Team consultancy using cognitive analytic therapy: a controlled study in assertive outreach

Authors

  • S. Kellett BSc MSc D Clin Psy,

    Corresponding author
    1. Consultant Clinical Psychologist and IAPT Programme Director, Sheffield Social and Healthcare NHS Foundation Trust, Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
    • Correspondence:

      S. Kellett

      Clinical Psychology Unit

      Department of Psychology

      Western Bank

      Sheffield

      S10 2TN

      UK

      E-mail: s.kellett@sheffield.ac.uk

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  • M. Wilbram BSc D Clin Psy,

    1. Clinical Psychologist, Assertive Outreach Team, South West Yorkshire Foundation NHS Trust, Barnsley, UK
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  • C. Davis BSc D Clin Psy,

    1. Clinical Psychologist, University of Nottingham, Nottingham, UK
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  • Gillian Hardy BSc MSc PhD

    1. Professor of Clinical Psychology, Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
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Abstract

Accessible summary

  • Cognitive analytic consultancy involves mapping the dysfunctional procedures and relationships that exist between team and patient using cognitive analytic theory.
  • The study showed no impact on patient outcomes, but a significant organizational impact in terms of team practices and relationships.
  • Cognitive analytic consultancy offers promise in helping in-patient and community clinical teams manage those patients not suitable for individual or group psychotherapy.

Abstract

The objective of this study was to evaluate the clinical and organizational efficacy of formulation-based consultancy to clinical teams using a randomized control trial methodology. Patients in an Assertive Outreach Team (AOT) were randomized into cognitive analytic consultancy (CAC; n = 10) or treatment as usual (TAU; n = 10). CAC consisted of three consultancy sessions with individual team members to formulate and map the dysfunctional roles and procedures adopted by both patient and team. Subsequent changes to practice were then supported via team supervision. Measures of patient and team functioning were taken across four discrete study phases; (1) baseline team training, (2) case consultation, (3) team supervision and (4) 3-month follow-up. Team members were additionally interviewed before and following the trial. No differences were evident between CAC and TAU in terms of patient outcomes. However, the climate of the AOT significantly improved longitudinally over the course of the trial, with CAC facilitating enhanced clinical and team practices. The results are discussed in terms of methodological limitations, the advantages/disadvantages of team consultation and the potential for the further development of the CAC model.

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