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The Genius of Tony Ryle – Past, Present and Future

Anna Jellema, 2018. The Genius of Tony Ryle – Past, Present and Future. Reformulation, Summer 2018, pp.5-8.

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In putting this article together, I was reminded of a quote used by Hilary Beard in her 2003 paper in Reformulation on the early days of CAT under Tony Ryle – “discovery consists in seeing what everybody has seen, and thinking what nobody has thought” (Beard, 2003). When we come to the field of psychotherapy, I think Tony was not just a discoverer – he was a genius: “a person who displays exceptional intellectual ability, creative productivity, universality in genres or originality, typically to a degree that is associated with the achievement of new advances in a domain of knowledge” (Wikipedia). 

Of course most innovations in psychotherapy, like Tony Ryle’s, are going to be the product of synthesis, of bringing together and reworking disparate elements. However, Tony also had the virtue of exceptional intellectual courage, in that he was prepared to challenge and radically re-orient his own thinking in developing his creative synthesis of several forms of psychotherapy. I think he has no equal in this. 

And CAT is, above all, not just theoretically interesting, but also exceptionally useful. Although I became involved with ACAT back in the early 1990s when I started CAT training, Tony Ryle had in fact dogged my steps from the 1970s when I first became a clinical psychologist and came across his work on using dyad grids (Ryle, 1979a). In the 1980s I discovered his book on “Student Casualties” (Ryle, 1969), and that simple and practical approach to understanding mental health difficulties was helpful to me in setting up a student counselling service in further education. 

But I think I had been attracted to CAT because of my own history; my parents were language teachers. My father taught French and Spanish – but he also knew Esperanto, an artificial language which is based on many European languages and was developed as a “common language”, intended to help different communities speak to one another. With this background, as a young psychologist I began to wonder how the two main strands of psychological therapy at the time, the psychoanalytic and the cognitive-behavioural, could talk to each other, through the medium of some kind of “common language”. And then I came across CAT.

One of Tony’s key achievements was his development of his original Procedural Sequence Model into the Procedural Sequence Object Relations Model (PSORM) which still forms the basis of CAT today. As Mikael Leiman has spoken about some of Tony’s innovations I won’t say much about these here, but I think Tony had great generosity of spirit in being open to the influence of Mikael in developing the theoretical basis of CAT. Although Tony and I did not always agree, particularly over the relevance of attachment theory, in person he was always courteous to me. His mischievous side, however, couldn’t resist re-telling the story during one conference, of when one of the Bowlby children wandered away unsupervised on Hampstead Heath…!

Having also spent many years working for Relate, I have always seen CAT as a kind of good, productive “marriage” of many forms of psychological understanding. The Catholic writer on marriage, Jack Dominian (1974) thought that a sound marriage could be described as having three key functions: to heal the past; to sustain the present; and to enable growth for the future. So I have structured this article along the lines of past, present and future; and also in relation to three key healthy reciprocal roles, which I’m describing as healing, nurturing, and encouraging growth.

So how did Tony Ryle come to develop CAT as a model which can “heal” past splits and struggles in understanding? 

 

How did he come to be the kind of person who devoted his life to such synthesis and bringing together? While we all know about Tony’s interest in politics, particularly in socialism and communism, he was very much a polymath, and seemed to keep abreast of major cultural developments in many fields. 

I suspect he may also have been influenced in his psychological thinking by the work of some eminent philosophers, as these were people whom he knew personally. Tony’s uncle was the philosopher Gilbert Ryle, who is now seen as the founder of “philosophy of mind”. In “The Concept of Mind” (G. Ryle, 1949), Gilbert Ryle put the final nail in the coffin of Cartesian dualism - the idea that body and mind are entirely separate - and Tony set out his agreement with his uncle’s thinking in many papers. . In Tony Ryle’s work we can find other echoes of Gilbert Ryle, including the importance of not just of “knowing that”, but also of “knowing how”, which is echoed in Tony Ryle’s model of procedural knowledge.

