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Alison Jenaway, 2017. An Alternative Psychotherapy File. Reformulation, Winter, p.48
Introduction
Having worked for some time with young people, trying to engage them in CAT, I have found that the standard psychotherapy file feels quite complicated and difficult to understand for most young people. I am not the first to recognise this problem, and other CAT therapists, particularly those working with patients who have Learning disabilities, have been trying to develop a simpler version of the file. Various attempts have been made, including the psychotherapy file in diagrammatic form (Mark Dunn, 2002), a simplified version (King, R.) and a plain English version of the file (Vicki Richer, personal communication at YouthCAT meeting, 2016). Even a one page only file has been developed (Morris, P. 1995). As far as I am aware, no-one has actually tested out these different versions to see which of them are the most understandable, useful and acceptable to patients, but it seems that every CAT therapist has their own personal favourite. I would like to add my own version to the mix, and I have been collecting some feedback on it from my teenage patients, and those of my supervisees. We have simply asked them, when they return the file having filled it in, how easy it was to fill in on a scale of 0 to 10 , 10 being as easy as possible. Clearly, this is not the only criterion for judging how successful a psychotherapy tool is, but my main aim was to create something that young people found easy to fill in. So far, we have had feedback from nine teenagers, from 15 to 19 years old, and the average rating has been 7.7 (range from 5 to 10).
However many times people had tried to simplify the wording of the original psychotherapy file, it did not seem any simpler to fill it in. At some point a colleague gave me a copy of one of the Schema questionnaires from Schema Focused Therapy, designed by Jeff Young (Young et al, 2003). These consist of a list of single statements, which are easy to answer in terms of how much they apply to you. The young person does not have to recognise the whole pattern of a procedure in order to be able to rate it, and this seemed to me to make it easier to respond to. However, there was something missing from these simple statements, as it did not encourage the young person to then think of how they might fit into a pattern. I therefore decided to try and create several simple statements that could be rated easily, but would then indicate a particular CAT trap, if most of them applied. As I tend to use the Michael Knight developmental template diagram for young people (Jenaway and Rattigan, 2011), dilemmas are not so important to me, as I would see them as simply the opposite poles of the template, or as alternative ways the young person uses to get their needs met. In addition, I wanted to add some positive aspects of the procedures in, as the psychotherapy file can feel a bit negative, as if all aspects of the person’s procedures are a problem. I therefore tried to think of a positive statement which could apply to each CAT trap.
Lastly, as young people are so embedded in their family, or other care networks, it can be much harder for them to make changes. They often have no past experience of what it feels like to be happy, secure or successful, so change can be scary. I have therefore added a wider variety of snags for them to think about and tick if they feel they might apply to them. This seems to provide more scope for discussion than that provide by the two general statements of snags in the original file.
If you are working with a young person, please feel free to copy this file and have a go with it. Do contact me if you manage to get some feedback, either about how easy this one was to fill in, or about how they found the other versions you may have used.
References
Dunn, Mark (2002) Diagrammatic Psychotherapy File, Reformulation, Spring issue, p.17.
Jenaway, A. and Rattigan, N. (2011) Using a template to draw diagrams in Cognitive Analytic Therapy, Reformulation, summer issue, pp46-48.
King, R. (2006) Pull-out Section: The Psychotherapy File, Reformulation, summer issue, pp7-14.
Morris, P. (1995) See-it-at-a-glance Psychotherapy File, ACAT Newsletter, February issue, p19.
Young, Jeffrey E., Klosko, Janet s., Weishaar, Marjorie E. (2003) Schema therapy: a practitioner’s guide. New York. Guilford Press.