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A Personal View of ACAT

Potter, S., 1999. A Personal View of ACAT. Reformulation, ACAT News Winter, p.x.

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In the months before becoming Chair, I spent a good few hours putting the ACAT Members Handbook together. As I cut and pasted bits of text I read and re-read the contributions on the history and development of ACAT. What shone through was the warmth, energy and quality of thinking that founding members put into developing CAT and ACAT. As the first Chair of ACAT who is not a founder member and who indeed belongs to a second generation of CAT practitioners I can freely say that they can look back on some substantial achievements. Very quickly and unassumingly they have created in ACAT something that will endure.

Our organisation has a high ratio of member involvement which for a new chair is most reassuring. It is as if we know that CAT is not a model of therapy whose organisational support can ever be split between charismatic or stoic leadership and passive armchair followers. Collaboration extends to our work as colleagues as well as therapists.

After seven years ACAT exists solidly, nationally and professionally as the home of standard setting and innovation in the practice of CAT. The various practitioner training courses attract a rich mix of people from different core professional backgrounds within the public sector. Whilst celebrating these achievements what lies ahead? How should we channel our resources and energies?

In offering a personal view I am not committing myself to how this might translate into the ongoing work of the various ACAT committees where a lively democracy prevails but I do see a common theme of sustaining the unique CAT integration of theory and practice whilst engaging with a wider diversity of membership, ideas and applications.

Balancing integration with diversity

ACAT is remarkable among psychotherapy organisations because it is promoting and regulating a model of psychotherapy which successfully integrates diverse and seemingly opposed approaches to psychotherapy. The parallel between psychotherapy and the world of race and intercultural awareness comes to mind. Years ago doing anti-racist youth work with a sorry bunch of dispossessed skin heads and punks in the city centre of Manchester I was roundly accused by them of being one of those 'effing' integrators who want us all to be the bloody same. My answer then though more crudely put, holds true now in psychotherapy: diversity and difference can only be valued within a higher order model of integration. CAT is definitely at the cosmopolitan end of the psychotherapy continuum which has parochialism, prejudice and insularity at the other end. We must stay cosmopolitan and open without CAT becoming used as a bland formula for psychological help. Integration whilst retaining and respecting difference and diversity is not easy. We can argue that both the cognitive and analytic components are enhanced by the CAT integration. We have found that the clarity of CAT as an integrated theory makes it easier to combine the craft of therapeutic techniques with the humanism of a capacity to be in a deeply felt therapeutic relationship. Each of us has our own unique journey of integration in becoming a CAT practitioner or therapist and we don't know enough about this diversity.

Diversity of members

One of ACAT's tasks is to recruit a diversity of talented and capable new members. Whilst ACAT is firmly established and actively playing its part as a member organisation within the United Kingdom Council for Psychotherapy, it should n't lose sight of the complementary task of offering CAT as a scaffolding for enhanced psychological competence within existing professional roles such as those of psychiatrists, psychologists, GP's, nurses, social workers, mental health workers and counsellors. Many such people will not want or need psychotherapy accreditation. Increasing numbers may be accredited as psychotherapist in other organisations. Perhaps we have not fully appreciated the value of the practitioner training as -what might aptly be called -a conversion course to an integrative model of psychological therapy for those already well versed in another approach to psychotherapy or mental health speciality. In ACAT there is not a hierarchy of membership. People get involved and do different levels of training with different professional and personal journeys behind them. Procedures for accreditation and for monitoring standards and ethics are well established but lines of authority should criss-cross the organisation and go where ever the initiative is for this or that application of or innovation in CAT.

My first introduction to CAT was being encouraged by a psychoanalytic supervisor to write a goodbye letter as an exercise in focusing the therapeutic work I was doing. The idea intrigued me. How simple an idea and yet what rich complexity lay beyond in terms of impact upon the therapeutic relationship. There must be thousands who are intrigued by CAT and dip a toe in or read one of Tony Ryle's books but then take it no further. We need to know more about what stops them getting more involved with ACAT? We need to grapple with the difference between doing CAT and using CAT. Doing CAT most typically as the standard sixteen session time limited psychotherapy is at the heart of the CAT training courses. But what is required for using CAT? Can people in other therapies use CAT to inform or aid their own model of practice? What do we say to people who say they sometimes use CAT or that their work is influenced by CAT? Can CAT be used with only an introductory grasp of its principles and methodology? Or do you need to be versed in doing CAT before you can use it more loosely?

Sometimes we need to be protective of what we do. Recently, through people alerting ACAT Council we have come across one or two cases where therapists with no prior training and minimal supervision are claiming to be CAT therapists. Our view is to write to such people let them know of our ethical concerns about their practice and speaking positively of the professional benefits of joining ACAT and applying to our practitioner and psychotherapy training. On balance I think in most cases it is better to have people who are doing or using CAT to be within rather than outside ACAT's orbit where their work is regulated with clear boundaries to levels of training and claims to competence.

