Change to the recognition and revision of target problems and target problem procedures during eight‐session cognitive analytic therapy for self‐harm

Objectives

Defining target problems (TPs) and associated target problem procedures (TPPs) is a key competency of cognitive analytic therapy (CAT). This study sought to categorize types of TPPs identified, assess the acceptability of TP/TPP sessional tracking, assess whether changes in TP/TPP recognition and revision occurred and also whether change in TP/TPPs predicted severity of self-injury urges and psychological distress.

Methods

As part of the RELATE clinical trial, N = 31 participants were allocated to eight-session CAT. TPs/TPPs were rated for recognition and revision at every session in a nested ABC plus follow-up single case design. The competency of therapists was assessed. TPPs were coded as to whether they were a snag, trap of a dilemma. Linear mixed-effects models tested whether TP/TPPs changed over time and according to phase of CAT. Change in TPs/TPPs were used to predict self-injury urges and psychological distress (i.e., research follow-up measures taken by blinded researchers).

Results

There was strong interrater agreement on whether the TPP was a snag, trap or dilemma. The sessional rating of TPs/TPPs appeared acceptable, as during 97.68% of treatment sessions and 82.60% of follow-up sessions, tracking occurred. Compared to the reformulation phase, awareness and then therapeutic change of TPs/TPPs significantly increased during the recognition and revision phases. Recognition and revision of TPs/TPPs during CAT in the revision phase did not predict self-injury urges and psychological distress at research follow-up.

Conclusion

Early definition and sessional tracking of TPs/TPPs appear acceptable and changes to awareness and ability to change TPs/TPPs appears linear. CAT therapists should routinely integrate sessional tracking of TP/TPPs into their work.