Dr Tony Ryle, the founder of Cognitive Analytic Therapy
Tony 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.
Dr Anthony 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). The news was and is deeply felt by the CAT community both in the UK and overseas.
ACAT held a one day conference in memory of Tony Ryle on Friday, 10th March 2017 which was a time to come together and celebrate Tony’s life and the wonderful legacy he has given us.
Podcasts from this day can be found on the member pages of the website and reviews are below.
Review by Alison Jenaway, Consultant Psychiatrist in Medical Psychotherapy, CAT therapist and supervisor, Trustee of ACAT:
Around 150 people came together on 10th March, 2017 to celebrate the life and work of Tony Ryle. As Trustees of ACAT, we wanted the day to be a mixture of memories of Tony and of new developments and hopes for the future. The day went smoothly, without a hitch - apart from the very expensive flower display that I had ordered getting stuck in traffic and being delivered late. Even this may have been to Tony’s liking as, according to his family and those who knew him well, he would not have wanted any flowers or fuss in any case! The day felt like a coming together of all of those who love CAT and I think people were moved and inspired in equal measure.
Having spent months organising the day, and choosing some of my personal favourite speakers, it is hard for me to judge the content. Also, we did not collect any formal feedback, so I have asked a few people to give me their reflections of the day itself:
Rosemary Parkinson, CAT therapist and supervisor:
"It felt good to be part of something which each of us there felt passionate about. I thought the day perfectly balanced a “thank you and goodbye” to Tony, with a celebration of the therapy that he founded"
“The Tony Ryle Memorial Day worked really well. The day was a mixture of interesting stories, intellectual stimulation and a great deal of warmth. It felt good to be part of something which each of us there felt passionate about. I thought the day perfectly balanced a “thank you and goodbye” to Tony, with a celebration of the therapy that he founded. Some speakers, such as Donald Bermingham, Anna Jellema and Mikael Leiman, reflected on their time with Tony and it was great to hear stories from the early days. Then there were presentations from current therapists with new ways of working, such as Steve Potter and Alison Jenaway, showing how CAT is evolving, and also some research from Steve Kellett showing how, as a therapy, we are still looking to make sure that what we do works as efficiently as possible. There was even a talk by someone who had just completed their training. I enjoyed the video clips of people reflecting on their connections with Tony. In some ways, the whole day was like a letter to CAT - a chance to reflect on what has happened, to look at where we are now, and to think about where we might be going in the future. It was also a great opportunity to see familiar faces. It left me feeling inspired all over again by CAT.”
Carol Gregory, CAT therapist and consultant psychiatrist:
“I was so glad that I went to Tony’s memorial day. I had never met him and so it was a real pleasure to hear about him from people who had obviously known him well and whose clinical work he had influenced in such an important way. He was obviously revered for his intelligence, creativity and determination to bring a coherent theory and practice based model of therapy into the NHS to help people with relational difficulties; but he also came across as a very “real” person - with all the attendant complexities to his character that we all have. And I liked him all the more for this!”
Steve Potter, CAT therapist, supervisor and trainer:
"The diversity of voices and perspectives testified to the strength and depth of the legacy, both within the CAT model, and more widely."
“The day of celebrating the work and life of Tony Ryle was a rich and moving mix of looking back and looking forward. First encounters with Tony and his ideas were warmly and honestly described. The diversity of voices and perspectives testified to the strength and depth of the legacy, both within the CAT model, and more widely. Michael Leiman gave an inspiring account of both the clinical precision and intellectual adventure of working with Tony Ryle in the early days. There were engaging accounts from newcomers to the model, and of the determination involved in researching CAT. Although it might have been judged a day for those long involved in CAT and in the work of ACAT, there were very positive responses from trainees attending the day (a great day to see the model come alive) and outsiders who were impressed by the fond, and open relationship between a community of practitioners and its father figure. The day ended with an impressive “open mic” session (accompanied by a glass of wine) which, with its lack of structure, could have fallen flat, but which offered a rush of voices and perspectives - not all in harmony - on what an open, lively and creative legacy the founder of CAT had achieved.”
Thanks to you three for your thoughtful comments.
At the end of the formal part of the day, Liz McCormick led us in a mindful moment, encouraging us to notice what words came to us about the day - my word was gratitude, both to Tony Ryle for his incredible gift of CAT, but also to all of those who supported me in putting the day together, and agreed to contribute. Finally we ended with music, and what Glenys Parry described as “dialogic Bach” played by Stella on the oboe and Jason on the violin. This was yet another reminder of how talented the CAT community is in so many different ways.
Alison Jenaway, consultant psychiatrist in medical psychotherapy, CAT therapist and supervisor, trustee of ACAT
And finally a 'word cloud' created from the Legacy Day (with thanks to Steve Kellett):
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