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Reflections on the Publication of "Introduction to CAT theory and practice"

Kerr, I., 2002. Reflections on the Publication of "Introduction to CAT theory and practice". Reformulation, Spring, pp.7-8.

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Having rather rashly agreed to the suggestion of the indefatigable new editor of the newsletter (Mog Johnstone) to contribute a short piece on the occasion of the publication of the latest CAT book, I inevitably found myself wondering why I had – apart from the opportunity to advertise it! - and what, from the point of view of a co-author rather than a reviewer, there was to say about it.

It has in the end, however, seemed a useful and thought- provoking exercise, which may be of some interest to others, to reflect on what is new or different about the book and why we thought it worth writing. As this readership will be well aware, CAT in its present form is beginning to have been around for quite a while - a while in this case being almost two decades. It is just over a decade since the first book bearing the name of a new integrative model of therapy appeared. Despite having sold and continued to sell until recently a good many copies (to the delight of the publishers needless to say) it is clear that CAT has moved on considerably in the intervening years, both in terms of its theoretical base and its range of applications. This is evident from the specialist volumes and many papers which have appeared meantime. These have been due, increasingly, to the efforts of a range of dedicated and enterprising CAT practitioners who are, literally, too numerous to name, in addition to the continuing team of work from Tony Ryle himself. CAT is no longer the ‘one-man band’ it necessarily was in the very early days of the development of the model.

This diversification, growth and continuing dialogue with developments in other disciplines is of course important and is a process without end. Many of these more recent developments (for example in infant observation research, activity theory or the neurobiology of early experience) are mentioned in the new volume. Given this diversification and the special expertise of some CAT therapists in particular fields of mental health (e.g. forensic, old age, eating disorders and so forth) of which neither Tony Ryle nor myself has extensive or special knowledge, it might be questioned whether it is by now still possible for single or dual author ‘overview’ type texts on CAT to be possible or meaningful. A multi-author handbook addressing these diverse theoretical and clinical developments will certainly be needed before very long in addition to specialised volumes such as those recently focussing on child sexual abuse (edited by Phillip Pollock), earlier by Tony Ryle himself on borderline disorders or the forthcoming volume on old age (edited by Laura Sutton).

However, it seemed to us that a re-statement of the mature CAT model in its historical and its own developmental context describing the advances which have been made over the past decade could usefully be made in an ‘overview’ type volume. (Although as Michael Coombs, who was our very helpful commissioning editor at Wiley’s, gently teased us, ‘overviews’ are what get written in places like the civil service and do not on the whole serve as catchy titles for psychotherapy books!). In part this reflects the fact that the CAT model has also become a sophisticated general theory of development and psychological disorder and is not simply an approach to therapy. Thus, we hoped that the proposed volume might serve as a useful, comprehensive but accessible introduction to this general model and its applications. This, it appeared, would be welcomed not only by CAT practitioners and trainees but also an increasing number of interested colleagues in various spheres who, whilst not necessarily wishing to train in CAT, were interested to learn more of the model and take such an understanding into their own practice.

Perhaps the most important continuing development in the CAT model of development in recent years has been the firmer and clearer emphasis on the social and dialogic nature of the self as the basis and underpinning of any understanding of human distress or dysfunction and its treatment. This has gone hand in hand with the continuing clinical evaluation of the model. This in no way, I think, reneges on the importance of detailed, ‘cognitive’ type descriptions of neurotic procedures and their consequences but rather places them, properly, in the context of the deeper structures (our repertoire of RRPs) of the socially formed self. This implicitly stresses a therapeutic focus on whole persons rather than on dysfunctional parts of them or on diagnostic labels. In my view, this has been become one of the defining and distinguishing features of the CAT model in contrast to many others which, whilst acknowledging the importance of interpersonal issues in development, tend still to see the individual in an essentially Cartesian or ‘monadic’ way. This emphasis, if accepted, - and it is a difficult shift for some, - radically alters our understanding of the therapeutic enterprise and its focus even if more traditional (even behavioural!) techniques are still used. Thus symptoms, syndromes or difficulties are always understood to be embedded in and expressions of a disordered, social self and its constituent repertoire of RRPs. This point is well illustrated by many of the case studies in the book contributed by various therapists.

