Working together towards overcoming transgenerational trauma – Using cognitive analytic therapy with child-caregiver dyads

Abstract

Children, young people, and families who seek support from community CAMHS have experienced a disproportional number of childhood adverse experiences. Many families continue to endure uncertainty and adversity due to global events and political context (e.g. racism, poverty, and gender-based violence). Building trust within this context requires therapists to work in trauma-informed ways that focus on establishing effective therapeutic relationships. Cognitive analytic therapy (CAT) is an approach that mainly focuses on relationship patterns to help people overcome psychological distress and develop positive ways of relating that encourage emotional wellbeing. Whilst offering therapy within a child and adolescent mental health service, I have extended the use of CAT to focus on both the young person’s relationships and the relationship between caregiver-child; also referred to as a child-caregiver ‘dyad’. Theoretically, working dyadically offers advantages over individual therapy including providing opportunities to influence and overcome transgenerational patterns that may not be possible within individual sessions with young people. I have termed this way of working ‘Dyadic CAT’ and propose that there are several adaptations to individual CAT that therapists may consider when offering a dyadic intervention including: (a) identifying what to work on within therapy, (b) exploring ways of factoring in power imbalances, and (c) balancing the needs of three learners to promote discovery within therapy. CAT with dyads may also benefit from an additional phase focused on creating a ‘safe base’ prior to the reformulation phase. Early outcomes and anecdotal evidence indicate that CAT can be a successful intervention for caregiver-child dyads in promoting change and healing from transgenerational trauma. Further practice-based research is needed to develop the structure and practice of Dyadic CAT including the integration of other relational theories.