Pip Calvert and Jak Smith on Cognitive Analytic Therapy in Neuro

I am joined by Clinical Psychologist and Neuropsychologist Pip Calvert, and Cognitive Analytic Therapist, Jak Smith, to talk about the application of cognitive analytic concepts to neuro work. 

Transcript

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ingram wright: So, welcome to the new row clinic welcome to pip calvert and jack Smith you've kindly agreed to join me today for a conversation about cat in neuropsychology I wanted to say cat therapy, but that would be a redundant additional word wouldn't it, of course.

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ingram wright: But so.

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ingram wright: So I we're going to start as conventional for this podcast with them you're going to introduce yourselves, I wonder if you want to go first pick yeah sure so.

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i'm a consultant clinical neuropsychologist I work in an acquired brain injury service.

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Pip Calvert: Nearly community and base that I also do an enriched service into our local year rehab, which is the level to your rehab unit so post acute and i've been working there for nine years and i'm also trained practitioner.

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ingram wright: And jack.

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Jak Smith: yeah and my name is jack Smith and got a background in counseling and psychotherapy.

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Jak Smith: Currently work as part of the cognitive analytics therapy service which sits within tertiary level service as part of the Center for special psychological therapies.

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Jak Smith: and spent a lot well spent some time in the neural psychology Center for new rehabbing you as a service development a psychological therapy service and so that sits across for awards community and our patients are to level one and.

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ingram wright: jack I sort of for warned you that you have a counseling psychology background and i'm just wondering, I will will ask you the similar question pit but but jack.

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ingram wright: i'm just wondering about that journey into neuropsychology you prepared to tell us a bit about you know what sort of captured your interest.

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ingram wright: or working in a euro setting I should say.

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Jak Smith: yeah so just to clarify the early part and i've got a counseling background, so I didn't do a counseling psychology doctoral degree in counseling.

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Jak Smith: And then lay it on the train and become a registered psychotherapist so my background was informed by psychodynamic models take me on track relations theory in.

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Jak Smith: In the experience across the NHS about eight years in special services in in addictions in working with adults and children.

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Jak Smith: long and short periods of therapy and actually what happened is I found myself in euro psychology because I was asked to go and develop the counseling psychotherapy service within the Center when you have we haven't used psychiatry.

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Jak Smith: I didn't have a formal training don't have a formal training in a new rule, and so it was a real intensive learning curve really under quite quite robust supervision agreement and.

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Jak Smith: and learn with the patients and teams that was working with, I suppose, and in many ways I probably felt a little bit.

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Jak Smith: out there in the unknown, but I also think that that not knowing possession of it something different, you offered me the opportunity to begin to listen to the patients that we see in our clients have family and perhaps hear things that were not being treated by other.

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Jak Smith: Multi disciplinary team, so the challenge really was how do we begin to find a language.

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And how do we begin.

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Jak Smith: Listen, both to the objective and subjective nature.

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we're experiencing.

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In the therapy room.

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yeah.

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Jak Smith: that's where the loop started.

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ingram wright: Thank you.

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ingram wright: What about you.

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ingram wright: How did you how did you get into new row work.

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Pip Calvert: probably a little bit further back, I remember going to do my undergrad in psychology and I was really interested in mental health, particularly what.

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Pip Calvert: would be labeled as schizophrenia don't know I just really sparked my interest for learning about here, and of course it was always presented as a brain disease.

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Pip Calvert: So I just got really into that and and started more about the brain and then we were learning about the brain that really sparked my interest.

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Pip Calvert: And so I came out of the gate I want to work in brain stuff didn't really know what that was about massively and then I did I did.

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Pip Calvert: Two or three assistant post, but one was in your psychology acquired brain injury that and that's about really, really sparked my interest and.

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Pip Calvert: Then I went and worked in secondary care mental mental health.

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Pip Calvert: And that's where I came across across CAP was also my Supervisor was accountable, one of my supervisors was a counseling psychologist that was also really interested in euro so I was already started to kind of get that that blend.

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Pip Calvert: And I when I got on the doctor I was just absolutely convinced, I wanted to be in in Europe, and particularly quite brain injury service, but I also wanted to be a mental health, I wanted to do both.

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Pip Calvert: And that's what I ended up I ended up doing so in every single one of my placements I made sure I was doing something near related.

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Pip Calvert: And, and then, when I came out, I was lucky enough to get to two positions one in your psychology practice and then acquired brain injury and one in the in a secondary care mental health and mental health service.

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ingram wright: Thank you Pepsi so it's it's helpful to hear about people's journeys it's one of the things that others have talked about in the podcasts and about how.

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ingram wright: I sorry, there was a real there was sorry i'm just pausing now there's a real loud noise I think it's probably my emails it's just.

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ingram wright: Did you hear.

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ingram wright: Did you just hear that, so I keep trying to shut down it restarts.

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Pip Calvert: Okay, I let me just make sure i've got everything shut down.

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Pip Calvert: Right okay sorry about that.

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ingram wright: Sorry, so we're just going to pick up from where you finished pit I can edit it out and make it all sound seamless.

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ingram wright: So thank you for that um it's interesting to hear about your journeys into sort of new row.

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ingram wright: settings and it's one of the things that's come up on the podcast and there are a lot of people listening are sort of.

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ingram wright: at the early stages of developing their interests in various aspects of clinical practice, so I think it's really helpful to hear about your journeys and we're here to talk about cat and and I guess, one of the first things is for those people who don't know.

