Personal therapy as part of CAT training

Coumont, V., Parry, G. and Evans, M., 2001. Personal therapy as part of CAT training. Reformulation, ACAT News Autumn, p.x.

This policy was developed at a meeting between Val Coumont, Glenys Parry and Mark Evans 21/10/00, notes prepared by Val Coumont, discussion at the ACAT North Trainers Group 6/7/01 and the Course review group 7/9/01.

How different is therapy as part of training from any other CAT?

There may be issues unique to training therapy, for example, specific attention to the boundaries, and the possibility of seeing one’s therapist in a professional context. But an overstated concept of a ‘training’ therapy as a different thing to an ordinary therapy could be a pernicious fiction, colluding with our wish as a trainee CAT therapist to disown the wounded, ill, damaged or unassimilated parts of oneself. Sometimes one of the issues in becoming a therapist is projecting the damaged parts of ourselves into our clients, so we can feel ‘I don’t have any significant psychopathology’. Owning one’s core pain, understanding one’s reciprocal role procedures and procedural enactments, and tackling them honestly and fully as a ‘patient’, with no restrictions, seems important. Lorna Benjamin speaks of the ‘heart of darkness’ of therapy, how ‘every psychopathology is a gift of love’, implying that we do not wish to relinquish the core pain that is part of oneself and one’s earliest attachments. Ironically this may be a particularly difficult issue for professional therapists who feel they have to be mentally healthier and more ‘together’ than their clients.

Issues for the CAT trainee

We wish to produce a leaflet for the start of the course "You and your training therapy", to state some key principles, e.g.

What is the purpose of therapy during training?

There are three main reasons to undertake a cognitive analytic therapy before qualifying as a CAT practitioner. First, it allows the trainee to formulate, recognise and revise his or her own repertoire of reciprocal roles, problematic procedures and reciprocal role enactments. This is an important way to improve one’s ability, as a therapist, to understand what is happening between oneself and one’s client.

The second good reason is that undertaking training itself, although enjoyable and challenging, is frequently experienced as stressful. Therapy gives an opportunity to explore personal issues raised by work with CAT clients that are inappropriate to discuss in supervision.

The final reason is the importance of having the experience of being in the client’s chair, the experience of being a patient. In general, one can have more empathy with and compassion for clients by having been through the painful or difficult parts of the experience oneself, and can have more confidence in the power of the method to create change, if one has benefited oneself.

What is unique about training therapy?

Nothing really, the aim is to have a personal therapy that is as authentic and ordinary as possible. Personal issues raised by one’s work as a CAT trainee therapist can be explored, as can anything or everything else.

Is my personal therapy evaluated as part of the course?

No, definitely not. The course requirement is simply to complete a personal CAT, and this is the only fact ascertained by the course team. Your personal therapy operates in the same conditions of client confidentiality as any other CAT. Your therapist is responsible for providing you with a private and safe environment. The therapist will not communicate any details of therapy to others, including the ACAT trainer team. All that is required is a) that the training therapist is a qualified CAT practitioner and b) that the therapist signs a ‘completion of therapy’ form to confirm that a CAT has been undertaken.

The only circumstances that could justify moderating this absolute duty of confidentiality would be if the training therapist believed a trainee client was at risk of harming his or her patients. These exceptionally rare circumstances would be discussed in detail with the trainee client.

How do I find a training therapist?

ACAT provides a list of therapists willing to offer CAT to trainees. It is up to you to contact therapists and make a decision on which one you wish to see. It is perfectly OK to arrange more than one consultation before making a decision. It is important to choose someone you feel able to work with, who you are unlikely to encounter in any other context. This may require you to travel. It is not unusual to see a therapist up to an hour’s journey from your base. You can start your therapy at any time during the course, but you cannot complete course requirements until the therapy is completed.

Issues for the CAT training therapist

There are a number of issues for the CAT therapist undertaking a training therapy for the first time.

Where trainee is senior in age, status, academic qualifications or experience, therapist could get drawn into admiring-admired reciprocal role enactment, or a malign contemptuous-contemptible enactment, feeling the client knows more about therapy and is looking scornfully upon one’s efforts. This can include intellectualisation and using the tools narcissistically, or an invitation to collude with the idea ‘I don’t need this, I’m only doing it as a training requirement’.

Another challenge may be the borderline trainee who may have problems with drugs, alcohol, self-harm or promiscuity. The training therapist may feel over-responsible, needing to remember that he or she is not required to make any kind of report to the trainers. Honesty with the trainee is required about the need for ongoing therapy or if the training therapist feels he or she should not carry on.

It can be hard to handle the trainee client inviting collusive professional ‘chat’ about a third person, or where there is shared ‘knowledge’ of a third party colleague.. A particularly difficult case is when a trainee takes an intense dislike to a colleague, especially difficult if the training therapist happens to share this dislike. The therapist has to refrain from any collusion and work on what the colleague ‘represents’ to the client.

It can feel like dilemma when the trainee suffers a major loss or other trauma at the start of therapy, e.g. losing a parent, partner, miscarriage or being in a serious accident. There is no point in emphasising TPPs when one’s client is overwhelmed by grief.

It feels more risky when you use the negative counter-transference. For example, those trainee clients who leave one feeling de-skilled and confused, unable to reformulate.

Issues that are triggered during training are often raised in therapy.

Some courses/supervisors make a recommendation ‘you should deal with this in your therapy’ – someone else directing what should be a personal exploration

If trainee clients never mention their therapist role, is there a need to address something being avoided?

Using the tools and modelling them, without rigidity, can feel exposing. There is an internalised requirement to do CAT ‘by the book’ in a training therapy.

For the training therapist, there is at times an ethical question, ‘when do we have a duty of care not to let someone qualify who could do damage to patients? The usual answer, to share it with the trainee client, may not always work. Trainees though have many fears about the possibility of feedback from the therapist to the trainer team. There should be a conversation at the outset about the terms of reference of the therapy, and some clarification of this at the start of the course.

Having listed the challenges, there are many pleasures of being a training therapist.

The opportunity to work with someone who is likely to be reflective and insightful, and who believes in the model.

Having a shared language for feelings

In many cases, the trainee’s capacity to be self-aware with a sense of humour

The opportunity at times to do longer-term CAT-based work in part II of training

Frequently, the trainee has a number of well-functioning areas in their life and a reasonable support system, by contrast with some of the highly damaged and deprived NHS patients. This gives a certain exploratory freedom to the therapy.

The satisfaction of watching the trainee mature and develop into a CAT therapist.

Val Coumont

Glenys Parry

Mark Evans

Full Reference

Coumont, V., Parry, G. and Evans, M., 2001. Personal therapy as part of CAT training. Reformulation, ACAT News Autumn, p.x.

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