Dr Tony Ryle 1927 - 2016

It is with great sadness we let ACAT members know that Dr Tony Ryle died peacefully on Thursday, 29th September, 2016 surrounded by family members.  He was 89.   The family has set up a memorial page at just giving should people wish to remember Tony by making a donation to MSF which was a charity he supported actively (www.justgiving.com/fundraising/AnthonyRyle)

This news is deeply felt by the CAT community both in the UK and overseas and ACAT sends its sincere condolences to Tony's family.

ACAT is holding a one day conference in memory of Tony Ryle on Friday, 10th March 2017 which will be a time to come together and celebrate Tony’s life and the wonderful legacy he has given us.  If you wish to attend and would like further information please go to:  http://www.acat.me.uk/event/903/legacy+of+tony+ryle+-+one+day+celebration+2017-03-10.htm

Jason Hepple - Chair of ACAT

Dr Tony Ryle, the founder of Cognitive Analytic Therapy

Tony Ryle in 1995Tony Ryle’s first work was in General Practice. Together with colleagues who shared his socialist and egalitarian views and his support for the newly established NHS he was a founder of the Caversham Centre, a group practice which offered an appointment system, a carpet in the waiting room, a receptionist and a nurse and good clinical care. It was described by the local bookie’s runner as ‘the poor man’s ‘arley Street’.

Within a few years he found himself increasingly concerned with his patients’ problematic lives as well as with their diseases. He began to spend more time listening and talking to patients and took up some clinical assistant sessions at the Royal Free with the aim of extending his skills. At the same time he undertook some epidemiological research within his own practice population, investigating the inception and prevalence rates by age, gender and social class of the common psychological disorders. Further research within the practice, with the help of Madge Hamilton, an experienced social worker, studied the transmission of psychological problems within the family. Of this experience Tony wrote “I learned to value Madge Hamilton’s unpretentious use of psychodynamic ideas and her way of thinking about families. And from the many parents who commented on how moving and useful it was to sit down with her through the long research interviews, I learned to appreciate the power of the listening professional to catalyse self-reflection.”

I learned to appreciate the power of the listening professional to catalyse self-reflection

In treating patients with mental health problems in general practice Tony never felt the need to choose between pharmacological treatment and psychotherapy – he felt that patients who needed both should receive both. Of his psychotherapeutic work with patients he wrote, “I have had a lifelong ambivalence towards psychoanalysis but my attitude was not simply negative and I was glad of its guidance when my listening to patients began to evoke powerful transference attachments and rejections, and I welcomed the attempt it made to understand personality in terms of developmental processes.”

In 1964 Tony joined the University of Sussex as the Director of the University Health Service. The common problems of students were psychological and the University setting offered support and time for training and research. A close working group of doctors and nurses evolved and provided much brief counselling as well as formal individual and group psychotherapy. The main focus of Tony's research shifted closer to his clinical work and he made considerable use of Kelly's repertory grid techniques over the succeeding 15 years. He received supervision from a psychoanalyst and his psychotherapy practice reflected a basically object relations and group analytic theoretical orientation. But his reservations about psychoanalysis had not gone away and as he read more widely and struggled to make sense of psychoanalytic writers, and as he tried to link psychoanalytic ideas to his clinical work and the repertory grid data, he became increasingly interested in integrating the ideas and methods of the different psychotherapies.

Research into the process and outcome of psychotherapy needs measures related to individual aims; in the case of dynamic therapy these go beyond symptomatic and behavioural changes to the revision of underlying structures and processes. He had already used repertory grid methods to demonstrate that such changes were achieved. To look at the process of change, Tony studied the notes of a series of completed psychotherapies. He found that the work was centred on identifying and confronting the ways in which the patients were failing to revise manifest but unrecognised harmful ways of thinking and acting. Non-revision could be accounted for in terms of three patterns which were labelled traps, dilemmas and snags. These descriptions emerged in forms which owed something to the sequential descriptions of behaviour therapy (traps), something to the way repertory grids display the limited options open to individuals (dilemmas), and something to psychoanalytic understandings of the operation of (conscious or unconscious) guilt and to the understanding of the link between individual disturbance and family and group processes provided by family and systems approaches (snags).

The next step was to use these ideas in the first sessions of therapy with new patients to determine what their particular patterns might be, so that it could be seen whether therapy changed them. At this point, what had started as a research procedure proved to have a profound and positive impact on the course of therapy. In identifying and describing their problem procedures (as they came to be called), patients began to recognise their operation and to revise them. This observation initiated the most satisfying phase of Tony’s career, the development of Cognitive Analytic Therapy, an approach which maintains as its core features the early description of problem procedures through the joint work of the patient and therapist, the use of these descriptions by the patient to recognise and control damaging ways of acting and their use by the therapist to avoid reciprocating and reinforcing such damaging patterns.

what had started as a research procedure proved to have a profound and positive impact on the course of therapy
 

At this time Tony began to visit Guy’s Hospital to supervise brief therapy, and heard about, applied for and was appointed to the new Psychotherapy Consultant post at St. Thomas’s, so commencing his third career. As the only psychotherapist serving a population of about 180,000, he clearly had to decide where to put his energy. Tony focussed on training and service provision, and while a proportion of junior psychiatrists trained and did good therapeutic work, it became clear that the only way to provide a service was to attract non-medical trainees. As soon as Tony was in post, large numbers of social workers, occupational therapists, nurses and others started requesting supervision. They proved an excellent resource but the rapid growth in referrals would not have been coped with but for the parallel accelerating demand for CAT training which yielded an inexhaustible supply of trainees from outside the hospital, prepared to see patients in return for supervision.

In order to try to meet the needs of the population of the catchment area, not just the demands of those who found their way to the head of the queue, a policy of offering only the minimum sufficient intervention was established. Very few patients received long-term treatment, the great majority, including those with personality disorders, being given 12-16 sessions of CAT. During his 10 years at St. Thomas’s, Tony personally assessed around 1% of the adult population of the catchment area. Most of those, unless psychotic or seriously substance misusing, were treated in the unit by trainees.

From the early trainees there emerged a group of experienced practitioners who became involved in teaching and supervision and who went on to form and develop ACAT. Aided by Mikael Leiman, Tony developed the distinct theoretical basis of CAT and continued research, in particular into Borderline Personality Disorder. After retirement from the NHS in 1992, and while spending the summer months walking and gardening in Italy, Tony continued to be involved in teaching, supervision, research and theoretical development. As he slowly reduced his involvement others came forward concerned with theory and research and with the battle to develop effective services in the beleaguered NHS. Despite being taught in many separate centres in the UK and abroad CAT has retained its core values and continues to evolve new applications and methods. On finally stopping work in 2010 Tony was content to know that the model was in safe hands.

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11st April 2017
CPD Event: Understanding and working with eating disorders within a CAT framework - offered by CAT South
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