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ingram wright: Would either of you volunteer to describe you know what are the key characteristics, what do we need to know about cats to to sort of begin to have a conversation about it.

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ingram wright: So if you want to go first obviously eating to answer that question.

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Pip Calvert: also got up my presentations.

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ingram wright: you've got some notes to help.

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Pip Calvert: really interesting question in terms of because I think we know it in CAP, but then when you're actually asked to describe it can all get a little bit.

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Pip Calvert: Willie and, of course, that particular psychologists and psychotherapist we all get accused of being bullied I was, I was trying to think about how do I do this the signal, but now i'm waffling so i'm clearly failed in.

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Pip Calvert: There anyway, so the way I would describe it when i'm teaching it to people is it's an integrative psychotherapy.

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Pip Calvert: So it's based a lot on object relations and so that way of how we learn to relate to one another through our relationships and then the how that helps us relate to ourselves.

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Pip Calvert: it's also based on some of the got skis work about how important social interactions are in our own development.

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Pip Calvert: And then the cognitive element of it is that Tony Ryan, who developed it it really like how competent therapy describe difficulties very, very clearly so.

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Pip Calvert: It made it a bit more accessible, the more psychodynamic psychoanalytic and therapies, I guess overall it's about.

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Pip Calvert: helping us understand almost have to describe how we relate to one another and we relate to ourselves as well.

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Pip Calvert: And then, where that comes from that it comes through all of our relationships from very early on, all the way through you know and it continues developing really I guess that's probably how I talk about it does that fit with you jack.

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Jak Smith: yeah I think it covers a lot of what I would say as well, really, I think one of the important things, for me, often the whole gun line, particularly working in your own complex disabilities is is how.

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We.

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Jak Smith: kind of learned to relate to ourselves and our template of ourselves others in the world, now this isn't just through our relational experiences with.

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Primary caregivers book with cultures that were brought up in the time society.

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political influence on things.

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Jak Smith: yeah and how these kind of interactions become internalized really the kind of inner dialogue and we anticipate people will see your screen is the scene ourselves.

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Jak Smith: And how we learn really to develop ways of adapting and survive and and to get on.

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Jak Smith: You know in directed behavior in to get things to get our needs met and.

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Jak Smith: How these patents can be very helpful but, but they can come a time when the maybe become problematic or limiting.

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belief of mine from the devil.

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ingram wright: So thinking about a new row a new row setting and I suppose, in response to what you've both said how does cat have particular or find particular applications with new row populations or on euro settings have you got some notes on that pip.

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Pip Calvert: You gotta take the MIC you can't you won't be able to see on the podcast but.

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ingram wright: No more no more next is holding up pip is holding up books that she's got for reference, just in case some of the questions get tricky.

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Pip Calvert: i've got the arts, because all of a sudden, I had this anxiety about how do I talk about this, because she just wants you doing it you don't really think about how to explain it until you're in conversation I was clearly a bit anxious about being.

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ingram wright: The question the question, the question is, what is it about cat that particularly works in in the euro setting right well, what is it that that makes you believe that it has a particular application.

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jack do you want to go first.

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Jak Smith: So I think i'm.

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Jak Smith: Flying car really in new population that experience of doing that cross, and if we population groups and and I think what I find helpful is cats desire to understand the whole person not just symptoms of the condition, so you know.

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Jak Smith: we've got it designed to kind of think about how people have experience the world and grow know.

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Jak Smith: How that informs how they relate cells, but it also gives an insight and how they might relate to a condition that been diagnosed with and and how that influences people's.

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Jak Smith: ability to self manage or to engage in a new rehab program or this idea that health care is fundamentally relational.

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Jak Smith: So we're entering in to relationships with people.

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Jak Smith: Colleagues, with clients patients family, and so I think can can be applied, both as an individual treatment model, but it off as a framework for thinking about systems or thinking about kind of team consultation.

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yeah.

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But.

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ingram wright: What about you have you have you had time to find the right page in the in the in the chapter.

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Pip Calvert: yeah, why do you think I asked.

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Pip Calvert: And I agree with everything that that tracks just said, I think.

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For me.

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Pip Calvert: What I found when I was doing my cat training the clients that I would tend to think more about in it was.

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Pip Calvert: My newer clients, rather than the people I was working within an adult mental health, because that that service was always very cat had the anyway, that was one of the reasons I went to work.

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Pip Calvert: And I always kept thinking about the newer clients and for those of us who you know around your psychology new particular brain injury.

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Pip Calvert: We talk a lot about what somebody was like before that they had their brain injury seen about lovely where the pre morbid.

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Pip Calvert: And and that's a big thing for me about thinking about yeah who was this person, how did they manage and cope and survive in the world how did they relate to people beforehand.

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Pip Calvert: Because if we're actually going to truly understand how the brain injury has impacted on them, we really need to understand who they were before how they related so.

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Pip Calvert: That got me thinking about how cat could help us then think about who that person is how they coped.

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Pip Calvert: Because, particularly when you have something so huge like a brain injury or any other neurological you know condition, whatever it might be i'm obviously talking about brain injury because it's what I specialize in.

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Pip Calvert: When when something like that huge happens, of course, you're going to go to your usual coping strategies, I know what i'm Mike I go to my coping strategies when i'm really stressed and I haven't had anything that huge happened to me.

