“You’re changing the pattern”: cognitive analytic team formulation with learning disabilities care staff

Abstract

Purpose This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach.