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Coombes, J., Taylor, K. and Tristram, E., 2009. Research Into the Use of CAT Rating Sheets. Reformulation, Winter, pp.28-29.
Background
Our interest in conducting this small scale research project arose out of our curiosity about the reality of how frequently CAT Rating Sheets are actually used in practice and whether they are considered useful by CAT practitioners. We noted that course assignments, both at practitioner level and psychotherapy level, seem to expect use of CAT Rating Sheets with threat of downgrading in their absence. Our collective personal experience however suggested that in reality rating sheets are either not used at all or used infrequently. In order to answer questions about this possible disparity we devised a questionnaire to explore whether people do actually use rating sheets and if so how often and what they find useful about them (or not). If not using them then why not, have they used them in the past and why did they cease using them. We were also interested in what factors might have influenced an individual’s use of rating sheets such as CAT training course completed or therapeutic orientation prior to CAT training.
Owing to restrictions with confidentiality and admin availability we obtained a sample of CAT practitioners by involving the course members of IRRAPT 2007-9 and requested they pass on the questionnaire to CAT colleagues who would be willing to participate in the study. This yielded a response from a total of 26 practitioners from a variety of backgrounds. We are aware that this may not be representative of the CAT community as a whole, and we invite further feedback and comments. It may be that this could be taken forward into a larger scale study into the use of rating sheets in CAT.
Research Findings
In response to the enquiry “Do you use rating sheets?” 14 people responded “No” and 12 “Yes”. Of the “No” respondents 9 reported they had never used rating sheets and 5 reported they had used them in the past but for a variety of reasons had stopped.
Of the “Yes” respondents we found that 7 practitioners use them only occasionally, 2 use them often, 2 very often and 1 person used them all the time.
At first glance the figures for “Yes” and “No” respondents seemed fairly evenly distributed but we noted that of the 26 respondents 21 either didn’t use them or only used them occasionally. This meant that less than a fifth of our sample always, often or very often use rating sheets. It was interesting to note that of the 21 non-users or occasional users 6 had not had any exposure to rating sheets in their practitioner training and had even been discouraged from using them. We also noted that 58% of respondents had some experience of the use of rating sheets but apparently chose not to use them.
There was some evidence that background training has influenced people’s experience of or preference to use rating sheets (or not) and that place of initial CAT training or influence of a supervisor may have a bearing.
A number of reasons were given for stopping use of rating sheets such as “Already enough to do and think about in the sessions”; “Poor patient compliance”; “Supervisor discouraged ”; “Not helpful, confusing for me and the patient – too reductionist”; “No time – only helpful with concrete types”; and “The diagram serves as the measure”.
Some felt that existing rating sheets were not user friendly and told us they had devised versions of their own for example using 0-10 scaling rather than “More/Same/Less”.
Positive comments about rating sheets included “Helpful with certain types of patients”; “Helps keep trainees focussed and on track”; “acknowledge they can be helpful for patients monitoring their own progress”. Other general comments about rating sheets included “Found them interesting but time consuming”. The small numbers of practitioners who used rating sheets often, very often or all the time generally seemed to like them and felt they were essential. However one person used them mainly because she felt they were required to be used as part of accruing training hours.
Others had rather more negative views about rating sheets including “Feels like an intrusion in the therapy”; “Tedious and unhelpful”; “Patients don’t like using them” and one person felt they could easily be scrapped from the CAT model, “makes it easier to be lumped with the CBT model”
Some respondents expressed openness about trying out rating sheets in the future as if to see if they were useful ; “I plan to use them in my next one or two cases to have the experience”.
Potential Implications of Research Findings
Our findings seemed to confirm our sense that rating sheets are not widely used by CAT therapists in day to day practice. Many therapists seem to view them as a tool that may be used occasionally when deemed appropriate for a particular patient. A high proportion of therapists simply chose not to use them at all with many seemingly viewing them as a hindrance. A small proportion of therapists incorporated rating sheets into their work on a regular basis with only the smallest number viewing them as essential to practice.
As a result of these findings we find ourselves wondering if rating sheets should remain part of the mainstream CAT tools or whether they might more helpfully be viewed as an optional tool with their use left up to the therapist’s discretion and versatility rather than being imposed as a mandatory part of CAT practice and training.