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Pip Calvert: So why wouldn't they go to that and I think what I was finding a lot in my work is that things would be interpreted in the lens of the brain injury.

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Pip Calvert: So it's always about the brain injury and and one of course my You know, as I see my role as a as a psychologist is to question that sometimes ago, is it the brain injury or is it.

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Pip Calvert: This is them as a person and that's not a judgment it's not a criticism it's just it's, we need to recognize that because it's an IT alters how we work with that person and what we're targeting and what we're trying to do.

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Pip Calvert: So CAP to me then helped me think about how do I frame that how do I have a way to put that together, which you can then add into that gut brain injury understanding.

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Pip Calvert: And it also helped me then think about how I have conversations with the stuff about well, maybe they're doing that because this is how they used to cope.

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Pip Calvert: beforehand, why don't we chat their relatives and it was just a way of pulling together all of that, and then the other thing I would say, an awful lot in my work.

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Pip Calvert: with how the person with the brain injuries be related to by the staff, so no stuff you know I mean the fact that it's such a hard job, and you know they're they're also.

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Pip Calvert: doing everything they can, but of course they bring their own stuff with them, and you could you could I could see that in the world, you know, because that the.

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Pip Calvert: People will get quite worried or parenting to people and then you see the person with a brain injury real reacting quite strongly to that and to be quite splitting those reactions.

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Pip Calvert: To it's just a way of being able to help people frame that and think about it and and I guess also.

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Pip Calvert: being influenced by predator knows work, so you know the American year psychologists, who is a big advocate of using or psychodynamic and psychoanalytic approaches in in brain injury.

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Pip Calvert: And it was my way of sort of crossing the two over of how do I make this accessible to me because I understand.

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Pip Calvert: Cat as much as I can, as always stuff to learn how do I bring those two together so it's kind of bringing my two passions together it just seemed to work, it just seemed to help me.

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Pip Calvert: talk to the people I was working with about how do we understand this person and how do we help them work better with.

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yeah.

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ingram wright: Going jack do you want to come in on.

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Jak Smith: Well i'm just excited hearing that because that's really my experience with something about cats, you know this cognitive description of psychoanalytic ideas makes it accessible.

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Jak Smith: To the people that were working with, but the teams.

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ingram wright: And, especially as I was listening to you both talk, I was thinking about.

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Jak Smith: Well it's not.

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Oh sorry.

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ingram wright: it's a bit of a bit of a delay, did you get that as well pip.

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Pip Calvert: I didn't, but I could see you both pause.

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ingram wright: sorry about that.

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ingram wright: So I just crushed over you there jack I didn't realize I did do you want to just pick up from where you were.

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ingram wright: yeah where were you.

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ingram wright: Well, I pip you finished you finished your bit, and then I think we got about 10 seconds in and from my end it looked like you froze and then I jumped in.

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ingram wright: Okay yeah but just just just go from whatever thought you've got and we'll just leave it in as if it's as if it never happened yeah.

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Jak Smith: Great so what comes to mind when pip was talking was just the value of cat in ny brings a cognitive description to psychoanalytic ideas and this.

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Jak Smith: makes quite a complex language accessible to not only the teams that were working in but the patients or family that we're supporting as well, and we can begin to kind of understand yeah quite complex ideas will use it.

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yeah.

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ingram wright: I guess you were both talking, I was thinking about how the so much complexity working in Giro populations isn't so as a neuropsychologist who has sort of.

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ingram wright: diagnostic assessment biases i'm listening to you both talk and thinking, this is something that's unreachable to me right so i'm i'm comfortably in my diagnostic assessment camp.

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ingram wright: And i'm wondering if, in the teams that you work with there's that kind of split between those who are working.

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ingram wright: At a relational level with the clients and those who are much more focused on diagnostic assessment would you accept that that is a bit of a split in terms of how we practice if you're nodding.

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yeah I definitely say within your psychology because, of course, understand psychology has tended to come from all over the place, most traditionally where let's support the neurologist let's call it the neurosurgery surgeons about diagnosing a presentation, whether it's you know.

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Pip Calvert: Progressive condition or fits the brain injury, so I think understandably lots of yours psychologists, in particular, would identify with that and then think.

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Pip Calvert: That I I I certainly see a new generation coming through her much more interested in working with the person post that let's understand.

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Pip Calvert: But actually I saw, so I think it's really helpful for within diagnosing as well i've certainly found it.

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Pip Calvert: really helpful and thinking about what's going on between me and the person i'm working with was were actually thinking about how they got a brain injury or no.

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Pip Calvert: or what's the extent of it, so I, I can see influencing all of those areas we I think I think i'm just gonna be there isn't it it's that it's that development and.

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Pip Calvert: Also, the question about can you do therapy with somebody who's had a brain injury and of course polly that depends on the severity of it but that's always been one of the debates in you know in brain injury so.

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ingram wright: what's the answer.

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Pip Calvert: Is you can.

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Pip Calvert: Absolutely okay it's just how you do it what you do what you're targeting and what you're expecting if people, because one of the things I talk a lot about so.

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Pip Calvert: A cell phone and another consultant your psychologist vicki target we do a lecture on your psychology and adult mental health to the.

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Pip Calvert: first year trainees on the Manchester training course one of the things we talk about is how we can add out.

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Pip Calvert: therapy psychological therapy, because we actually asked a lot of people in psychological therapy regardless if you've had a brain injury or not so.