Apart from basic theory and practice the book reviews briefly the contexts and applications of individual CAT therapy, and, increasingly, CAT-informed treatment approaches. Whilst these various fields of activity require and doubtlessly will receive more detailed presentation down the line we hope that this overview may give a useful indication of what is going on in CAT, whet the appetite and encourage more exploration in these and other fields.

Helping to write this book has also highlighted for me those many areas, both theoretical and practical, where much more work needs to be done. For example, the role of culture in the formation of the self and how CAT conceptualises and works with this and how in turn culture impacts on this work. The nature-nurture debate continues to simmer with interesting questions; for example those implied about the extent to which ‘pre-programmed psychological tendencies’, however conceived, shape and inform the development of our repertoire of RRPs. More work is needed on the implications of CAT theory for the study of group dynamics. Many clinical areas are ripe for further exploration: chronic psychosis, chronic fatigue syndrome, learning difficulties, maternal mental health and childhood problems all spring to mind. There will be many others, some not yet obvious. All these represent research and /or clinical studies for future generations of trainees and practitioners.

On a personal note, doing this book has of course afforded a unique insight into Tony Ryle’s highly original and sophisticated internal and external dialogue and into the sometimes rather combative style of thinking and creating which is his trademark. It seemed that out of our own dialogue have also come, in a rather interesting Vygotskian way, some further thoughts and insights, which may be evident in the book. In contemplating the writing of this volume Dr Ryle had wished for some ‘interlocutor’ and challenger (we all seek and need response to our utterance) from ‘another’ who has trained more recently in psychotherapy and psychiatry and is still working in the NHS. He may have had occasion to regret this at times when drafts were late or they disagreed in emphasis or substance with some of his own views! Writing is always an education in itself and has certainly caused me some serious thinking and advanced my ‘take’ on the model in its still evolving state.

Not least this book has afforded an occasion for Tony Ryle himself, well into his so-called retirement, to address the origins and evolution of the model and to add his own continuing thoughts and understandings. These are of course of considerable interest to us all and they are many, given that he has never sat back but has always endeavoured to draw on advances in neighboring theoretical and clinical disciplines and learn from CAT’s own clinical applications. Thus the volume also offers a further insight into Tony Ryle’s undiminished passionate odyssey to develop a socially relevant and effective means of helping ordinary people to extend the choice they have in living and to alleviate their distress or oppression in a broader, social sense.

Finally, I was powerfully reminded in detail in the co-writing of this book, just what a significant and monumental achievement the CAT model has been. I was also reminded what a labour of love the development of the model must have been over the years in the face, certainly in the early days, of, at best, disinterest and, at worst, disdain from the psychotherapy establishment of the time. This has changed very considerably with many interested parties and organisations now beating a path to the door of ACAT, but I suspect this struggle is what still makes it hard for Tony Ryle to quite appreciate the extent to which CAT is becoming mainstream and paradoxically ‘establishment’, apparently in tune with the ‘Zeitgeist’ and appealing to the needs and interests of a new generation of trainees, mental health professionals and above all, clients and patients. These factors alone make me confident that this volume will have a general and interested response, one which will I hope extend beyond the immediate confines of the CAT training world. Buy it and see if you agree – we all look forward to further dialogue!

Ian Kerr

Ryle, A & Kerr, I.B. (2002)

Introducing Cognitive Analytic Therapy: Principles and Practice

John Wiley & Sons.

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Kerr, I., 2002. Reflections on the Publication of "Introduction to CAT theory and practice". Reformulation, Spring, pp.7-8.

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