Delivering cognitive analytic consultancy to community mental health teams: Initial practice-based evidence from a multi-site evaluation

Stephen Kellett, Jeetender Ghag, Katie Ackroyd, Kate Freshwater, Jayne Finch, Adam Freear, Judith Hartley, Mel Simmonds-Buckley

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
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Objectives: This study sought to employ the hourglass model to frame the methodological evolution of outcome studies concerning 5-session cognitive analytic consultancy (CAC). Design: Pre-post mixed methods evaluation (study one) and mixed methods case series (study two). Methods: In study one, three sites generated acceptability and pre-post effectiveness outcomes from N = 58 care dyads, supplemented with qualitative interviewing. The client outcome measures included the Clinical Outcomes in Routine Evaluation Outcome Measure, Personality Structure Questionnaire, Work and Social Adjustment Questionnaire, Service Engagement Scale, and the Working Alliance Inventory. Study two was a mixed methods case series (N = 5) using an A/B phase design with a 6-week follow-up. Client outcome measures were the Personality Structure Questionnaire, Clinical Outcomes in Routine Evaluation Outcome Measure, and the Working Alliance Inventory, and the staff outcome measures were the Working Alliance Inventory, Maslach Burnout Inventory, and the Perceived Competence Scale. Results: In study one, the cross-site dropout rate from CAC was 28.40% (the completion rate varied from 58 to 100%) and full CAC attendance rates ranged from 61 to 100%. Significant reductions in client distress were observed at two sites. Qualitative themes highlighted increased awareness and understanding across care dyads. In study two, there was zero dropout and full attendance. Clients were significantly less fragmented, and staff felt significantly more competent and less exhausted. Potential mechanisms of change were the effective process skills of the consultant and that emotionally difficult CAC processes were helpful. Conclusions: Cognitive analytic consultancy appears a promising approach to staff consultation, and testing in a clinical trial is now indicated. Practitioner points: CAC is a suitable method of consultation for care dyads struggling to work effectively together in CMHTs. Staff feel more competent and clients feel less fragmented following CAC, and the benefits of CAC appear to be maintained over follow-up time. CAC processes can be difficult for care coordinator and client, but this is not an impediment to change.
Original languageEnglish
Pages (from-to)429-455
Number of pages27
JournalPsychology and Psychotherapy: Theory, Research and Practice
Issue number3
Publication statusPublished - 1 Sept 2020
Event7th International CAT Conference: New Frontiers in CAT Understanding and Practice - University of Nottingham, Nottingham, United Kingdom
Duration: 20 Sept 201723 Sept 2017

Bibliographical note

Publisher Copyright:
© 2019 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of British Psychological Society


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