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Pip Calvert: I think, of course, you can but it's what it's what you're doing and it's the timing of it or is it actually the intervention is more with the family or the or the staff and actually That in itself is therapeutic it depends what we mean by psychological therapy yes.

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ingram wright: Do you do you think in terms of of of I suppose thinking about for him therapy might be most appropriate where there might need to be modifications.

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ingram wright: Is there some kind of prerequisites of diagnostic assessment process that has to be undertaken, or is it is, it is it possible, in your experience, just to dive straight in.

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ingram wright: Because i'm wondering sometimes some of the barriers to accessing therapy might be actually.

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ingram wright: We need to understand this person's cognition before we can work with them right so that involves an extra step in the process which might well prove to be a barrier in terms of the Max in therapy.

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ingram wright: You can't access conventional therapy because you've had a brain injury and we need to understand whether your memory and your attentional systems are up to the job in terms of being able to tolerate that that that therapy.

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ingram wright: What do you thoughts.

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Pip Calvert: Jackie you Okay, if I if I jump in on those okay.

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Pip Calvert: Sorry for the people who can't see on the podcast and yeah I think I don't think there's any hard and fast, I think, absolutely, we need to.

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Pip Calvert: Understand about where the person is at cognitively if we're, not that I think we're putting them under a lot of pressure, because then there's that expectation that they can engage in.

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Pip Calvert: In more traditional psychological therapies, whether that's cognitive behavior therapy or whatever it is.

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Pip Calvert: So yes, I think there is, I think, on the converse of that, though I think we often don't think about people who.

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Pip Calvert: Technically don't have a brain condition and why they're called me she has out because everybody.

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Pip Calvert: With with mental health presentations will have something going on with their cognition it's just not necessarily because of an organic cause.

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Pip Calvert: Of the we would talk about in terms of the brain injury.

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Pip Calvert: So look, I mean if you look at any of the literature, you know people who are anxious and again vicki ticket and I talked about this in our lecture that.

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Pip Calvert: Anybody who's actually I mean Have you ever had that experience, I know I certainly have a being in an exam and you're sat there, and you put your pen down.

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Pip Calvert: And then you can't find your Pen, you know it's there.

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Pip Calvert: Because you've just put it down you can't actually see it.

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Pip Calvert: So I can't visually scan and pick that out, which is a cognitive process because i'm under have massive amounts of stress and anxiety that point in time.

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Pip Calvert: And then, all of a sudden it's there and then the paranoia kicks in about somebody just move that i'm losing my mind slightly so in any kind of situation there's always something cognitive going on and I don't think we think about just general Sarah.

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ingram wright: suggesting that psychological assessment is a prerequisite for every project.

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Pip Calvert: And what I think what i'm saying is that course, we need to think about what some of these abilities are.

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Pip Calvert: And, and you know if we just look at the general literature OK, I can never remember what the own the source of it is you know that that adage that we hear that.

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Pip Calvert: Even if you go to your GP you're only remember one in four things that get talked about yeah.

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Pip Calvert: automatically We therefore need to adapt and think think about that and that's just always where I come from.

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Pip Calvert: So yeah somebody who you know, certainly doesn't have day to day memory, so you know they can't remember you.

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Pip Calvert: that's going to be quite challenging but does that mean you don't call it a beauty with them absolutely not, I mean the people in the podcast wrote see but i've got bright blue hair.

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Pip Calvert: And it's one of my my goatees now see if somebody will remember me if they don't remember my name or what we talked about like blue hair or MBA.

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Pip Calvert: You know if if somebody doesn't have you know very good language abilities, again, we obviously need to think about that I think those those.

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Pip Calvert: People those difficulties are the most challenging to support in terms of psychological therapy.

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Pip Calvert: And through through a prerequisite in terms of a cut off, I think the things that you have to think about absolutely.

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Pip Calvert: But I have always been so surprised by the people that work with way you think this person's got a really bad memory problem.

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Pip Calvert: But yet we're doing work and it's how I saw them so there's a lady i'm working with a moment and others confidentiality, or it may too much.

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Pip Calvert: But she she has quite profound memory difficulties, but I spoke to her recently and she's like I remembered your name.

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Pip Calvert: And that was a real huge breakthrough for her but we've done so much work and she's feeling so much better in herself.

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Pip Calvert: because of course we know we can make people feel better, even if they can't remember how they felt better and what necessarily has been talked about so memory doesn't always have to be an explicit declarative I remember all the facts and figures.

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Pip Calvert: of it so again it's what we're talking about I think sometimes you just have to get to know the person, a little bit before you can make that make that decision, so do you dive right in yeah.

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Pip Calvert: But do you spend a bit of time getting to know that person, I guess, a bit like you would do if you're assessing somebody suitability to engage in in therapy, full stop.

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Pip Calvert: You know if you're in a mental health services i'm not send me now we used to do it varied into the number of sessions, just to see if how somebody would find talking in this way and being able to engage in that same thing to me it's just thinking about in slightly different way.

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ingram wright: jack you anything anything to add to what pip set there.

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Jak Smith: And I think one of the things that are valuable not being in the room, psychologists was just.

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Jak Smith: Working together and collaborating doing joint assessments.

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Jak Smith: And having a pre assessment conversation.

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Jak Smith: Thinking closely with colleagues and being able to join up you know.

