Eight-Session Cognitive Analytic Therapy (CAT) for Self-Harm: A Co-Produced Demonstration of the Delivery and Effectiveness of Brief and Focal CAT

Abstract

When cognitive analytic therapy (CAT) is used to help people that self-harm, then patients are typically allocated to the 24-session version. RELATE (relational approaches to self-harm) was a National Institute for Health Research (NIHR) funded feasibility randomised controlled trial; it evaluated delivering 8-session CAT compared to treatment as usual for patients that were self-harming. This is a co-produced case study with Jade who was a participant in the RELATE trial. The aims were: (a) to describe the treatment protocol, (b) demonstrate protocol fidelity, (c) index therapeutic competency, (d) evaluate nomothetic clinical outcomes, (e) evaluate of change in the idiographic target problems and (f) for Jade to provide a description of her experience of the tools, phases and approach of CAT. Results show that the CAT was competently delivered with high fidelity to the protocol. Self-harm reduced and non-overlap analyses found that improvements to recognition and revision of two of the three target problems occurred (and these would be coded as being evidence of a ‘highly effective’ intervention). Improvements were maintained at follow-up. Jade had low expectations before starting therapy, felt that the tools of CAT were helpful, building and maintaining trust in the therapeutic relationship was an important contributor to change and follow-up was useful. The conclusion is that it is possible to deliver brief CAT that is focal to self-harm with high treatment integrity. Guidance on how therapists can best utilise the brief CAT approach are provided.