We are amazed you have time to read this. We haven’t had time to write this blog. But it appears we all have found some time. To take a moment, see what’s out there, something to inspire us in our work. New ideas or familiar ones. Ideas to confirm our practice or ideas to take us to new places. It is these challenges that lay behind our new book.

I (Jamie Kirkland) am working my way through my NHS Glasgow emails, sifting through the ‘work’ related requests: a risk assessment is due; a parent would like to have a ‘catch-up’; a patient is wondering if I am on the ward Thursday; the Team meeting is going to be re-arranged. At the same time looking at ‘managerial’ requests, answering questions like: Can you make sure you have read and signed this policy document? Is your appraisal up to date? Fancy being a national assessor? There are extra sessions at work available, are you interested?

Then finally to get around to the supposed ‘luxury’ emails: Next year’s conference will be in person if you want to register? Can I speak to you about the advertised role in the department? Can you tell me what it was like to do a serious case review? And lastly to the email highlighting the looming Blog deadline, asking are you still interested? Well, yes, I am and of course, I’ll be at that conference, and I have indeed read everything. Though perhaps I don’t have the space for anything else, as they say, the cup overflow-eth, I’ll have to jettison the ‘luxury’ list.

It is exactly the meeting of all these demands that has pre-occupied me and Jenny Marshall as we have been co-editing a book this year. The book ’Reflective Practice in Forensic Settings: A Cognitive Analytic Approach to Developing Shared Thinking‘ edited by Jenny Marshall and Jamie Kirkland was the product of a forensic conference in York in 2019.

Cognitive Analytic Therapy – identifying and treating negative learned behaviours and beliefs

Cognitive Analytic Therapy (CAT) is a well-established model of therapy (see www.acat.me.uk). It considers the ‘roles’ a person takes up in relation to others and themselves. ‘Roles’ that invite the ‘other’ to reciprocate, even if that person (a professional) does not want to. For example, a neglected and abused client may expect you (the professional) to neglect or abuse them (even subtly). It is their template for relationships. But you do not want to reciprocate this.

Relational templates formed in early relationships shape interactions going forward. Templates can lead to unhelpful patterns of behaviours that keep a person stuck, with self-defeating traps or (seemingly) limited choices. Choices are seen as unavoidable and self-defeating. The model tries to help the person understand this and develop new ways of acting and behaving.

The beauty of this model is that once we include ‘the other’, meaning ‘us’ in relation to an ‘other’ we can extend the theory. We can apply this relational therapy between individuals and ‘their’ team. We can consider ‘relational’ dynamics between teams and agencies, even - to keep the idea going - between large organisations.

The York conference was a gathering of clinicians from all parts of the UK who are part of the development of this theory. They saw the opportunities to use it in team working. Specifically, in this context, the delivery of reflective practice. After all, the professional working with a person in the criminal justice system may be expected to reciprocate a role with the client. To monitor a license condition could be experienced as ‘controlling and judging’ not ‘containing and nurturing’ because of that client’s early experiences. Working with people in the criminal justice system, indeed across mental health generally, can make clinicians take up positions, in relation to the client, that challenge their work, beliefs and attitudes. It is precisely this ‘push and pull’ in our work that reflective practice has gained a foothold in management responses to the challenges faced.

The ongoing process of reflective practice

But who has had the space to step back and have time to reflect? To gather one’s thoughts and put something to paper? We know the value in supporting staff to take a moment to reflect at work. Studies show it can sustain and maintain a workforce. Early responses to the Covid-19 pandemic from psychologists was ‘psychological first aid’ and ’15-minute care spaces’. Yet, when there is pressure, many of us can close down (to survive), it’s the psychological version of comfort eating. And many staff needed to do this and did. For us, as authors, reflective practice sessions were cancelled on a regular basis.

With this as a backdrop, it was not an irony to us as editors that in delivering reflective practice we can find staff teams unable to attend due to pressures of work and yet we were asking chapter authors to find space to write when juggling the new world of ‘Microsoft Teams’, closed schools, isolation and loss. It felt unbearable to ask for a deadline on a chapter – cruel even.

Yet what transpired was that we applied exactly the same principles to the writing and editing this book as we would hope to do in delivering reflective practice. We gave ourselves permission to take a little longer to complete the work. And were grateful for Pavilion to agree! We checked in with each other and we checked in with the other contributors. We listened and were compassionate. We nudged if needed and withdrew if it felt best. We praised and encouraged.

Often the best creativity comes out of times of tension, stress, and difficult circumstances. It should not be a surprise that during the present pandemic the creatives in society (musicians, actors, artists, performers) have perhaps kept the rest of us afloat with new ways of expressing their art. Out of necessity. Out of a ‘drive’ to do. Out of kindness.

The book has been written as both accessible for the novice and an exploration by those writing the chapters. An attempt to use a relational model (CAT) to deliver reflective practice but invite the reader to try these ideas out. We believe that the book gives the reader enough to start the process and ideas to get it going in your own practice. We are also inviting the reader to be part of the future direction in this work. Read it and contribute. The model encourages dialogue.

It was (and still is) a pinch yourself moment, how did we get here to the final product? We don't suppose anyone really knows how we get to a 'good enough' endpoint where reflective practice is concerned. It can take 5 minutes or take years. You just trust in the process and know when enough is enough, for now.

 

To find out more details about Jamie Kirkland and Jenny Marshall's book, and how the CAT model can help improve your clinical practice, click here.