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Our expertise and suppose but, but also that, if the kind of lived experience of the person you're looking for something you have to meet that yeah.

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Jak Smith: It feels important and, of course, there are options and ways of working with the model flexibly, I think, recording sessions, with people.

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ingram wright: I wondered if some of those sort of adaptations and not quite as great and profound are prominent in the work as we might think they are.

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ingram wright: Because on the flip side of this as you were talking, I was thinking you know, one of the things that i'm pushing for is for conventional access to conventional mental health services for individuals.

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ingram wright: who've had brain injuries, because often people are denied access because of their medical condition, and it may well be that sort of.

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ingram wright: Conventional service which is sensitive to the variation in people's abilities, whether it's attention or memory, or whatever.

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ingram wright: is perfectly suitable to someone who's had a brain injury provided those difficulties are not profound or severely debilitating in terms of the mentality of the therapy that's delivered.

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Pip Calvert: I I i'm a big advocate for for that as well because there.

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Pip Calvert: I mean there's a limited number of us in terms of who do work with people you know whether it's some different tracks background.

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Pip Calvert: And works collaboratively with other people to understand what those cognitive difficulties are and how it might impact on engagement therapy.

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Pip Calvert: yeah or people like me and yourself and Graham who are you know trained in terms of your psychology stuff there's there's a limited amount visiting some internal psychological therapist full stop.

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ingram wright: But yes, I think, the more we can help people access those because the difficulties might not actually be directly about the brain injury.

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Pip Calvert: And you know it's one of those ethical things and i've actually really I need to concentrate on the people who've had the brain injury and it's about that, so my skill that's where my expertise is, of course, I can help.

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Pip Calvert: in other ways, but I would then be reducing the amount of services available to those people that require special simpler.

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Pip Calvert: So absolutely I think there is, I think we don't, as I said before, I don't think we think about it enough in general terms, in terms of psychological therapy.

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Pip Calvert: it's not thought about, and you know in.

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Pip Calvert: I think it's becoming more thoughts about I really like when I see people talk about what were the headlines so let's just review at the end of the meeting that's a perfect cognitive strategy.

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Pip Calvert: You know let's come back let's actually focus on that let's think about the headlines takeaway brilliant that's called as a strategy so it's no it doesn't have to be.

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Pip Calvert: Really high level, it might be encouraging note taking because why as a clinician are we, the only person taking notes.

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Pip Calvert: It shouldn't feel threatening that the other person in the room is taking its taking notes, is it about a recording of the session is it a session summary.

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Pip Calvert: There are very basic things that we can do and Okay, it might mean that you lose on doing that inverted commas for people can't see me.

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Pip Calvert: If we lose 10 minutes of having a conversation, but actually if you can make use of that 10 minutes in a way that helps somebody gain an awful lot more from the other 15 minutes or 45 minutes or whatever, like the session you do.

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Pip Calvert: that's much more of a benefit it's the idea of maybe you go a bit slower to get a bit a bit server and I think I think every psychological therapy should be doing that anyway, regardless.

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Jak Smith: just wanted to add something if I can i'm not sure.

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Pip Calvert: I think he might just.

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ingram wright: To spend the whole of Saturday editing this.

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ingram wright: By remain very grateful to was all sparing the time to have this conversation jack it was it was a bit too late at the start you're very much back with us now, if you want to do you want to pick up from where you.

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ingram wright: Were you were it's quite it's quite a demanding working memory task isn't it remembering what you're about to say 30 seconds ago it's proving your point pip yeah.

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Pip Calvert: Absolutely, because let's face it, when that happens, sometimes we have to be the person who then goes, I think you were roughly around here, which means we have to be cognitive on the ball and that's a cognitive intention yeah yeah.

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ingram wright: We just had a moment during the podcast where we realized that the challenge the challenges of recording a podcast mirrored some of the challenges of anybody engaging in therapy and maintaining attention to it to a dialogue which is quite complex and emotive right absolutely so perfect.

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Pip Calvert: cuz cuz I can I remember where jack was up to other than he said, can I just add something in yeah sure, because then I was gonna let him.

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ingram wright: Know gonna let you know jax had plenty of time to think about what he was about to say yeah.

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And so.

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Jak Smith: Just to keep this cat really what i've been doing to try and keep up with the conversation is not something that I dialogue.

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Jak Smith: And so you just you're right, I think, cuts valuable in in and your population thinking cognitively with people is.

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Jak Smith: that these are tools that help people to keep hold of a dialogue, you know we map we call sequential diagram matic reformulation we're talking about one thing we might move to another and we're doing this together and we're doing in a way that's using the words if the person, you know.

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Jak Smith: And it's always on desperately trying to keep hold of the conversation i'm also leaning on the map is a cognitive strategy for making sure I don't get too lost in it helped me navigate something that feels quite fragmented and destroying it on my side because of connection.

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Jak Smith: In the room, or we reconnected and the man was that right.

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yeah.

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Pip Calvert: I love that because yeah absolutely just by by the nature of cat and this is what we call a map so it's basically.

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Pip Calvert: For those people who have never seen it is, it will literally draw out some of the patterns that we're talking about, so we have ways of describing how people relate to one another, so it might be.

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Pip Calvert: Controlling to controlled, we would talk about so that means that one person seems like the taking.

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Pip Calvert: command and they're they're being controlling so the other person with them feel controlled, and we would describe that by writing out in a certain way.

