Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
Centre for Psychological Therapies Research, University of Sheffield, Sheffield, UK.
Clin Psychol Psychother. 2017 Nov;24(6):1263-1272. doi: 10.1002/cpp.2090. Epub 2017 May 3.
"Exits" in cognitive analytic therapy (CAT) are methods that change unhelpful patterns or roles during the final "revision" phase of the therapy. How exits are conceived and achieved is currently poorly understood. This study focussed on the revision stage to explore and define how change is accomplished in CAT.
Qualitative content analysis studied transcripts of sessions 6 and 7 of a protocol delivered 8-session CAT treatment for depression. Eight participants met the study inclusion criteria, and therefore, 16 sessions were analysed.
The exit model developed contained 3 distinct (but interacting) phases: (a) developing an observing self via therapist input or client self-reflection, (b) breaking out of old patterns by creating new roles and procedures, and (c) utilisation of a range of methods to support and maintain change. Levels of interrater reliability for the exit categories that formed the model were good.
The revision stage of CAT emerged as a complex and dynamic process involving 3 interacting stages. Further research is recommended to understand how exits relate to durability of change and whether change processes differ according to presenting problem.
Exit work in cognitive analytic therapy is a dynamic process that requires progression through stages of insight, active change, and consolidation. Development of an "observing self" is an important foundation stone for change, and cognitive analytic therapists need to work within the client's zone of proximal development. A number of aspects appear important in facilitating change, such as attending to the process and feelings generated by change talk.
认知分析治疗（CAT）中的“出口”是在治疗的最后“修订”阶段改变无益模式或角色的方法。目前，人们对出口的构思和实现方式知之甚少。本研究聚焦于修订阶段，以探讨和定义 CAT 中如何实现变革。
对 8 节 CAT 治疗抑郁症方案的第 6 和第 7 节会话的记录进行定性内容分析。符合研究纳入标准的 8 名参与者，因此分析了 16 节会话。
开发的出口模型包含 3 个不同（但相互作用）的阶段：（a）通过治疗师的输入或客户的自我反思来发展观察自我，（b）通过创建新角色和程序来打破旧模式，以及（c）利用一系列方法来支持和维持变革。形成模型的出口类别的评分者间信度水平良好。
CAT 的修订阶段是一个复杂而动态的过程，涉及 3 个相互作用的阶段。建议进行进一步的研究，以了解出口与变革的持久性的关系，以及变革过程是否根据呈现的问题而有所不同。
认知分析治疗中的出口工作是一个动态过程，需要通过洞察、积极变革和巩固阶段的进展。“观察自我”的发展是变革的重要基石，认知分析治疗师需要在客户的最近发展区内工作。许多方面似乎在促进变革方面很重要，例如关注变革谈话所产生的过程和感受。
