CBT for culture change: formulating teams to improve patient care.

Background: Increasingly, clinical psychologists and CBT trained clinicians work with and within teams. The cognitive model enables us to formulate the processes maintaining distress, and work with people to effect change. The model tends to be used to understand individuals' difficulties, but may be effective in making sense of problems within teams.

Aims: This study aimed to (i) explore the value of the cognitive model in formulating key staff-service user relationships; and (ii) determine whether such an approach would yield useful team based interventions.

Method: The cognitive interpersonal model was used to develop an idiosyncratic conceptualization of key staff-service user interactions in an in-patient setting. This then informed management team planning aimed at improving provision for service users, and staff experience. Additionally, frequency of challenging behaviours and levels of staff burnout were assessed before and after service changes, as preliminary outcome data.

Results: The team formulation was effective in (i) making sense of interactions contributing to the maintenance of service users' challenging behaviours and staff burnout, and (ii) deriving systemic interventions likely to effect change. This was then used to guide service development planning. In support of a CBT approach to understanding and intervening with teams, preliminary data indicate that staff burnout and incidents of challenging behaviours reduced over time.

Conclusion: The cognitive interpersonal model can be used to formulate relationships within teams and guide systemic change. This is likely to have a beneficial impact for both service users and staff.