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Pip Calvert: And then we would write how people were then cope with that so it's a real visual tool, so if somebody struggles from a cognitive point of view about remembering what they've heard.

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Pip Calvert: They are better at remembering what they see and it's a perfect way of doing that and I apologize now I think my cat might be making a good appearance.

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Pip Calvert: yelling in the background, and so yeah it's a perfect perfect well and I think the sorts of stuff about that around cat that.

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Pip Calvert: helps people with cognitive difficult to since we're in cat we use letters as well and we're not you know it's obviously not the only therapy that tends to use letters.

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Pip Calvert: But we'll do that to sort of summarize our our initial understanding there's no reason you didn't couldn't add to that later on, so people have got a letter and, obviously, it depends on the density of that letter and how you write it.

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Pip Calvert: But as as therapists, we should also be thinking about what people might can manage and cope with that letter it's lovely there's so many things that we can just naturally adapt that are already in CAP.

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Pip Calvert: To us, with people who have cognitive difficulties.

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ingram wright: Do you think I mean either of you do you think that there are particular clients and we're talking about cognitive limitations, generally speaking, not just in the sort of brain injury population but.

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ingram wright: As as they might apply to the to the characteristics of cat, I suppose, as a as an interaction as a form of therapy and but other particular clients you think.

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ingram wright: cat is unsuitable for it, it doesn't work for where you'd actually be thinking you know cat isn't for you, maybe you ought to go to someone who delivers therapy in a slightly different way, or maybe you need something else at this point in time.

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ingram wright: What what what's been your experience of that kind of dilemma space.

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Jak Smith: yeah I think the other therapies that work probably that with different presenting problems or.

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Jak Smith: Difficulties cuts that definitely has a relational focus.

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Everything has to have to the next.

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Jak Smith: element to it, and I think in terms of.

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Jak Smith: suitability some something about stability and having a clear focus in some ways, it does not have to be pinned down at the beginning, but about what the works, going to be.

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Jak Smith: In terms of the neural population.

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Jak Smith: And we might work with it with the team, you know that bringing a difficult in they feel that this person needs therapy and kind of see.

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Jak Smith: The reasons wine, it also have a space of what it might be struggling with and how we might use caps consultation mother, with the team to think about what it what it's like to work with this person and why we feel stuck and yeah i'm staying away from talking about complex people because.

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it's healthcare stuff we bring.

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let's be honest yeah.

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Pip Calvert: And I don't think there's a difference between so we talked about using or doing cat.

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Pip Calvert: To doing cat would be more of the therapy, the more traditional kind of therapy, because that can have different levels to it as well, so it depends on the.

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Pip Calvert: Traditional traditional account you'll be doing a lot of work for understanding that person's path and therefore how that's related to their their present difficulties.

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Pip Calvert: In your settings I often don't necessarily do the really a lot of the digging because that's not what the person comes with so they come without.

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Pip Calvert: Having this problem because i've got this new presentation so it's all about the new presentation so i've got to start where they're at and.

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Pip Calvert: And so you wouldn't necessarily always do that digging but you doesn't mean you can't do an understanding about how they relate to people so again there's different levels of their.

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Pip Calvert: where's the using a cat would be more as well jack is talking about without consultation and supervision and helping to.

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Pip Calvert: Just I was smiling when jack said about when people come good this personally therapy, because you know the like that, and now okay.

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Pip Calvert: And i'll always have that in my head about is this because you'll find it difficult to support this person.

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Pip Calvert: So they might therapy could help them to actually are they ready for that is that, where they see it, because if they're not there, then we're not we're not doing that.

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Pip Calvert: So maybe I start using cat to help you think about what might be going on for them.

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Pip Calvert: So it might be a consultation about let's think about the person, what do you know about them and we can map that out, or it might be thinking about how you're relating to their difficulties.

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Pip Calvert: Again, you can do it now and that kind of way I think me in my experience and.

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Pip Calvert: It depends, where the persons that we've obviously already talked about cognition you know if they've been really severely impaired.

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Pip Calvert: Then doing individual you know cat work with them is probably not going to help, but it doesn't mean that we can't have an understanding of them using a cat cat approach not might be talking to family and staff members about how they found working with this person.

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Pip Calvert: And, but I think there is definitely stuff around how people just find talking generally about about emotions.

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Pip Calvert: And where they might come from and how they relate to people and maybe to themselves if that isn't even within their vernacular not because they've got a language difficulty from the neurological condition, but just it's just not in their.

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Pip Calvert: Their repertoire because they've never really experienced that they're going to really struggle something like like car.

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Pip Calvert: So it doesn't but doesn't mean you can't do some pre work with that it's all about exploring it with the person that you're trying to explore the possibilities are so.

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Pip Calvert: there's very few people that I would rule about doing something with them to support and try and make life, a bit easier, but what am I doing traditional.

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Pip Calvert: What we will call cat which is either 16 sessions or 24 sessions probably not and I don't do an awful lot of that work in my role.

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Pip Calvert: Just because there is always other things going going on, so we often have to jump about with our and now you've got a letter from the dvla We just need to sort that out, but we can talk about how you cope so have you just done it somewhere.

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Pip Calvert: And withdrawn and ignored it and now it's got to about point or benefits or things like that always tells us something about their coping strategies.

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Pip Calvert: So we're always having to jump jump about, which means that traditional therapy is actually really difficult to do, but it doesn't mean we can't use cat to help people think about how they cope and manage.

