Letter to the Editors

Anonymous, 2009. Letter to the Editors. Reformulation, Winter, p.6.

Dear Reformulation,
It seems that CAT is quite often referred to as a cognitive therapy. I am concerned that reducing our name in this way will have consequences that are limiting and misleading in regard to the breadth of ideas that CAT is informed by and can continue to grow from. Ryle began from a cognitive translation of object relations concepts, which are psychoanalytic in origin. Later, these were joined byVygotskian/Bakhtinian transformations, notably of the concept of internalisation, akin to the analytic concept of internalising the therapeutic relationship and the dialogic between transference and counter-transference. For this reason we must keep the distinction between CAT and cognitive therapy clear.

Depending on cognitive analytic therapists’ backgrounds, the emphasis will be different. However, we have a unique integration at the heart of CAT: for example the descriptions of relationship difficulties formulated by Tony Ryle as ‘reciprocal role procedures’,’ self states descriptions’ along with ‘traps, snags and dilemmas’. These procedures are explored with clients through the use of cognitive, psychodynamic, analytic, and creative constructs and techniques. The aim, as with most therapies, is to enhance self reflection and new sense of self. In CAT’s case there is a particularly coherent and shared understanding of the ‘other’ and the relational nature of self.

CAT is analytic because object relations theory is post Freudian, the ancestral line is very clear, referring as it emerged to the mind as essentially relational. Reciprocal roles are able to depict clearly the process of splitting at a more observable stage socially and developmentally than Klein’s original infant observations!

CAT works beyond the social and the manifest, through non-verbal and unconscious expression of dreams, slips, and disavowed meanings. CAT s understandings refer to the interpersonal and the intrapsychic and are therefore analytic. Though CAT’s position on the unconscious is more attuned to Jung’s collective unconscious, whereby the unconscious symbolism is linked to interactive developmental and social realities, in CAT archetypes are in fact the characters of our experience and internal world.

CAT does not embrace the innate drives of Freudianism and thereby does not speculate on unconscious drives to life and death, with the destructiveness this anchors as a central human condition.

CAT technique combines both the active stance of the cognitive tradition and the receptive transference style of the analytic tradition, adding to it a theory of relational working unique to CAT. CAT harnesses change through mind and emotion, believing that working through is modelled well through a more collaborative, relational stance.

As such, CATs theoretical underpinnings are apart of a living analytic tradition and by reducing our name by for example where we place ourselves in UKCP’s or HPC’s cognitive section, we limit dialogue and creative association. We limit our reciprocal roles as a profession. Although it may appear that joining the ‘Cognitive’ section of UKCP is nothing but expedient in these NICE times we live in, the analytic maybe rendered nameless and thereafter speechless as the next generations of CATs learn their craft.

By viewing the individual as having conscious and unconscious/ subconscious layers of mind we can think about the way that discoveries can emerge creatively under the right conditions, which may, as Jung proposed, respond to the innate creative potential toward healing and self actuation.

Emerging new sense of self may be found through dreams, reverie through art for example and simply in the relational stance which is receptive, whereby the therapist, as Ryle advocates, resists collusion, whilst remaining genuinely empathic and thereby supporting the individual to process the reciprocal role difficulties, the conflict in analytic terms, and develop a deeper understanding of role origins, nature, hooks, openness to transformation, and inevitability to different degrees of repetition.

The creative and analytic theories and methods that I learned as an art psychotherapist were to my mind deeply integratable with CAT and enabled the development of time-limited art psychotherapy.

There is an assumption out there, and I think reducing our name inadvertently confirms this, that we are a modified form of CBT. CBT, though helpful to many, doesn’t have object relations in its formulation and doesn’t have the integrated theory of mind that I believe CAT does. CBT’s new ‘fifth way’ is perhaps its embracing of the creative unconscious that I see CAT took up way back along with cognitive developments.

My concern is that abridged references and classifications of CAT as a ‘cognitive therapy’ is that the creative analytic elements will not be explored analytically. I mean, for example, that if the use of arts media becomes directive or solely projective, it loses its capacity to be understood to reveal an embodied expression of self and potential self and so to be used to inform deeper change. The problem might come that a wealth of learning, knowledge and continuing exploration is reduced to some kind of ‘add on’ and not as something there in the archaeological history of CAT, many of whose pioneers were ‘creatives’ of various kinds. ‘Cognitive’ maps little more than sophisticated behaviourism.

If in CAT we seek to excavate with clients the possible origins and the nature of their unmanageable thoughts, feelings and experiences only at the reformulation phase of CAT and then use a more specifically cognitive stance thereafter, I wonder if we may block the depths of emotional resonances that support working through and self re-creation . As such this could undermine the ethos of collaboration in CAT. The brief focal work of James Mann (Mann. Time-limited Psychotherapy. Harvard University Press. 1973. page 87-199), though without our cognitive descriptions, fits well into the CAT framework in that the dynamic method he describes orbits around central problematic motifs. This is essentially what we do through TP, TPPs and SDRs, in CAT, which is incidentally a key Jungian view, believing that core issues push forward for expression and transformation. [(Mann was an acknowledged early influence on CAT in the first small RCT that compared pre-CAT to Mann’s model. See Brockman et al. Source of reference: dialogue with Tony Ryle 2009]

Now seems the moment that we as a profession are prompted to give this matter our attention as UKCP moves to HPC. We might gain a degree of safety aligning ourselves with cognitive therapists, rather than the HIPs, who are integrative humanists.

Full Reference

Anonymous, 2009. Letter to the Editors. Reformulation, Winter, p.6.

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Comment on James Turnerâ€™s article on Verbal and Pictorial Metaphor in CAT
Hughes, R., 2011. Comment on James Turnerâ€™s article on Verbal and Pictorial Metaphor in CAT. Reformulation, Winter, pp.24-25.

Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.
Ryle, T., 2009. Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.. Reformulation, Summer, pp.33-34.

Using and Understanding of Primary Process Thinking in CAT
Sacks, M., 2003. Using and Understanding of Primary Process Thinking in CAT. Reformulation, Autumn, pp.30-32.

Memories from a pre-CAT Time
Mikael Leiman, 2018. Memories from a pre-CAT Time. Reformulation, Summer 2018, pp.16-17.

CAT's Dialogic Perspective on the Self
Ryle, A., 2001. CAT's Dialogic Perspective on the Self. Reformulation, ACAT News Autumn, p.x.

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Letter to the Editors

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