Change to the recognition and revision of target problems and target problem procedures during eight‐session cognitive analytic therapy for self‐harm

OBJECTIVES: Defining target problems (TPs) and associated target problem procedures (TPPs) is a key competency of cognitive analytic therapy (CAT). This study sought to categorize types of TPPs identified, assess the acceptability of TP/TPP sessional tracking, assess whether changes in TP/TPP recognition and revision occurred and also whether change in TP/TPPs predicted severity of self-injury urges and psychological distress. METHODS: As part of the RELATE clinical trial, N = 31 participants were allocated to eight-session CAT. TPs/TPPs were rated for recognition and revision at every session in a nested ABC plus follow-up single case design. The competency of therapists was assessed. TPPs were coded as to whether they were a snag, trap of a dilemma. Linear mixed-effects models tested whether TP/TPPs changed over time and according to phase of CAT. Change in TPs/TPPs were used to predict self-injury urges and psychological distress (i.e., research follow-up measures taken by blinded researchers). RESULTS: There was strong interrater agreement on whether the TPP was a snag, trap or dilemma. The sessional rating of TPs/TPPs appeared acceptable, as during 97.68% of treatment sessions and 82.60% of follow-up sessions, tracking occurred. Compared to the reformulation phase, awareness and then therapeutic change of TPs/TPPs significantly increased during the recognition and revision phases. Recognition and revision of TPs/TPPs during CAT in the revision phase did not predict self-injury urges and psychological distress at research follow-up. CONCLUSION: Early definition and sessional tracking of TPs/TPPs appear acceptable and changes to awareness and ability to change TPs/TPPs appears linear. CAT therapists should routinely integrate sessional tracking of TP/TPPs into their work.