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that's interesting just.

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Because it's.

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Jak Smith: A window within my role i've got.

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Jak Smith: different parameters, you know I don't I don't get pulled into the kind of other aspects of the.

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Jak Smith: claims and things and and and allows us to really think about 13 so some people really might want to tell back to think about what what does it mean to be dependent.

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Pip Calvert: On people.

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Jak Smith: not uncommon for me to hear people come and talk about feeling like a child, again, or you know these kind of interested in themselves, I suppose, in people might have a desire to think more about what is it about the situation now that.

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Jak Smith: How do you cope with that How does that change how you feel in the world and relationships and so cat can really offer a framework for that.

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Pip Calvert: For that word that I hear an awful I don't want to be a burden on my family so again that's something about how they're relating to themselves, but then also how they are anticipating the family relating.

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Pip Calvert: To them, so cats cats presents a really nice way of thinking about that so yeah I agree jack I think it depends on the parameters of.

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Pip Calvert: My roles wider just.

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use it in different different way.

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ingram wright: I was gonna ask you both about language it's interesting that you know you've.

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ingram wright: picked up on terminology that's often used whether it's burden pre morbid pick you mentioned earlier on, it is an awful term isn't it, but we use it and and we don't necessarily question its usage or complex jack is a term you are.

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ingram wright: Perhaps raising a bit of an eyebrow about in terms of how it might be used to describe a person and I presume you are quite careful about the language that you use and you do see it as laden with meaning and importance people.

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Definitely definitely other than the other one that I don't know if you hear jack I always.

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Pip Calvert: i've got an interesting case for you red flag red flag red flag quite it's quite interesting so yeah language is incredibly important and.

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Pip Calvert: it's heavily laden and it's laid in in different ways for different people and we can't always be fully aware of that, but.

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Pip Calvert: I really liked how jack was describing earlier that, coming from a non euro background it made him, be able to question some of that but also maybe hear things that that may be traditional.

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Pip Calvert: approaches to your psychology wouldn't here and I totally agree agree with that, I think that kind of relates to what I was saying about seeing things through the.

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Pip Calvert: lens of the brain injury or the neurological condition, and I think, to be free of that sometimes is a really it's a really good thing.

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Pip Calvert: And, but then, of course, you need you need the balance to two languages, a year is incredibly important and using the person's language is so important, we might then frame it and suggest.

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Pip Calvert: You know, a term like I said controlling before judgmental and that might not be how somebody else would describe it, so we need to use that that language.

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Pip Calvert: Because also I think some of those language that some of those terms like say have a meaning for somebody else, so you might label it, you know you might see.

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Pip Calvert: This quite critical other people were then you're very criticized by that because we've got that reciprocal role going on, so they don't want to use that word because that's.

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Pip Calvert: too difficult for them at that point in time, so you have to find a different way of describing it and yeah I think language is incredibly important not to be pathology rising and just be human with it, and I think if we can't describe things way that is non jargon is.

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Pip Calvert: potentially controversial I don't think we're doing our jobs properly, and I think we are failing that we work with if we aren't able to describe it in a different way yeah.

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ingram wright: yeah.

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ingram wright: reaches his country controversial point in the in the podcast there, I admit it.

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Pip Calvert: If I.

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Pip Calvert: get my Armor on and be shot.

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ingram wright: Jackie sorry I interrupted you.

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ingram wright: jack's got some lovely drawings, to help him.

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ingram wright: reorient to the conversation we were having about 30 seconds ago.

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ingram wright: Did you want to come in on that.

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Like no.

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yeah.

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Jak Smith: yeah we were just talking about language in the power of words really isn't in cat today and logic model and it thinks a lot about dialogue in a dialogue.

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Jak Smith: Our external dialogue and and you know there were, I think I was just picking up on something about how we might have good intentions with a certain type of dialogue, but it could set up.

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Jak Smith: and certain patterns really so this idea of use it or lose it was often Nice does come up in in new rehab and.

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Jak Smith: being kind of been in a position to be able to hear and patients in the in the Center reflect on how they felt they always had to meet you always have to be doing.

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Jak Smith: And sometimes when they weren't able to do that, they felt like they weren't fill in the expectation, and so we could begin to think about this part and just you know through something that really well me and in me get it.

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Jak Smith: But there's also another side of the dialogue that.

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Jak Smith: It has a different meaning, as well as a consequence.

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Pip Calvert: yeah yeah and we can't always be aware of that, because I think as clinicians and we could become quite anxious about that I go I can't say this because what about that.

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Pip Calvert: I think if someone's you go in with them well meaning intention, but you then listen to the reaction and response to it, and then you might need to name that with the person that word seems like it's got.

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Pip Calvert: a really big meaning for you, so I apologize if.

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Pip Calvert: You know that's a good can we talk a bit about that you invite them to talk about that and actually that's a really good way of assessing how able to even to engage in those kind of those kind of conversations.

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Pip Calvert: And then it's just about adapting adapting and you might then get to a point where that feels a bit more tolerable but you've got to start somewhere so as long as your intention is is good and you're open and curious and listening to the feedback you'll be fine that's that's no additional.

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ingram wright: Checks noting vigorously I see you're talking pig.

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Jak Smith: I just like that idea of open curiosity to learn together really you know to.

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Jak Smith: feel very relational very collaborative.

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Jak Smith: Co produced you know, like.