In Tony’s wartime diaries (Ryle, 2014) Tony also writes amusingly about one of the greatest of all philosophers, Ludwig Wittgenstein, whom he describes as “Winkenstein” or “Witkinstein”, “an awful strange man”. Tony was only 15 when he got to know Wittgenstein in 1942 - Wittgenstein was working as a pharmacy porter at Guy’s Hospital and being supported by Tony’s father John Ryle. 

At this time Wittgenstein was in the process of developing his radically new approach to philosophy. He was abandoning the ideas of the Tractatus (Wittgenstein, 1922) - his “picture theory” of language (language works through pictures or “representations” in the minds of the speaker and the listener) and developing his new theory, published posthumously in 1953 as the “Philosophical Investigations” (Wittgenstein, 4th edn., 2009). Wittgenstein began to see that language cannot be separated from its social context, which determines its meaning. His new “common sense” approach to philosophy calls to mind Tony Ryle’s later concept of reciprocal roles, where meanings are bound up with and embedded in relationships. 

Thus, in their textbook (Ryle and Kerr, 2002, p.40), Tony and Ian Kerr write, “We do not store representations to which we apply a mayonnaise of meaning, representations are inextricably imbued with the meanings acquired in the course of our activity in an intersubjective universe, through our relations to others, notably parents, whose own meanings in turn will reflect those of the wider society”. While Tony clearly acknowledged the influences of Vygotsky and Russian “activity theory” on his thinking (Ryle, 1991), I think there is also an echo of Wittgenstein here. 

As a socialist and a democrat, Tony was concerned throughout his career about the plethora of psychotherapies, a veritable “Tower of Babel” which has made it hard for psychotherapists to talk to one another. So in his early books and papers he was determined to create what he called “a common language for the psychotherapies” – for example in his paper of this title (Ryle, 1978) where he started to integrate cognitive psychology with Freudian defence mechanisms and behaviourist theory. We could also think here of his work on Dilemmas, Traps and Snags, as patterns of disturbance which underlie almost all surface presentations (Ryle, 1979b); and “How can we compare different psychotherapies? Why are they all effective” (Ryle, 1984). 

Tony’s exceptional and intuitive ability to observe high-level patterns or “procedures” also led to major papers in which he “rewrote” psychoanalytic thinking, for example with regard to transference and counter-transference, and projective identification. Many of his papers are complex theoretically and repay repeated study, including the paper which truly “launched” CAT as a therapy, “Cognitive theory, object relations and the self” (Ryle, 1985).

However another aspect of Tony’s particular genius was that he could so often simplify without oversimplification – he could both perceive the essence of psychological phenomena, and also could convey this clearly to others. He realised how making use of what he called “common-sense psychology” - and ordinary language - would often put us on the right track - which again is an echo of Wittgenstein who wanted to “show the fly the way out of the fly-bottle” (Wittgenstein, 2009).

But to my mind Tony’s work was never bettered than when he wrote as far back as 1975, “Self-to-self, self-to-other: the world’s shortest account of Object Relations Theory” (Ryle, 1975) in which he laid down very straightforwardly – and in only two pages - what were to become the foundations of reciprocal role theory, and thus of CAT. If he warrants the title of “genius” for any particular paper, then it seems to be this one...but then I thought of his paper, “The structure and development of borderline personality disorder” (Ryle, 1997) which is another absolute masterpiece in both its incisiveness and its conciseness...and you may well be thinking of others. CAT often refreshes the parts that other therapies cannot reach!

So how can we nurture CAT well at the present time? 

What aspects of CAT could we reinforce and strengthen right now, for example in our training courses and supervision? I’ll make some suggestions, highlighting a few key words, the first of which is:

