Balmain Nadia, Melia Yvonne, John Christopher, Dent Helen, Smith Karen
Staffordshire University and Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.
Staffordshire University, Stoke-on-Trent, UK.
Psychol Psychother. 2021 Mar;94 Suppl 1:120-136. doi: 10.1111/papt.12326. Epub 2021 Jan 23.
Service users with complex mental health difficulties are more difficult to engage in treatment and drop-out rates are higher, resulting in poorer clinical outcomes. Cognitive analytic therapy (CAT) is widely applied to service users with complex needs and shows promise in terms of engagement and outcomes. The aim of the present study was to examine the 'lived experience' of service users who have been retained in a full course of CAT treatment to provide important insights to why CAT seems to be an engaging psychotherapy, to inform future CAT delivery and practice with clients with complex needs.
Semi-structured interviews were undertaken with six service users aged between 25 and 47 years who had accessed secondary mental health care services and had received an average of 24 sessions of CAT. Transcripts were analysed using interpretative phenomenological analysis (IPA).
The analysis yielded three superordinate themes with subthemes within these. The first superordinate theme referred to changes due to CAT (e.g., insight, tools to cope). The second theme referred to strong emotions evoked by CAT (e.g., feeling frustrated, scared, and upset). The final theme concerned the process of CAT (e.g., endings and therapeutic relationship).
Whilst service users appeared to develop increased insight and acquire skills, there was variance in experiences of sustained and meaningful change post-therapy. The findings suggest adaptations may be required with these service users such as delivering the sequential diagrammatic reformulation (SDR) in a hopeful way and addressing systemic barriers to 'exits' being made.
Overall, service users with complex mental health difficulties describe benefitting from CAT, identifying improved insight and the acquisition of tools to cope. However, therapists need to be attuned to the potential fragility of service users and risk of negative affect, particularly during the reformulation phase. Consideration of delivering the SDR in a hopeful way may be therapeutic. Systemic factors such as service users being pulled to maintain the status quo in their relationships, and lack of support for or resistance to change by important others limit service users from availing of 'exits' from problem procedures. This implicates the need for more attention to systemic and possibly multi-agency working with this group of service users.
有复杂心理健康问题的服务使用者更难参与治疗，且退出率更高，导致临床结果更差。认知分析疗法（CAT）广泛应用于有复杂需求的服务使用者，在参与度和治疗结果方面显示出前景。本研究的目的是考察完成整个CAT治疗疗程的服务使用者的“亲身经历”，以深入了解为何CAT似乎是一种有吸引力的心理治疗方法，为未来向有复杂需求的客户提供CAT治疗及实践提供参考。
对6名年龄在25至47岁之间、接受过二级心理健康护理服务且平均接受了24次CAT治疗的服务使用者进行了半结构化访谈。使用解释现象学分析（IPA）对访谈记录进行分析。
分析得出三个上位主题，每个上位主题下又有子主题。第一个上位主题涉及CAT带来的变化（如洞察力、应对工具）。第二个主题涉及CAT引发的强烈情绪（如感到沮丧、害怕和心烦）。最后一个主题涉及CAT的治疗过程（如结束和治疗关系）。
虽然服务使用者似乎获得了更多的洞察力并掌握了技能，但治疗后持续且有意义的改变的经历存在差异。研究结果表明，对于这些服务使用者可能需要进行调整，比如以充满希望的方式进行序列图示重新表述（SDR），并解决阻碍“退出”的系统性障碍。
总体而言，有复杂心理健康问题的服务使用者表示从CAT中受益，洞察力有所提高并获得了应对工具。然而，治疗师需要意识到服务使用者可能存在的脆弱性以及负面影响的风险，尤其是在重新表述阶段。考虑以充满希望的方式进行SDR可能具有治疗作用。系统性因素，如服务使用者在人际关系中被促使维持现状，以及重要他人对改变缺乏支持或抵制，限制了服务使用者从问题程序中“退出”。这意味着需要更多地关注与这类服务使用者的系统性工作，可能还需要多机构合作。
