Clients' experience of the process of change in cognitive analytic therapy

Formulation is argued to be of central importance in most psychotherapeutic approaches, yet little is known about client's experience of this. This study sought to explore the client experience of receiving cognitive analytic therapy (CAT). It aims to gain a better understanding of the use of specific CAT tools (e.g., reformulation letters and diagrams) and how these tools relate to clients' understanding of change.

Grounded theory methodology utilizing a three-stage analysis process was used to explore client's retrospective accounts of change in CAT.

Fifteen semi-structured interviews were conducted with nine participants who had received CAT. Data analysis involved initial coding of transcripts and further theoretical sampling and interviewing followed. This led to the production of a model that was then taken to three further participants for exploration in further interviews. An audit was conducted of the analysis process.

A core conceptual framework of 'doing with' the therapist emerged from the analysis and represented clients' experience of receiving CAT and participating in the reformulation process. This framework subsumed four interrelated themes; 'being with the therapist', 'keeping it real', 'understanding and feeling', and 'CAT tools'.

CAT was seen as an active and emotional experience facilitated by a trusting and collaborative therapeutic relationship. The CAT reformulation was seen as important but only when embedded within this context. Whilst, this was a small study theoretical generalizations are discussed about the process of change and further clinical and research recommendations are presented.