Cognitive analytic therapy (CAT) within the perimeter fence: an exploration of issues clinicians encounter in using CAT within a high secure hospital

Purpose - This paper aims to describe issues clinicians encounter when delivering cognitive analytic therapy (CAT) within a high secure hospital (HSH).Design methodology approach - Focus groups were conducted with six staff using a semi-structured interview. Thematic analysis was used to analyse the data.Findings - Five main themes emerged from the data. These were: concerns around therapy and the therapeutic relationship; issues with CAT stages and structure; issues around CAT tools; issues connected with the HSH setting; and concerns about integrating CAT and teamwork. Clinicians addressed these issues by helping others understand therapeutic relationships and adapting CAT tools and structure.Research implications - It is recommended that HSH managers ensure that therapists are fully supported and subsidiary therapy staff members are appropriately trained. Additionally, the Association for Cognitive Analytic Therapy (ACAT) and CAT training organizations need to demonstrate sensitivity to the HSH context and fully prepare trainees for forensic work.Originality value - This paper describes how clinicians effectively address challenges when delivering CAT and makes recommendations for future delivery.