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Anderson, N., M., 2009. International ACAT Conference "What Constitutes a CAT Group Experience?". Reformulation, Winter, pp.25-26.
The question derived (arose?) because, although I can remember a time when in vestigial (primordial? early?) CAT we had still to develop reformulation letters and SDRs for example, somehow in ACAT we have managed to achieve an agreed format for individual CAT. We have an individual CAT model that we use with our patients and in our various trainings for teaching, supervision, and research purposes. Over the years there have been various attempts to integrate these CAT tools and skills with therapy in a group. From Mitzman and Duignan (1994) in the early days through to Jason Hepple, Maggie Ruppert (2008) and myself presenting at recent conferences, formats of Group CAT to date have contained both similarities and differences. I believe there is no agreed consensus as yet on what is Group CAT. If we can find something close to an agreed model then we can begin to teach people to run CAT Groups alongside their individual work.
In recent times, also, it seems to me there has been a shift in thinking from trying to take what we can do with individuals into the group as if still seeing a group as the sum of its members, towards something that seems more creative. This I would describe as an increasing recognition of a group as being something other than just the sum of its parts. This otherness might be described in group analysis, as the group having a metaphorical group matrix in which each member could be seen as a nodal point in a field of communications both conscious and unconscious. Whatever happens to one affects all in some way. So it seems appropriate to think of a successfully developed model of Group CAT to be one that, alongside utilising the CAT tools we know, will also encompass the challenge to describe and contain the enhanced dimensions of the group, however we might see them.
In the dialogue stream workshops at the conference, I was privileged and grateful to share the efforts of the participants to explore this question. Participants worked impressively hard in great heat for which, many thanks to you all.
What did we learn?
As yet, not surprisingly, we have not answered my question but we learned that many people are exploring Group CAT in varying ways. This allowed us to look at some elements of a possible Group CAT agreed model such as:
a) Pre-group preparation. Some people offer prospective group members diagrams and written reformulations. Some don’t. Some suggest individual diagrams are taken into the group. Others don’t.
b) We talked about and explored using diagrams to describe the group Process. We learnt that if we tailor our diagrams to the group, e.g. develop a “Group States Diagram” we can identify RRs that individuals can respond to or be enacting for the group. We can also link these to RRPs in this way whilst always bearing in mind that anything happening in the group has a meaning for the group as a whole.
c) We thought about written group reformulations and how these might differ from the standard individual format. We recognised that we can still understand the individual’s contribution in the group reformulation.
We also saw that, just as with diagrams, if written group reformulations are first provided by the group leader/conductor, we can soon have the group developing and producing its own diagrams and reformulations. In this way the group becomes a therapy team in its own right.
d) We looked at the role of the group leader/facilitator/ conductor and at how this might differ from individual work. So from “push where it moves” in individual work, we might perhaps say “push where the group moves” for example. We have looked at our group interventions as always aimed at the group ZPD.
e) Finally, we thought about time-limited groups, group goodbye letters and endings. We also discussed what I call the “fast, open group” – my development of a combination of the strengths of the group analytic slow open group model with CAT – where I believe progress and maturity is enhanced.
In this model, the group is open-ended. When some people leave, others join what is now an experienced therapeutic team able to help new members learn to use the group more speedily. This also has the added advantage of offering other experience, such as mourning a lost member and experiencing siblings joining with all the feelings this involves.
In summary, we have yet to find an answer to the dialogue stream question but it does feel like a work in progress. As such, I conclude with a proposal:
We should develop a Group CAT Special Interest Group in ACAT. Jane Blunden and I would like anyone interested in exploring this topic to join us in forming such a group.
An initial idea for the special interest group is a survey to explore and collate the models currently being used by ACAT members. This would be with a view to identifying what succeeds and what doesn’t do so well etc.
With this information, it might then be possible to think about any extra skills training that might help people looking to enhance their confidence to attempt CAT Groups.
References
Duignan,I & Mitzman,S.F. (1994). Measuring individual change in patients receiving time-limited cognitive analytic group therapy. International Journal of Short Term Psychotherapy, 9 (2/3), 152-160
Ruppert,M, Birchnall,Z, Bruton,C, Christianson,S. (2008): Integration of Cognitive Analytic Therapy Understandings with Interactional Group Therapy (Yalom Style) a workshop presented at the ACAT conference in January 2008. Reformulation issue 30 summer 2008