• Integrative - CAT remains the most universal and integrative model of therapy that exists. But what current knowledge do we have that could be better integrated with existing CAT thinking, to develop and strengthen the model? Understandings about EMDR and modern neuroscience, perhaps? 
• Humanistic - ACAT currently belongs to the Humanistic and Integrative Psychotherapy College of UKCP. In the HIPC Quinquennial Review report, last year, we were given particular credit for what they considered to be our basic values which they saw as being absolutely in line with theirs. Their report states, “...we found the tutors, their training style and their students deeply humanistic in their way of being. They embody openness, immediacy, collegiality and authenticity...” I don’t think we stress enough that our basic stance as CAT therapists is a deeply humanistic one with respect and equality with the client as absolutely central. We are ordinary, straightforward and anti-elitist; we don’t have hidden agendas. 
• Practical – to quote Kurt Lewin, “There is nothing so practical as a good theory” (Lewin, 1951). What I have found extraordinary about the CAT model is its ability to offer something new to any supervisee – new ways of thinking about and of doing therapy. This is particularly the case when we are doing what I call “CAT-ish” supervision – not the kind of formal supervision that you receive on a CAT training course, but what CAT thinking can add to ordinary mental health practice, working with staff of all kinds of specialist training and experience, or none. Doing “formal CAT” may not necessarily be the best way to influence others. 
• Coherence - One of the key findings from attachment research is that emotional security is related to narrative coherence, the ability to tell a story that is logically and emotionally meaningful (Main et al, 2003). So I suggest we would do well to keep on giving enough attention to the narrative forms of reformulation, the Reformulation and Goodbye Letters, as well as to diagrammatic forms such as the SDR. 
• We tend to stress the “scaffolding” or basic structure of the CAT model as being particularly helpful; however, this can lead us to downplay the importance of content (in contrast with process) in therapy. I think there is still some work to do here, e.g. in incorporating more routinely some psychoanalytic understandings into CAT. We may not accept analytic accounts of the causation and maintenance of disturbance, but there is still much value in many of their detailed descriptions and understandings of complex psychological phenomena. Tony Ryle clearly preferred the work of Fairbairn and Guntrip to that of Melanie Klein, but it can make a huge difference to the success of some CAT therapies to be able to talk with the patient about their envy and greed, for example; let’s not throw the baby out with the bathwater! After all, Tony once said that he thought that the future of psychoanalytic thinking in the NHS might rest with CAT!
• The concept of “core pain” has been a less fashionable concept in CAT recently, because Tony thought it was insufficiently reciprocal; but it’s also important that we don’t lose sight of unmanageable feelings in CAT, especially those which are somehow “missing” in the work. I’m thinking here of Bowlby’s seminal paper, entitled “On knowing what you are not supposed to know and feeling what you are not supposed to feel”. (Bowlby, 1988, Ch. 6). Sometimes it’s what’s not present, which matters most. 

Finally, a few thoughts about the future growth of CAT, to help carry on Tony’s legacy 

How does a model survive the death of its charismatic founder? Is this the time for all of us in ACAT to do some serious thinking about where to now? What may be the Strengths and Weaknesses of CAT, and ACAT – where lie the Threats to us, and even more so, the Opportunities? These are some of the issues which have been concerning me: 

How do we continue to keep therapists interested, not just in doing or using CAT, but also in developing the CAT model? Now that so much of the model has been well established, how do we keep people engaged with this task, and responding to new theoretical and practical challenges? And how do we help people sustain interest in their therapeutic careers that may last for many decades? (Ronnestad and Skovholt, 2013).

Then there’s the matter of keeping therapists in ACAT and engaged with the organisation. We never quite seem to get through the 1000-member ceiling in ACAT! Given the numbers of new trainees each year, we must be losing a fair proportion of qualified Practitioners. We need to understand what may be going on – how do we build the membership? What procedures or roles might be being enacted? And what makes so many of us loyal to ACAT? How do we stimulate such loyalty?

Will CAT’s main legacy turn out to be, in the long run, its influence on other therapy models? In for example, developing greater relational focus in CBT, or bringing greater structure to counselling practice? Will there be more “CAT-ish” work, than pure CAT? 

And how should we respond to current and future NHS pressures? Are the old structures of CAT (for example the16 session model, devised by Tony in the 1980’s) still fit for purpose now? How can ACAT, via its training and supervision practices, ensure we are “fit for the future”? 

To conclude, many of us have been thinking about how can CAT thrive in an age in which authoritarian and narcissistic ways of relating are increasingly promoted? How do we lead, so that we may better influence the zeitgeist? It may help if we give much more attention to “organisational CAT” (e.g. Moss and Tanner, 2013). Despite our grounding in the model, it still seems very hard at times for us as CAT therapists to think, “Where are we relationally in all this? What are our reciprocal roles?”, when we are faced with challenges from cultures and organisations that are very different from ours. I think that we ought to be better at this than we are.

