ABSTRACT

Through case examples, this chapter describes the use of Cognitive Analytic Therapy (CAT) with 'hard to help' clients and as an explicit framework to inform staff/team/system care and risk management. It considers enhancing insight of relational patterns, the management of endings, transitions of care and collaborative relational risk assessment. The chapter shows how the use of CAT can make complex dynamics explicit, understandable and manageable. Finally, it examines the ways in which CAT can improve staff relational management, foster risk reduction and enhance public protection and client care. The CAT formulation allows the therapist and client to recognise the risk-related behaviours or boundary pushing, which will inevitably arise in therapy and general care of the client, as reciprocal role enactments, or Offence Paralleling Behaviours. A relational understanding and regular reflective practice for all staff, preferably enhanced by CAT-informed training for staff, is therefore invaluable.