CAT for People with Multiple and Complex Needs

Over at least the last decade the Cognitive Analytic Therapy approach has been used in a number of charity or third sector organisations to help promote relational care.

Some services have benefitted from training in CAT Skills for Case Management, delivered from an introductory level, ranging through to a full six-month ACAT accredited training. Building on this, some organisations have developed CAT-based reflective practice throughout different levels of their organisational structure. This mirrors developments in some NHS Trusts where over the years CAT has provided a common language and framework supporting not only frontline staff and teams, but managers too.

In the third sector, such applications have included work with people

who lack secure housing
with multiple and complex needs
with substance use difficulties
struggling with mental health difficulties, or
overcoming impacts of abuse, including domestic violence
managing interactions with social services around safeguarding

As an example, YMCA Together, working across the north west of England, has made use of the CAT approach in a number of its services.

Supported by CAT therapists and trainers, staff working within homelessness, mental health, drug and alcohol and domestic abuse service services trained in CAT Skills Case Management. CAT reflective practice was integrated across the organisation, at different levels of seniority, from senior management to staff working face-to-face with service users in a variety of roles.

Ellie McNeil, Chief Executive of YMCA Together, describes the journey of the organisation in her blog.

“….we initially brought in the CAT approach to enable the delivery of a project supporting people with multiple and complex needs. Disenfranchised, excluded, rejected and frightened manifested as aggressive, disengaged, self sabotaging, and rejecting. We knew we needed a different approach, not only to elicit change with service users but more so to support the staff in their roles.…..

I am incredibly proud of where we are as a team and believe we have got to this place because of the shared understanding, language and framework that CAT gives us. Working in a CAT informed way helps me to ensure the organisation can be a positive place for service users and staff members now and in the future.

YMCA Together have since supported a member of staff to complete their own training as a CAT Therapist; and have delivered their own ACAT-accredited CAT Case Management Skills training course for internal and external staff.

A paper on using a CAT framework to aid structured decision making about applications for off-site visits away from their residential recovery service for people with substance use challenges was published in 2023 (Vaughan and Portman 2023).

Ina womens' refuge setting, Steph McManniman has written about ways in which a CAT perspective enables her to understand and work with women who have survived domestic violence:

"The CAT skills training offered me an awareness of the “pull” to “join the dance” and I started to identify [reciprocal roles] as they were happening, sometimes before they were played out. This enabled me to start side stepping these enactments; learning some survival strategies. Whilst some clients could accept and internalise what we were trying to achieve, others found this difficult and this was more often when I was being viewed “as if” I were Controlling or Intrusive. I see now that this is linked to their ZPD and the effects of trauma from domestic abuse they had suffered."

CAT for People with Multiple and Complex Needs

Further reading