This month we invited Dr Miles Rogish, Consultant Clinical Psychologist at The Disabilities Trust, to give us his personal take on the research he has been doing on compassion focused therapy.

“Having worked most of my professional career in acquired brain injury rehabilitation, challenging behaviours in the people we serve has always been an aspect of my work. I have also asked myself how to better support the staff I work with when they are the target of challenging behaviour. Having seen many great staff members burn out from stress when working with particularly challenging behaviours and talking to them about this, their rationale was often around ‘behaviours not changing’, ‘nothing working’, ‘not feeling safe’, or ‘not understanding why the behaviours were occurring’. I was first exposed to Compassion Focused Therapy (CFT) in the mid to late 2000s.

This is a third wave psychological intervention technique rooted in the analysis of our basic motivational systems, like living in groups, and care for kin, for example [1]. I was immediately impressed with the simplicity it brought to the understanding of someone’s behaviour and noticed how easily it could be adapted to explaining challenging behaviour (formulation). I was also impressed at how CFT could be used to help staff understand their own emotional responses to stressful work.

When I started working as the Consultant Clinical Psychologist at York House in 2014, I decided to try and use CFT to help staff manage the stress they experienced when working with challenging behaviour. I started by developing and piloting a CFT-based stress management program for staff. My outcome measures did not show any impact of the training on staff perception of challenging behaviour, but a few members of staff began discussing how my CFT-based formulations had changed their attitude towards a number of patients. I found case study evidence where, after sharing the CFT-informed formulations that explained the development and maintenance of challenging behaviour in a service user and guided staff through how to manage their own behaviours and emotions in response to these behaviours, staff reported becoming less frightened of the service user and engaged better.

From this insight, I have embarked on a research and improvement program aimed at evaluating the impact of CFT-informed formulations on staff working with challenging behaviour. The first study at York House found that this approach allowed staff to feel reassured about their own feelings, sometimes distressing, feelings, when working with challenging behaviour. They found that the CFT components provided an accessible and an easy way to understand behaviours in service users, and that the training allowed them to establish practice and interactions that felt natural and could be generalised across service users. [2].

This study was since repeated with similar results. In response to the pandemic, we also looked at the impact of online versus face-to-face CFT based training and tutoring. Staff found both helpful but expressed a preference for face-to-face as this provided optimal opportunity for questions, discussion and peer support.

We have also replicated the study in a community-based service (Daniel Yorath House) and the results are currently being analysed.

The overall positive results of all of these studies motivated me to develop a basic introduction to CFT informed neurobehavioural formulation that will be rolled-out across the Disabilities Trust. The aim is to see if providing a basic framework that gives an understanding of common presentations that challenge can help staff can recognise motivation in others and their own natural reactions, thereby enabling them to better manage stress.”

References

[1] Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41.

[2] Kerr, B., Bonnick, E. Aimulajiang, Y. & Rogish, M. et al. (2022) Using compassion focused therapy-based formulation to improve staff support; an interpretive phenomenological analysis. Manuscript submitted for publication. Department of Psychology. University of York