Under the Transforming Care initiative within the UK, there has been a significant shift towards helping people with learning disabilities (LD) to live within the community; in ‘homes not hospitals’ (Houlden, 2015). This move towards supporting people to return home from hospital units, arose from significant human rights abuses perpetrated by those within ‘caring’ roles (e.g. Winterbourne view; see Flynn, & Citarella, 2013). In order to meet the care and support needs of people with LD in the community and reduce the risk of any further admissions, care-worker input is often provided to facilitate daily living. Where additional mental health needs are also present, this is often supported through the provision of ‘in-reach’ from community health teams – whereby specialist services advise, consult and supervise care-worker input.

For staff and professionals fulfilling these roles within LD services, the perceptions that they hold of their client can significantly impact upon the client’s experience of services and the quality of their care provision (Russell, 2019). Indeed, people with LD have talked of staff seeing them as ‘a different person’ once they transitioned back to living at home within their community, rather than being seen as a ‘bad’ person in hospital (Head, Ellis Caird, Rhodes, & Parkinson, 2018). Having returned home, it was important for these people ‘feel safe’ and ‘happy’ in their homes and they viewed staff as having a key role in helping them to feel this way (ibid.). From this, it can be seen that the foundation to effective community health care is to ensure staff are sufficiently trained and supervised to understand and dynamically manage relational and behavioural difficulties in-line with evidence based clinical models. Within these contexts, psychological consultation has been suggested to benefit staff and clients, through facilitating a consistent team approach across the network (Kerr, Dent-Brown & Parry, 2007).

However, evidence suggests frontline staff working with this client group often feel under-supported and ill-equipped in working with the interplay of psychological, social and physical needs they are presented with (Bromley & Emerson, 1995; Hastings, 1995). Staff burnout and reduced team morale have been found to be influenced by staff feeling unskilled and unsupported in working with such complexity, in addition to the impact of the work itself (Robertson et al., 2005; Mills & Rose, 2011). In the face of these challenging environments, Varela and Franks (2019) suggest staff often experience threat-based responses, that eventually become cemented into practice; especially where low levels of support are available. Within these circumstances, staff are likely to fall out of dialogue with clients, as the reciprocal process of commun- ication, and therefore any attempt to understand the client becomes lost (Varela & Franks, 2019).

To provide staff teams with the tools to develop their understanding of clients and provide a coherent team approach, there has been an increasing interest in psychologically informed working with staff groups; such as team formulation and consultation. Team formulation involves a process of collaborative sense-making underpinned by psychological theory, to inform the understanding and approach of staff groups working with a client (Johnstone & Dallos, 2014). The Division of Clinical Psychology (DCP, 2011) propose numerous potential benefits to team formulation, including facilitating consistent interventions, encouraging collaborative working, gathering key information succinctly, generating new ways of thinking, processing staff counter-transference, and increasing staff reflectiveness and empathy. Research suggests whilst the range of models used to provide a framework for team formulation is diverse, CAT is one of the most frequently adopted models; second to the use of cognitive behavioural therapy (Ghag, Kellett & Ackroyd, 2019).

CAT is considered a fundamentally relational model for understanding individuals’ experiences, through recognising how internalised relational experiences, termed ‘reciprocal roles’, come to influence how we engage with the world, other people and with ourselves (Ryle & Kerr, 2020). Although CAT was originally designed as time-limited individual therapy, the application of CAT with teams has become increasingly recognised; for example, the ‘Map and Talk’ approach (Potter, 2010). The use of CAT with services has been suggested to enable staff to express and make sense of their reactions to the client, sustain empathy, and maintain a therapeutic approach (Carradice, 2017). Thus, it can be seen that CAT appears to offer a potentially suitable model for working relationally with staff within LD services.