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Title: Contributing to a developing evidence base : considering the implementation and effectiveness of Cognitive Analytic Therapy
Author: Hallam, Craig
ISNI:       0000 0004 7964 1715
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2019
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Cognitive Analytic Therapy is increasingly being utilised in National Health Service (NHS) mental and physical health settings as a framework to understand service users and the possible nature and reasons for continuation of their distress (Ryle, Kellett, Hepple, & Calvert., 2014). The approach combines aspects of cognitive and psychodynamic models of psychotherapy and centres around the concept of 'reciprocal roles', a term used to conceptualise inter- and intra- personal patterns of relating between individuals and within the self (Ryle & Kerr, 2003). The framework is being adapted for clients presenting with a broad range of difficulties (e.g. Wicksteed, 2016; Chanen, McCutcheon, & Kerr, 2014; Hepple & Sutton, 2004), including people with learning disabilities (Lloyd & Clayton, 2014). Despite its prevalence and implementation in clinical services, CAT remains at an early stage in terms of its developing evidence base (Ryle et al., 2014). An array of academic works have developed theoretical and clinically useful guidance documents to inform and shape clinical practice (e.g. Ryle, Leighton & Pollock, 1997; Meadows & Kellett, 2017), however fewer studies have robustly explored how CAT is being implemented within clinical services and considered its effectiveness (Ryle et al., 2014). The present thesis aims to contribute to the evidence base for CAT in more methodically robust and systematic ways. One of the key threads of the thesis is the concept of 'effectiveness', the thesis starts by presenting effectiveness as considered within evidence-based medicine philosophies (see Herbert, 2003) which typically use empirical, psychometric methods of assessment to frame 'effectiveness' as a scientifically and homogenously representative phenomenon. As the thesis progresses, effectiveness is considered from a more 'bottom up' and clinically realistic position. Overall, the thesis raises interesting questions about how effectiveness is understood and implemented in clinical environments. The systematic review and meta-analysis (chapter 1) aims to provide an up-to-date overview of the literature contributing towards the CAT evidence base. This centres around the use of three categories of psychometric assessment measures as a way of considering the overall 'effectiveness' of CAT. By grouping together and statistically combining multiple studies, the review aimed to provide a more statistically powerful commentary on the current status of the developing evidence base. The empirical paper (chapter 2) uses a thematic analysis methodology to explore how clinicians are using CAT within learning disability settings. This builds on existing accounts (e.g. Frain, 2011) which provide descriptions of anecdotal, individual applications of the model. Attempts have been made to describe adaptations for people with ID from the perspective of individual practitioners (Clayton, 2014), but to date, there has been no attempt to more systematically understand how clinicians are adapting their practice. The paper synthesises multiple practitioners' constructions of how they are adapting their practice, understanding the concept of ID and understanding effectiveness. This provides a richer and more contextualised understanding of effectiveness which, to some extent, contrasts with the epistemological underpinnings as presented within the systematic review. The two papers have different target journals: Psychology & Psychotherapy; Theory, Research & Practice is the target journal for the systematic review and the Journal of Applied Research in Intellectual Disabilities for the empirical paper. The chapters conform to author guidelines however, figures and tables along with further contextual information are provided in accordance with thesis guidelines. Author guidelines for the papers are available in appendices (A & G).
Supervisor: Greenhill, Elisabeth Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral