CATT is a specialist trauma therapy that has been developed from the ground up in consultation with young people, and it has a high success rate in supporting children and adolescents to overcome PTSD and complex PTSD.
But what does it look like in practice?
CATT: An Overview
CATT, or Children’s Accelerated Trauma Technique, was initially designed by Dr Carolotta Raby in 1997 to help young people in inner-city London that had been excluded from mainstream services due to emotional and behavioural difficulties. You can read more about the creation of CATT here.
Since then, the CATT model, which is a 12-stage protocol that allows each stage to be adapted to the individual, has been used across the UK and internationally to help young people work through PTSD and complex PTSD.
CATT integrates CBT theory with play, arts and creative methods to provide children and adolescents from age 4 upwards – a truly child-centred and safe means of communicating and expressing themselves. Even in adolescence, young people commonly use arts to express themselves, and engaging with young clients in this way enables them to process PTSD and complex trauma memories efficiently.
Other ‘adult’ trauma therapies, such as EMDR and Narrative Therapy, have not been designed specifically for children; they have merely been adapted. This means that in some cases, the therapy may not be as child-centred as it could be.
Offering an accessible therapy in a timely manner reduces the likelihood of additional and entrenched mental health and behavioural issues later down the line, and that’s what the CATT model offers.
Treating complex trauma and PTSD in children promptly with CATT, an evidence–based trauma-focused therapy that helps young people overcome PTSD & complex PTSD, can have a huge impact on their recovery and their ability to live a healthy life into adulthood.
Principles Of Treatment
CATT follows the principles of care set out by The National Institute for Health and Care Excellence (NICE). Alignment with these NICE guidance recommendations underpins the success of the CATT model.
They include;
Number Of Sessions
Trauma-focused individual CBT-based interventions should be based on a validated manual, and each young client should be provided with between 6 – 12 sessions. Further sessions can be added if there is an ongoing need.
Adaptability
Each young client is different, and the 12-stage protocol of CATT enables mental health professionals to adapt their sessions to suit the relevant age or developmental stage of the child, meeting them where they’re at.
Professional Delivery
Only licensed mental health professionals are able to train in CATT, by attending an in-depth interactive training course in the model and its clinical application delivered by our expert Trauma Psychology Training trainers
Parent And Caregiver Involvement
As appropriate, the important adults in the young people’s lives are involved in the therapy process. Improving the level of connection for everyone involved is beneficial.
Trauma Memory And Emotion Processing
During their CATT treatment, children and adolescents will be supported to use arts materials to communicate their trauma, rescript their trauma narrative, and process trauma-related feelings like guilt, shame and anger – all whilst being supported to remain emotionally regulated.
Management Strategies
Mental health professionals using CATT to overcome PTSD and complex trauma equip their clients with emotion regulation strategies for managing periods of heightened emotional arousal and flashbacks.
End Of Treatment Preparation
Children and young people attending CATT sessions will be gently prepared for the upcoming end of their treatment, smoothing the change and giving them the confidence they need to practise what they’ve learnt going forwards. Mental health practitioners using CATT allow for future sessions, particularly in relation to significant dates or events.
What CATT Looks Like In Practice
As a mental health professional, you’re probably wondering what CATT looks like in practice? How does it work? What do the sessions look like?
When a child or adolescent is due to begin their CATT sessions, the first step is to meet with both the parent or caregiver and the young person together to gain an understanding of the nature of their PTSD or complex trauma.
Further to the conversations had as a group, time is then spent with the parent or caregiver and the young person alone. The individuals may have different perceptions of events that have occurred.
Throughout the CATT protocol, practitioners are working towards a child feeling safe and regulated; as they succeed at building a connection with the young person, this engages the child further, and the combination of this safe relationship and various stages of psychoeducation and trauma memory processing facilitates reconnection and recovery for them.
A 12-Stage Holistic Model
CATT works best in person, rather than remotely via video call, as this allows you to really connect with the child and allows the child to feel comfortable.
CATT is a 12-stage holistic model, beginning with ensuring the setting is comfortable for the child, assessing trauma symptoms and ending with a return to needs assessment and review. Some children and adolescents with complex PTSD will require further sessions, and these can be offered because the CATT protocol is an adaptable process designed to meet the individual needs of its young clients.
Before reaching the trauma memory processing stage of the model, practitioners explain and discuss what PTSD is, the brain neurobiology of trauma, and the difficulties it presents for them with their young client in an age-appropriate way. This is a crucial part of the model because it helps the child become motivated to do the trauma memory work and establish goals for treatment. It also allows the practitioner to determine if there are additional basic or emotional needs that require a meeting before undertaking memory work with the young person.
Creative Storytelling Using Arts
During the first stage of the trauma memory sessions of CATT, practitioners use creative arts methods as a very practical way for the young person to express and detail their trauma experiences and related emotions, such as shame, guilt, loss and anger. Children are encouraged to turn their trauma memories into a story depicted through arts objects and toys.
Re-Scripting The Narrative
The second stage of the trauma memory work helps the child re-script their narrative. This stage is designed to also lift the emotional tone away from the intensity of the negative trauma-related emotions expressed in the first stage towards increased hopefulness.
Rehearsal
Rehearsal sessions are the next step of the CATT model. Most individuals experiencing PTSD or complex trauma will have begun to avoid people, places, or anything that triggers their traumatic memories. Now with a reduced or eliminated trauma response, the child should be able to better judge the perceived threat in these situations as they are discussed and re-engage in everything they have been avoiding. In cases of C-PTSD, the child is also supported with making new connections.
Evidence Gathering
The penultimate step of the CATT protocol is evidence gathering. Reports from the child or adolescent themselves, as well as communications with parents, carers and school teachers, can all be reviewed as evidence that the child has overcome PTSD.
CATT is suitable for all young people, except those with a high risk of suicide or self-harm as trauma therapies are not advised in cases of high risk.
Session and treatment lengths might look quite different for PTSD to complex trauma because every individual’s trauma experience is vastly different, and CATT is designed to be highly flexible to suit the needs of the child or adolescent in overcoming their trauma.
Ending CATT sessions with a young person is carefully planned and paced well to ensure a smooth transition away from the support of therapy. Check-in sessions can be offered for times when life might begin to feel more difficult for the young person again, such as anniversaries of deaths and other significant dates.
CATT Is The Only Child-Centred Trauma Therapy In Your Toolkit
Children’s Accelerated Trauma Therapy considers all aspects of the Principles of Care set out by NICE guidelines and has a proven history of success.
Many professionals adopt the model and its methods immediately after successfully completing the course to provide more holistic and comprehensive support and interventions for their trauma clients.
For further details about CATT training with Trauma Psychology Training, see our website.