We say that CAT is a dialogical form of therapy but I hope that we can give serious thought to what forms of dialogues we enter into with each other (see e.g. Cheyne and Tarulli, 1999), within ACAT as well as with the outside world. I hope we can really listen to those positions that may seem at first to be very “other”, and thus better understand and work with those fundamental and personal values that underpin our dialogues, different as well as shared.

Acknowledgments

I would like to particularly thank Dr Ian Ground and the members of the Monday morning Philosophy group at Explore, Newcastle upon Tyne.

References

Beard, H. (2003). “Discovery consists of seeing what everybody has seen and thinking what nobody has thought”. Reformulation, 18, Spring, 11-12.

Bowlby, J. (1988) On knowing what you are not supposed to know and feeling what you are not supposed to feel. Ch. 6 in J. Bowlby, A Secure Base: Clinical applications of attachment theory. London: Routledge. 

Cheyne, J.A. and Tarulli, D. (1999). Dialogue, difference and voice in the zone of proximal development. Theory and Psychology, 9, 5-28. 

Dominian, J. (1974) Future of the Christian family. The Way, 14, 276-287. 

Lewin, K. (1951). Field Theory in Social Science: Selected theoretical papers. New York: Harper and Row.

Main, M., Goldwyn, R. and Hesse, E. (2003) Adult attachment scoring and classification system. Version 7.2. Unpublished manuscript, University of California at Berkeley. 

Moss, M. and Tanner, C. (2013). CAT as a model for development of leadership skills. Reformulation, 41, Winter, 11-14. 

Ronnestad, M. H. and Skovholt, T. M. (2013) The Developing Practitioner: Growth and stagnation of counsellors and therapists.

Ryle, A. (1969) Student Casualties. London: Allen Lane.

Ryle, A. (1975) Self-to-self, self-to-other: the world’s shortest account of object relations theory. New Psychiatry, April, 12-13.

Ryle, A. (1978) A common language for the psychotherapies. British Journal of Psychiatry, 132, 585-594. 

Ryle, A. (1979a) Defining goals and assessing change in brief psychotherapy: a pilot study using target ratings and the dyad grid. British Journal of Medical Psychology, 52, 223-233.

Ryle, A. (1979b) The focus in brief interpretive psychotherapy: Dilemmas, traps and snags as Target Problems. British Journal of Psychiatry, 134, 46-54. 

Ryle, A. (1984) How can we compare different psychotherapies? Why are they all effective? British Journal of Medical Psychology, 57, 261-264.

Ryle, A. (1985) Cognitive theory, object relations and the self. British Journal of Medical Psychology, 58, 1-7.

Ryle, A. (1991) Object relations theory and activity theory: a proposed link by way of the procedural sequence model. British Journal of Medical Psychology, 64, 307-316.

Ryle, A. (1997) The structure and development of borderline personality disorder: a proposed model. British Journal of Psychiatry, 170, 82-87.

Ryle, A. (2014) Diary from the Edge, 1940-1944: A wartime adolescence. London: Hedge Press.

Ryle, A. and Kerr, I.B. (2002). Introducing Cognitive Analytic Therapy: Principles and practice. Chichester: Wiley

Ryle, G. (1949). The Concept of Mind. London: Hutchinson. 

Wittgenstein, L. (1922) Tractatus Logico-Philosophicus. London: Routledge. 

Wittgenstein, L. (2009) Philosophical Investigations. (4th edn.). Chichester: Wiley-Blackwell. 

Anna Jellema is a CAT Psychotherapist and an HCPC Registered Clinical Psychologist working in private practice. Until 2015 she headed up a small specialist CAT Service in the NHS in Newcastle upon Tyne and was Course Director for the NTW CAT Practitioner Training. She recently stepped down as Chair of the ACAT Training Committee and is now Chair of the ACAT Exam Board.

annajell@blueyonder.co.uk

Full Reference

Anna Jellema, 2018. The Genius of Tony Ryle – Past, Present and Future. Reformulation, Summer 2018, pp.5-8.

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