The intervention described above, although brief, showed how the core relational component of CAT translated into practice. This was done primarily through the use of the therapy map by the individual and the system. Walsh, (1996), talked about how developing a sequential diagrammatic reformulation in individual therapy can provide insight into organisational processes and enable a non-blaming approach to be taken. Being able to diagrammatically form a description of the context in which Sam’s disruptive behaviour occurred and the reactions it elicited in others, had a clear impact on the therapeutic process. The CAT framework showed how Sam’s disruptive behaviour was influenced by the school system and that both Sam and the teachers had a role to play through the enactment of an unhelpful reciprocal role and reciprocal role procedure. Sam was increasingly able to reflect on the unhelpful reciprocal role pattern being enacted and how different ways of relating could be explored. The teachers involved were also able to reflect on how different ways of relating could generate different responses and how the school (as a psychological organisation) could influence the psychology of the self (Walsh, 1996).

Feedback from the teachers involved was that they ‘liked this approach’. They found the ‘therapy map’ enabled them to more clearly understand the unhelpful reciprocal role procedure being experienced. Further, they were more able to see how Sam’s core reciprocal role procedure was being enacted at school and how the school system’s authoritative role was contributing. It also opened discussions around how Sam had internalised such reciprocal roles, enabling them to hold a less blaming and more compassionate stance when confronted with his disruptive behaviour. On reflection, it might have been therapeutically beneficial to have mapped with the teachers first their experience of Sam, which could have then been integrated into Sam’s map.

The therapist had been working at the school for several years and had built up good working relationships with the teaching staff and welfare team which enabled the contextual reformulation to be more readily received. A new professional to the school might further have exacerbated Sam’s unhelpful reciprocal roles by placing expectations on the teachers to engage with the contextual reformulation and try out new ways of relating, triggering resentment and frustration. Instead, it seems as if the positive outcomes of this piece of work came from ‘other to self ’. When the therapy was terminated prematurely, Sam had decided that he did not want to continue psychological work (which was dis- appointing for the therapist) but he did reflect that he found the work helpful, useful and non-blaming. The authors reflected that the piece of work had given Sam permission to leave school and not to have to continue with something that ‘he hated’. If Sam had stayed engaged in the therapy then the next step would have been to write a re-formulation letter and to help Sam increasingly recognise when he (unintentionally) invited others into a controlling pattern (self-to-other).

Working within the school system an implicit (or explicit) aim of psychological work is often to improve behaviour at school. With the intervention described here, the CAT process identified the target problem as being that Sam became anxious when he felt controlled. Whilst the focus of this intervention remained around the school, Sam’s Mum reported being more aware of how the ‘authoritarian’ role triggered his disruptive behaviour both at home and school, however there remained tension between what Sam wanted to do and what his parents were willing to agree to. Greater involvement of Sam’s parents in the contextual reformulation and how it related to home may have further enhanced their understanding of his disruptive behaviour, and facilitated different relational experiences at home. Whilst it was outside of the scope of this piece of work, it is recognised that caregiver participation is considered critical for young people with ‘disruptive behaviours’ who are considered to be at high risk of negative outcomes (Lee, 2012).

In using a contextual reformulation, it is necessary to consider whether helpful reciprocal roles have been established within and between the organisation, as this will facilitate the therapeutic process. In the case presented here whilst there were teachers who were actively willing to make changes to their relational style to work better with Sam, there were also teachers who were less willing to do this instead believing that the school needed to maintain a core ‘authoritarian’ position which should not be modified for individual students. Given that schools have to manage a large number of young people with varying needs and behaviours, it is an important point to consider and further research in this area could help explore what reciprocal role schools tend to take and whether an appropriate authoritative position is the ideal.

In this intervention, it was felt that CAT provided a way of communic- ating that suited the different individuals and organisations involved and reinforced its effectiveness as a case reformulation and consultation model. Given the interface between organisations and individuals (Falchi, 2007; Parry, n.d) there are benefits to using contextual reformulations to better understand challenging relationships within systems. In fact, Falchi (2007) argues that it is necessary to look at the organisation first and the psychology of the individual second. In the case presented here, the reciprocal role concept helped explain why teachers felt and responded differently towards Sam. This clinical example described here suggests that the power position of the teacher-to-student mirrors the parent-child role that is established in a child’s early life; a theoretical concept that is central to CAT (Ryle and Kerr, 2002).

Providing contextual reformulation that focuses on role relationships within an organisation has been found to be containing, educational and enabling of communication (Walsh, 1996). It was felt that these things were experienced in the case described here.

Given the high rates of oppositional and conduct disorders seen in children and adolescents, the recognised levels of stress caused by such problems and their unresponsiveness to treatment, developing theoretic- al approaches that will assist in their treatment is of great interest (Sawyer, et al., 2001; Victorian Government Melbourne, 2006; Zuddas, 2014). Multi- systemic theory talks about the need for treatment approaches to incorporate systemic level interventions and it is suggested that the relational nature of CAT, with its reformulation tools, can offer something unique to the treatment of disruptive behaviours. Indeed, the contextual reformulation can be used to assist the student and the school in their awareness of unhelpful relationship patterns (and the invitation to enact these) and thus explaining alternative ways of relating and responding to conflict that ensues. Such benefits have implications for enhancing school-based interventions that aim to reduce the impact of behavioural disorders within a school setting (Victorian Government Department of Health, 2006).

The application of CAT described here, although short, provides an indication of CAT’s potential when working with young people with disruptive behaviour within the context of the school system. More thought needs to be given to the role of CAT when working with disruptive behaviours within the school system and how this relational model can develop an understanding of unhelpful relationships that are often seen between students and teachers and which are often found in schools with high prevalence rates of behavioural disorders and high rates of suspensions and expulsions (Erford, et al., 2014). Given that there does not seem to have been much written about the use of CAT as an individual therapy model and as a contextual reformulation tool within this context, further psychotherapy research in this area would help establish its effectiveness and be of great benefit.