 

Diversity of applications in doing CAT

CAT seems unstoppable in finding new applications. We should draw these together before we lose track of them and ACAT perhaps already needs its own archivist. The emphasis on borderline and hard to help patients should not preclude asserting the effectiveness of CAT with the relatively easier to help but equally distressed individuals. CAT has applications to many types of mental health problem. It applies to different social and age groups. It can be applied to groups, individuals and couples. Perhaps one of the challenges for ACAT is to find ways of working with inter cultural issues through CAT and the mental health problems that can arise from prejudice, isolation, powerlessness and marginalisation. A good stepping stone is the current interest in what CAT has to offer in providing a narrative of the life cycle. The 1999 conference with its theme of CAT in the real world is starting with a particular focus on CAT with the Elderly from Laura Sutton and others, a group of us in ACAT have talked about CAT with young people and for me one of the most memorable sessions some years ago was Angela Wilton's on CAT in relation to birth stories.

In all this lies such rich scope for CAT as vehicle for the re-enactment of the tragic, heroic and comic patterns of relating to self and others from generation to generation. I doubt if I am the only one who can give heart felt family description of the transmission of demanding-obliging reciprocal roles from generation to generation in a marital and parental dance going back four generations to the 1870's. There is a cross over in all this to be made from CAT work with narcissistic and borderline personality disorders to the lesser shudders of disorganisation in our sense of self at times of crisis and life stage transition.

Diversity of applications in using CAT

CAT's richness as a model of the self, mind and emotion means there is much work to be done outside of the therapist's room. There are various people in ACAT pursuing the idea of CAT as a consultative tool and as a supervisory tool for GP's and others, in relation to team dynamics, hard to help patients, care planning. These themes could be extended to probation and social work and in secondary, further and higher education not to mention management and organisational development. We have n't so far as I know yet got a film critic versed in CAT though it is a small step on from reformulating Shakespeare and Scott Fitzgerald.

Other current themes

The work of supervisors plays a pivotal role in ACAT's promotion of CAT and establishing and maintaining good standards. Supervision is CAT's laboratory for new ideas, for advances in training and practice. We have what might be called a collegiate approach to supervision. It is best suited to group supervision with the greater emotional democracy and opportunity for spotting reciprocal roles and their various supporting procedures. This should be strengthened and is unique to ACAT. Supervisors are the culture carriers and maintainers of standards. Recent and rapid developments in CAT theory and practice: activity theory, micro supervision, new ways of doing the SDR have not necessarily percolated through to all of us. Supporting further training and continuing professional development for supervisors is a priority and perhaps an area that ACAT should invest in.

We should look after each other. Obvious but worth mentioning. CAT is emotionally challenging of its practitioners in that it requires a versatile and adept use of roles in any one therapeutic session as we move between active and creative use of task, time and role boundaries. Alongside an analytic capacity for self scrutiny and a humanistic capacity to be in a therapeutic relationship we also need the teacher's capacity for lesson planning and managing. Such role versatility is humbling and wonderful grist to the therapeutic mill because it cannot be done smoothly or invisibly in a way which is free of mistakes and awkwardness. It is often with such mistakes and awkwardness that we spot the in session replays of reciprocal role procedures. As with any therapy in this context it is possible to get overwhelmed or hurt and lose perspective. Alongside the supervisory and training work we visit upon each other we need a culture of care for each other and a compassion and sensitivity in knowing what it is like doing a highly skilled and challenging form of therapy.

We have a golden opportunity to practice what we preach in ACAT. Are there particular lessons we can learn and apply from our model of psychotherapy to our own processes of organisation development and leadership? If so can they help us avoid or exit from patterns of burn out, narrowing of vision, grandiosity and splitting and projective identification so disabling to most organisations and those in leadership roles.

Some other themes are the importance of research competency among CAT therapists which is dealt with elsewhere by the research committee position paper. The are areas which some think we have neglected in the current evolution of CAT such as experiential aspects of learning and group process. There is a discussion to be had waiting somewhere in the wings about manuals and guidelines and the avoidance of a painting by numbers approach to therapy. Without excluding anyone, we need to greet the new technology of email, mail base and web site to save time, money and promote the network and collaborative member led organisational structure. We seem to be underway with regular seminars and workshops through the membership division as part of an emerging programme of Continuing Professional Development and in time this may become more formal and important as part of continuing accreditation. Of all these I am sure we shall here more and sooner rather than later if the next annual AC AT conference bears the fruit it promises.

If there are directions we should be going or things we should be attending to please write in or email me or write in to the newsletter "Reformulation".

Steve Potter

Full Reference

Potter, S., 1999. A Personal View of ACAT. Reformulation, ACAT News Winter, p.x.

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A Personal View of ACAT
Potter, S., 1999. A Personal View of ACAT. Reformulation, ACAT News Winter, p.x.