality of material, use of creativity and/or a general appraisal of the work as a whole.

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Appendix 3: Marking guidelines for Clinical Case Report

Marking Criteria for a Cognitive Analytic Therapy Clinical Practice Reports (CPRs)

Structure Guidelines Marking Criteria

Extensive

Sufficient

Insufficient

Introduction

Referral/request

Setting the service and patient context

Culture and diversity issues

Initial hypothesis and preliminary plan/s

This section should set the context for the work

for the markers with a brief description of the

service setting. The initial referral/request should

be described. Outline the cultural/diversity

factors that need to be taken into account during

the work. Briefly summarise your early

hypotheses and the rationale for offering CAT.

(GM, R, PPSV, CT, OSIL)

Strong and

convincing evidence

that the work is of

professional

doctoral standard.

Demonstrates

advanced and

original scholarship

of a quality to satisfy

peer review.

Satisfactory or

good evidence that

the work is of

professional

doctoral standard.

Demonstrates

some scholarship

of a quality to

satisfy peer review.

Inadequate or no evidence

that the work is of

professional doctoral

standard. Demonstrates

little or no original

scholarship of a quality to

satisfy peer review.

Literature Review

Theoretical evidence

Research/experimental evidence base

The rationale given for CAT should be based on

relevant theory, evidence and research linked to

the client’s presentation. The prime focus of the

CPR is the ability to integrate CAT theory into

practice and identify relevant theoretical issues.

(Therefore this section may be shorter than in

other CPRs) (GM, R, CT)

Assessment of the Problem/s

Description of key difficulties

Evidence an ability to establish an early CAT focus

Risk

Provide a systematic account of the joint

exploration of the key problems, the

development of Target Problems and the issues

underpinning them, including a description of

how you gathered the information and built the

therapeutic alliance. The relevant information

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gathered during the reformulation phase of

therapy should be presented succinctly and

systematically to enable the markers to make

sense of complexity. Potential risk issues should

be clearly identified.

(PA, E, R, CT)

Please note: The significant proportion of this CPR

is the account of the work within therapy,

therefore the literature review and assessment

section will be shorter than in usual CPRs.

Preliminary Formulation and

Goals

Ability to set up CAT structure and generate CAT tools

Joint creation of the reformulation (letter and diagrammatic)

Joint identification of Target Problems, Reciprocal Roles and Target Problem Procedures

The case study should demonstrate evidence of

the collaborative and flexible creation of the CAT

tools. The reformulation section should include

Target Problems; Reciprocal Roles; Target

Problem Procedures, along with the map(s)

created (the Sequential Diagrammatic

Reformulation (SDR) or Self States Diagrammatic

Reformulation; the reformulation letter. The case

report should demonstrate the therapist’s ability

to empathically generate these tools within the

patient’s Zone of Proximal Development (ZPD)

and illustrate their ability to attend to time-

limited nature of work and anticipate meaning of

ending for patient. (Use appendices where

necessary).

(PF, CT)

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Therapeutic alliance/relationship

Development and maintenance of therapeutic relationship.

Describe how you were able to establish and maintain a therapeutic alliance and relationship, including where relevant, establishing and maintaining therapeutic boundaries and reflection on challenges to these by patient and self; identifying and attending to enactments and potential or actual therapeutic ruptures; recognising and reflecting on counter- transference responses to the patient, both those elicited by the patient and those personal countertransference responses.

Intervention

Intervention or ‘Active Therapy’ phase. Describe your ability to work therapeutically within a CAT framework

Risk Management

Reformulation

Ending of therapy and goodbye letters

The intervention should flow logically from the

previous section/s. The case study should

demonstrate an ability to sustain the CAT focus

and revise appropriately and to work

collaboratively within the patient’s ZPD, to

include: ability to use CAT tools, emphasising

those which the patient most readily uses;

identify and reflect with the patient on self-self

and self-other RRPs; reflect and use the

therapeutic relationship as it pertains to

identified RRPs/SDR; draw upon

creative/alternative techniques outside CAT to

facilitate ongoing exploration and to build

recognition and revision of procedures;

demonstrate an appropriate use of self within the

therapeutic relationship; work with the time-

limited nature of CAT and the meaning of ending

for patient.

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A positive approach to risk management and

monitoring should be included.

Any revisions to the reformulation would be

commented on and provided

Ability to make in-the room links, which enhance

patient’s understanding and capacity to change

via transfer/use of CAT tools post therapy.

Active attention to time and endings throughout.

Production and sharing of CAT goodbye letter to

reflect progress and assist with ending.

Goodbye letters (the therapist’s and the client’s)

should be provided in the appendices. The

client’s goodbye letter should be carefully

anonoymised, and re-typed with all specifically

identifying information (age, gender of children,

locations, etc) redacted. (PI, CT)

Evaluation and Outcome

Reviewing change against the Target Problems

Further recommendations

(There may be over-lap with ‘ending therapy’)

Evaluate the work systematically through review

of change against the Target Problems; including

consideration of change and work still to be done

that was shared in the goodbye letters and/or

final sessions (ie, the work that has been done

and work that needs to be done in future). CAT

specific monitoring/rating sheets (where used)

should be reviewed. Clearly identify which

aspects of the goals have been achieved, what

aspects of the work were less successful and

provide recommendations as to how this might

inform future work. (E, R, CT, OSIL)

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Discussion

Consider the strengths and weaknesses of the work. This would include the ability to self- reflect, critically evaluate and express personal views on the work.

Conclusion

The case study should demonstrate an ability to reflect on the case as a whole and to critically appraise the work: identifying strengths, limitations and (with hindsight) and potential revisions. It is encouraged to express personal viewpoints, supported by arguments/evidence. Reflections should include consideration of any relevant cultural, ethical and professional issues.

This section should demonstrate learning from the work and use of supervision.

The report should end with a concluding

paragraph synthesizing all the main issues and

arguments within the report to bring it to a close.

(GM, R, PPSV, CT, OSIL)

Presentation

Contents Page

APA

Grammar/Punctuation

Style

The work demonstrates a logical structure, is

clearly presented with an appropriate and

professional use of language.

The report and any appendices should fulfill APA

guidelines in terms of both style and

content.(GM, R, CT)

Professional Issues

Confidentiality

Consent

Relevant professional / ethical issues

No identifying details are visible. Confidentiality

and anonymity is carefully protected.

The issue of consent has been explored and

explained appropriately.

The relevant professional and ethical issues have

been explored.

34

BPS Competency Framework (2014)

2.2.1. Generalisable Metacompetencies (including Relationships) = GM

2.2.2. Psychological assessment = PA

2.2.3. Psychological formulation = PF

2.2.4. Psychological intervention = PI

2.2.5. Evaluation = E

2.2.6 Research = R

2.2.7 Personal and professional skills and values = PPSV

2.2.8 Communicating and teaching = CT

2.2.9 Organisational and systemic influence and leadership = OSIL