CAT Care Planning with teams
CAT Care Planning can be helpful where care is provided by a staff team in a range of health and other settings. Many CAT therapists provide consultation to staff around care planning as part of their role. Examples include work with secondary care community mental health teams, inpatient mental health settings, and learning disability teams.
Different types of CAT Care Planning exist, including Team Formulation, Reflective Practice, and Five-Session CAT Care Planning. In this article we will look at the third of these in more detail.
Five Sesson CAT Care Planning: It’s All About Relationships
CAT consultation taking place over five or six sessions is used widely in some NHS Trusts. This approach may be offered when the relationship between a care provider and a service user is becoming strained.
For example, staff in a busy and possibly overstretched service may be limited in terms of their energy or availability to people using their service. At the same time, someone using the service may have developed difficulties because they were not looked after well in their earlier life. They may have been neglected, hurt, or abused by those who were supposed to be caring for them. As a result, they will have learned that reliable care is hard to come by. They may believe that it is unsafe to trust any sort of care. It may then be very difficult to accept care on offer from staff. This is likely to be even more of a challenge if the staff offering a service are stressed or overstretched themselves.
In a team setting such as a residential home, a crisis team or community mental health team, someone receiving support may have contact with several different people. Building relationships with several different people may make things even harder. The care environment may feel even less predictable.
Living in a ward or residential setting which is not your own home can lead to feeling less in control of this environment and relationships within it. In such a situation a person may feel even less safe, and more at risk of being harmed or hurt again.
Trying to Stay Safe
People may feel threatened and upset when situations and relationships remind them of ways they have been hurt or let down in the past. It may be very easy to experience strong and overwhelming feelings, such as fear, shame, disappointment, and anger. To try to cope, protect themselves and stay safe, they be very wary and cautious about care on offer. Or they may push care away, reject staff and perhaps behave in ways that are hostile towards others. They may also act in ways which hurt themselves, through self-harm or suicide attempts.
Caring Under Pressure: Trying and Feeling You’ve Failed
Staff trying to offer care may feel their attempts to care are not enough, or rejected. They may feel they’re getting things wrong, and feel frustrated or guilty. In a stretched health service, there may be limits and restrictions on the care they are able to offer. This can add to difficult feelings for both staff and service users.
What Can Go Wrong?
Staff may end up trying too hard to make things better for the person, become exhausted and less able to fulfil expectations. Or they may struggle to cope with feelings of blame and failure, and start to feel less warm towards the person. They may distance themselves as a way to try to protect themselves, withdraw, and be less available.
Where relationships between service user and staff have become very strained, responses by staff may even become rejecting towards the person. Experience of poor care will of course confirm the service user’s expectations and beliefs about how untrustworthy care can be, and the cycle of mistrust will be strengthened.
The More the Merrier? Splits in Teams
In a team where several staff members are working with a person, it may be that some team members will feel strongly protective and caring, striving to help and stick up for the person. Others in the team may feel more frustrated and hostile. Team members can end up disagreeing with each other and getting into conflicts over the best way to respond to a patient with many needs. Team care may become very inconsistent and confusing for the patient. This can feel as if old patterns of unreliable care are happening yet again. Fears and worries are confirmed and trusting in services is even more difficult. It can feel to the person that old patterns of neglect, absence and abuse are happening all over again.
Staff Can Struggle Too
Morale can suffer within teams where there is a lot of service pressure, or not enough staff or resources to meet the needs of those they work with. Sometimes friction can arise within over-stretched teams. Staff can feel burned out and may go off sick or leave altogether. Temporary staff may come in to replace them, so they will not know patients or residents very well, and be less familiar with policies. It’s easy to see how the quality of care can be compromised in this sort of situation. It has been found that where staff wellbeing is poor, it is more likely that mistakes happen. This can sometimes lead to serious failures in care.
Staff are human too, and of course they will be just as likely as anyone else to experience stresses and difficulties in their own lives outside of work.
So How Can Five Session CAT Care Planning Help?
CAT Care Planning is an approach which tries to help remedy some of these unhelpful patterns so that the quality of care improves. The CAT therapist will spend up to five sessions with the patient or resident, learning about them and the emotional states and patterns they experience in the “here and now”. These sessions tend to follow a set structure. They focus less on past events than in a full CAT therapy.
Creating a Space to Connect and Learn
With the person’s consent, the staff member also sits in on the sessions. They observe this more theraputic conversation, without feeling pressure to “do” anything. They can learn more about the patient, and also more about their own responses to them. This enables the staff member to understand the person better and rebuild warmth and empathy. It is more possible to step out of the problem pattern they have become stuck in, whether that is trying too hard to protect and rescue the person, or being absent, unresponsive or rejecting. Working together in this way can help foster a joint compassionate understanding.
Working Together Better
Through this process, the patient, therapist and staff member have a chance to pause and stand back from the patterns that have been going on in their relationship. They can think and reflect together in a setting that is protected and supported through the CAT therapist’s close attention to the person’s story and ways of coping. Drawing out patterns using CAT maps can help this process along.
The three parties in this process can develop ideas and suggestions for change together. These may help the person and the staff member decide on how they communicate about strains in their relationship. They might agree a way of responding to each other if problems arise again. Particular pieces of work they can do in the future might be identified. This might be learning a new skill or a technique for coping . New ways to manage interactions with the team might be agreed together, so that relationships can improve. For some people, Five Session CAT Care Planning is a first step towards having further individual therapy.
From a staff perspective, this type of approach can help staff stay better connected to their service users at an emotional level and more clear about help they can offer. They can understand better the pushes and pulls in the relationship, and their own role in this. This can lead to improvements in care offered and also in staff morale.
Thanks are extended to Kate Freshwater and Angela Carradice for helpful contributions to this page.