Introducing Cognitive Analytic Therapy - Anthony Ryle

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of life and the dominant values of current society, internalized in the individual, are seen as active determinants of psychological health or disorder. Recognizing this, we suggest that, as therapists, we should strive to avoid describing psychological disorders as simply “illnesses” and should also play our part in identifying and articulating whatever social action may be called for in response.

      The book is the result of the collaborative work of two authors who share responsibility for the text. Our contributions were different, in part because AR was the initiator of the CAT model and has a much longer history of writing about it. In so far as this conferred authority it also risked complacency which, he felt, needed to be challenged. IK brought a more recent experience of psychiatry and psychotherapy in the NHS, reflected in particular in the discussion of psychosis and of the “difficult” patient and contextual reformulation. He also wished to emphasize the importance of a full bio‐psycho‐social perspective. Our longest and most fruitful arguments were involved in writing the theoretical Chapters 3 and 4.

      Acknowledgments

      We should like to thank the many colleagues and patients who have contributed material to this book and who have been named in it. There are also innumerable others who have made important contributions to its production, directly and indirectly, both recently and over a period of many years. They are too many to name but we should like to express our gratitude to them collectively. Some of these contributions are referenced, although given editorial constraints we have been able, regretfully, only to cite books and peer‐reviewed publications, and material that was directly relevant to points being made in the book. We apologize to colleagues for omissions or oversights which will inevitably have occurred; however, our aim was not simply to undertake a comprehensive collation of all CAT‐related publications. This will be an important task for more specialist review literature and multi‐author books on CAT subsequently. We would like to acknowledge the support provided by the staff at John Wiley and, in particular, the early encouragement offered by Michael Coombs who commissioned the first edition, the subsequent support (and patience!) offered by Darren Read during the initial stages of this revision which he commissioned, and subsequently helpful assistance by freelance copy editor Caroline McPherson and, during the production stages, by Rahini Devi Radhakrishnan, under the strategic eye of Darren Lalonde overall. Finally, we should like to thank our partners Flora and Jane for making, in various and important ways, the writing of this book possible.

      The Structure of the Book

      Chapters 1 and 2 will give a brief account of the scope and focus of CAT and how it evolved and will spell out the main features of its practice. Most of CAT's relatively few technical terms will appear in these chapters; they and other general terms which may have a different meaning in CAT are listed in a glossary. In order to flesh out this introductory survey and give readers a sense of the unfolding structure of a time‐limited CAT, Chapter 2 also offers a brief account of a relatively straightforward therapy. Chapters 3 and 4 consider the normal and abnormal development of the self and introduce the Vygotskian and Bakhtinian concepts which are part of the basic theory of individual development and change. Subsequent chapters describe selection and assessment (Chapter 5); reformulation (Chapter 6); the course of therapy (Chapter 7); the “ideal model” of therapist interventions and its relation to the supervision of therapists (Chapter 8); applications of CAT in various patient groups and settings (Chapter 9) and in treating personality‐type disorders (Chapter 10); and the concept of the “difficult” patient and approaches to this problem, including the use of “contextual reformulation” and use in “reflective practice” (Chapter 11). Each chapter commences with a brief summary of its contents and includes suggestions for further reading and references to CAT published work, and to the work of others. In addition, Appendix 1 contains the CAT Psychotherapy File, Appendix 2 the summary of CAT competences extracted from Roth and Pilling (2013), Appendix 3 contains the Personality Structure Questionnaire, and Appendix 4 a description of repertory grid basics and their use in CAT.

      Case material derived from audio‐taped sessions is used with the permission of both patients and therapists; we gratefully acknowledge their help. Other illustrative material is either drawn from composite sources or disguised in ways preventing recognition. We have, on the whole, referred to patients rather than clients, although in this book we use the term interchangeably.

      Further information about CAT and about the Association for Cognitive Analytic Therapy (ACAT) in the UK may be obtained from the website www.acat.me.uk in the UK, from local associations in other countries, and/or through www.internationalcat.org.

      1

      The Scope and Focus of CAT

      Summary

      CAT evolved as an integration of cognitive, psychoanalytic, and, more recently, Vygotskian and Bakhtinian ideas. It is characterized by a predominantly relational understanding of the origins of patient problems and symptoms and an explicitly empathic, pro‐active, and compassionate therapeutic stance, with an active focus on issues arising within the therapeutic relationship. From the beginning it has emphasized genuine therapist–patient collaboration in creating and using descriptive reformulations of presenting problems. As such it offers a respectful, whole‐person, “transdiagnostic” approach that represents a challenge to many prevalent “diagnosis”‐led services. The model arose from a continuing commitment to research into effective therapies and therapy integration, and from a concern with offering appropriate, time‐limited treatment in the public sector. Originally developed as a model of individual therapy, CAT now offers a general theory of development and psychotherapy with applicability to a wide range of conditions in many different settings and in various “contextual” and systemic approaches.

      In order to locate cognitive analytic therapy (CAT) in the still expanding array of approaches to psychotherapy and counseling and to indicate the continuing developments in its theory and practice, its main features will be briefly summarized in this introductory chapter.

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