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Clients' experience of change: An exploration of the influence of reformulation tools in cognitive analytic therapy
Author(s) -
Tyrer Rebecca,
Masterson Ciara
Publication year - 2018
Publication title -
clinical psychology and psychotherapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.315
H-Index - 76
eISSN - 1099-0879
pISSN - 1063-3995
DOI - 10.1002/cpp.2339
Subject(s) - psychology , session (web analytics) , attribution , context (archaeology) , cognition , therapeutic relationship , intervention (counseling) , psychotherapist , qualitative property , diagrammatic reasoning , scale (ratio) , single subject design , qualitative research , clinical psychology , cognitive psychology , applied psychology , developmental psychology , social psychology , computer science , psychiatry , paleontology , social science , physics , quantum mechanics , machine learning , sociology , world wide web , biology , programming language
Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small‐N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self‐Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation‐10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT‐specific tools.