Community Mental Health Journal

, Volume 49, Issue 6, pp 722–727 | Cite as

Working With the ‘Difficult’ Patient: The Use of a Contextual Cognitive-Analytic Therapy Based Training in Improving Team Function in a Routine Psychiatry Service Setting

  • Rosangela Caruso
  • Bruno Biancosino
  • Cristiana Borghi
  • Luciana Marmai
  • Ian B. Kerr
  • Luigi Grassi
Original Paper


The clinical management of ‘difficult’ patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with ‘difficult’ patients reduced professional burnout symptoms, improved patients’ service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ) before (T0) and after (T1) CAT training, and at 1-month follow-up (T2). A significant decrease were found, at T2, on the MBI Emotional Exhaustion scores, the SES Availability subscale, the GEQ Attraction to Group-Social and Group Integration-Social, while the MBI-Personal Accomplishment scores increased from baseline.The results of this study suggest that a CAT-based training can facilitate team cohesion and patient engagement with a service and reduce burnout levels among mental health team members dealing with ‘difficult’ patients.


Cognitive-analytic therapy ‘Difficult’ patient Borderline personality disorder Multidisciplinary team training Psychiatric service Psychotherapy 


Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rosangela Caruso
    • 1
    • 2
  • Bruno Biancosino
    • 1
    • 2
  • Cristiana Borghi
    • 1
    • 2
  • Luciana Marmai
    • 1
    • 2
  • Ian B. Kerr
    • 3
  • Luigi Grassi
    • 1
    • 2
  1. 1.Section of Psychiatry, Department of Biomedical and Specialty Surgical SciencesUniversity of FerraraFerraraItaly
  2. 2.Integrated Department of Mental Health and Drug AbuseNHS-Local Health AgencyFerraraItaly
  3. 3.Department of PsychotherapyCoathill Hospital, CoatbridgeCoatbridgeScotland

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