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This.

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ingram wright: So we've all been sitting anxiously thinking when did the quiz questions going to happen, what.

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ingram wright: i'm thinking now my.

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ingram wright: Now might be a good now might be a good time well i've been sitting anxiously thinking when the quiz questions gonna happen.

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ingram wright: So i'm going to start with i'm going to i'm going to start with jack and no reference to any notes Okay, some of these questions you'll have heard before, but you just have to pick one there's no right or wrong answers for the audience to judge okay.

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ingram wright: jack.

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ingram wright: Miller, I.

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ingram wright: Say jack's going first and mixer or hippocampus jack.

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ingram wright: What did you what did you choose you just broke up there, you are the head along thinking time.

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ingram wright: makes it all hippocampus.

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ingram wright: hippocampus confident answer.

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ingram wright: pip teams are dreams.

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dreams.

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ingram wright: Perfect jack gold or silver.

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silver.

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ingram wright: pit pole vault or gymnastics.

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gymnastics I got more of a chance at it.

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ingram wright: Cattle dog.

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No.

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ingram wright: My cat is now horribly sitting on my lap so we got we've got cats actually in the room we're talking about cats.

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ingram wright: it's holding up a cat and pick fruit so fiber right.

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ingram wright: jack lemmon or line.

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Jak Smith: line.

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ingram wright: pip left or right hemisphere left.

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ingram wright: jack tea or coffee, I think I know the answer to this coffee.

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ingram wright: On pip netflix or I play.

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netflix.

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ingram wright: brilliantly brilliant well I think hundred percent to both of you.

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ingram wright: sticking with it.

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ingram wright: I have a final question, I have a final question which we had a bit of discussion.

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ingram wright: offline didn't worry about which is about how would you think about inviting colleagues in euro settings when you're a psychologist or therapist working in.

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ingram wright: neuro settings with neuro populations to use cat frameworks and ideas I mean, is it about big becoming a cat therapist or is it about.

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ingram wright: Using some of the ideas that we've talked about today or thinking differently about the work that you do what what are your thoughts about the sort of audience that aren't currently trained or experienced and using cat.

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You.

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Jak Smith: Know i'm.

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Jak Smith: Quite at the beginning of my career really I suppose i'm really excited about the possible, and you know the possibilities what cat could offer Nero, so I would encourage as many psychologists and people interested in human clinical psychology training.

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Jak Smith: And in terms of suggestions and using cat concepts in practice, I think, important thing really is that.

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Jak Smith: If people are going to begin to think in in a cat way in a relational way they've got appropriate supervision.

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Jak Smith: And you know because we wouldn't want to do any harm people, it can be quite powerful way of work, and when we work in relational models like cat.

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Jak Smith: And, but I wanted to offer something that I thought might be helpful any new sites, which is that there's a paper by somebody called Steve potter us in the world, and he.

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Jak Smith: wrote something called the help as dance and it's it's paper but it's also a questionnaire that describes familiar patterns in healthcare staff.

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Jak Smith: And it helps us to begin to think a little bit about our own reciprocal roles and our own responses in healthcare settings and I think if we're to begin to think about work in all relation and we have to have a good idea about ourselves, first and foremost and.

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Jak Smith: And so yeah so so maybe, starting with something like that, or even a cat therapy.

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and

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Jak Smith: it's not it was a huge part of my dreams.

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Pip Calvert: yeah i'd agree with that, I think, if you can start thinking about it any which way doesn't have an account mean obviously i'm going to advocate because.

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Pip Calvert: I find incredibly helpful and it's something that draws me to the if you can start to think more about how to relate to people that to me, is a massive massive star.

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Pip Calvert: And and yeah I mean reading articles, and so there are there are a few out there there's not massive amounts out there, on top of this definitely few.

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Pip Calvert: Because i'm going to plug my own, but I wrote, and you can just Google, it does come up free it's it's not it's not something that you have to pay to access.

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Pip Calvert: And, and then yet supervision and just chatting to so it might be that you contact somebody who is capturing but maybe not in in euro, and then you can put your two heads together.

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Pip Calvert: It might be that you contacted somebody like me who is Julie trained and that I agree with jack I think the supervision is is incredibly important.

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Pip Calvert: A because it's a big part of of cat anyway in terms of started to think about as you think about your own stuff and and what might you might be in acting and so.

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Pip Calvert: When we talk about acting we talk about what are you bringing to it and almost have you in the patient or miss class a little bit.

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Pip Calvert: And because you've both got your own stuff that just happens to trigger each other.

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Pip Calvert: And that's really, really important, I think, if you anybody even start there then you're starting to think about using cat in your approach.

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Pip Calvert: But yeah people want to go and train and it absolutely do I don't regret it at all I think it's incredibly helpful.

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Pip Calvert: i'm also starting my cat training, because I was working in mental health, I finished it in in euro and i've applied it more a year.

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Pip Calvert: And that's where i'm now specializing so yeah if you can think about patterns, think about how you're relating to each other that that to me would be brilliant.

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Pip Calvert: And like I said before, if you're thinking about how people related to one another, before then you're illogical condition brilliant you're already doing something that will add value to that person's input and isn't that what it's all about.

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ingram wright: Thank you, both of you for just spending the time today it's been lovely having this conversation i'm certainly persuaded that a lot of the ideas that you've shared are really important to was working in euro setting, so thank you for your time.

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