CAT Publications Update

Tony Ryle, 2005. CAT Publications Update. Reformulation, Autumn, pp.28-29.

There is a great deal to satisfy, challenge, and move readers here. Is there a particular message in it for CAT practitioners? I think that, even within the limits of a brief therapy, it is the need to prevent ourselves from being too busy, to try to stay with the patient’s feelings even at their most discomforting, to work with bodily processes. Also to be prepared not to know the answers, to be a witness, encourage self-acceptance, hold the hope, and accompany the patient through to their selffound other side. This message is illustrated most beautifully in the clinical examples given.

Thanks to Liz McCormick for asking me to review this book for Reformulation. It would be good to hear the authors’ own view of the comments made here.

CAT Publications Update and Journal Reviews
compiled by Tony Ryle

CAT Publications - This list depends on people letting me know when they have had new papers published – please contact me at

Bennett,D., Pollock,P. and Ryle,A.(2005) The States Description Procedure: the use of guided self-reflection in the case formulation of patients with borderline personality disorder. Clinical Psychology and Psychotherapy 12, 1 50-57.

Bennett,D. and Ryle, A. (2005) The characteristic features of common borderline states: a pilot study using the States Description Procedure. Clinical Psychology and Psychotherapy 12, 1 58-66.

Kerr,I.B., Birkett,P.B.I. and Chanen,A. (2003) Clinical and service implications of a cognitive analytic therapy model of psychosis. Australian and New Zealand Journal of Psychiatry 37, 5, 515-524.

Kerr,I.B. (2005) Cognitive Analytic Therapy. Psychiatry 4,5, 28-32. May 2005.

Ryle,A. (2005) The relevance of evolutionary psychology for psychotherapy. British Journal of Psychotherapy, 21 (3) 375- 388

Ryle,A. (2005) Invited comment on ‘State of Mind organization in Personality Disorders: typical states and the triggering of interstate shifts by Dimaggio et al. Clinical Psychology and Psychotherapy, 12, 360-366.

Journal Article Reviews

Childhood precursors of male domestic violence Worley,K.O.,Walsh,S. and Lewis,K. (2004) An examination of parenting experiences in male perpetrators of domestic violence: a qualitative study. Psychology and Psychotherapy, 77,1, 35-54.

An attachment theory - based study of seven men finding, not surprisingly, evidence of childhood adversity and a tendency to minimise of the violence done to their partners. The extensive reference list does not mention Philip Pollock’s directly relevant research.

Bipolar disorder and childbirth
Jones,I. and Craddock,N. (2005) Bipolar disorder and childbirth: the importance of recognising risk. British Journal of Psychiatry,186, 453-454.
Many readers of Reformulation will have met Daksha Emson at Guys or in CAT training contexts. All who knew her were powerfully affected by the radiance of her personality, and powerfully distressed when she killed herself and her 3-month old child while suffering from an acute psychotic episode. This paper draws on the enquiry into her death -a death which might have been prevented had a full risk assessment been carried out and had she lived in a borough with a mother and baby unit. Over a quarter of all maternal deaths are due to suicide, commonly occurring in women with a history of bipolar disorder, and frequently of abrupt onset. Management of bi-polar illness is always complex and doubly so in pregnancy; vigilance and full assessment are always called for.

Recovered memories-false or true?
Madill,A. and Holch,P.(2004) A range of memory possibilities; the challenge of the false memory debate for clinicians and researchers. Clinical Psychology and Psychotherapy 11, 299- 310.
Few psychotherapists can avoid having to decide how far their patients’ recovered memories of abuse are reliable or false. All, by now, should be aware of the dangers of creating or reinforcing false memories. But the issues remain complex. This paper offers a sober, helpful review of clinical and experimental studies.

Development of mind in childhood
Carpendale, J.I.M. and Lewis, C.(2004) Constructing an understanding of mind: The development of children’s social understanding within social interaction. Behavioral and Brain Sciences (2004) 27, 79–151.
The paper presents the evidence for the view that the development of children’s social understanding occurs within triadic interaction involving the child’s experience of the world as well as communicative interaction with others. Children’s understanding of mind develops gradually in the context of social interaction. The paper is followed by a number of interesting commentaries. Of these, that by Fernyhough proposes that the paper would be strengthened by attention to Vygotskian ideas, pointing to the key importance of the internalisation of semiotically mediated interpersonal activity - a view supportive of the CAT theoretical position.

Imitation as the basis of sympathy
Tevarthen, C. (2005) First things fi rst: infants make good use of the sympathetic rhythm of imitation, without reason or language. Journal of Child Psychotherapy 31, 1, 91-113.
The paper offers a fascinating review of observational evidence pointing to the early, extensive role of imitation from birth onwards. ‘Matching another’s actions may seek attention and provoke reply, accept or reject advances, express admiration or mockery’. The mirror neurons are a physical basis for the growth of human sympathy and the matching complex activity of the self with that of others is already present in a two month old baby.

Psychoanalytic theory

Fonagy, P. (2003) Psychoanalytic Quarterly (72,13-46) Some complexities in the relationship of psychoanalytic theory to technique.

In this paper Fonagy points to a marked decline in the number of citations of psychoanalytic papers appearing in both general and psychoanalytic texts. It is a decline to which he has not contributed, being a fecund author of quotable papers in which he manages to claim the freedom of an enfant terrible to challenge all the orthodoxies while assuming the role of defender of the faith. But he makes it hard to pin down what this faith is. In this paper the bulk of psychoanalytic theory, including Freud’s, is discarded as overspecified and as essentially bearing no generalisable relation to technique.
Freud’s contribution, which had ‘an intellectual potency that is arguably hardly equalled in the history of human ideas’(p30) is boiled down to two key principles of ‘mentalization’, namely that ‘intentionality is not restricted to consciousness’ and that ‘the expansion of the capacity think about desires, feelings and the context of an attachment relationship’ is therapeutic.

These principles are commonplace in psychotherapy circles, though both raise a number of theoretical questions to which psychoanalysts would traditionally have offered answers. But no longer, according to Fonagy, who echoes the accumulating criticisms of recent decades and offers his solution, which is to discard the traditional clinical model and to ‘de-couple’ theory from practice. This would allow technique to ‘progress on purely pragmatic grounds, on the basis of what is seen to work’, thus bringing ‘psychoanalysis more in line with modern, postempirical views of science’(p13). As this wish to be purely pragmatic suggests an essentially empirical approach (defined in my OED as ‘guided by mere experience, without knowledge of principles’) it is unclear in what way he wishes to be aligned with ‘modem postempirical’ science (beyond being modem). But Fonagy’s critique is concerned only with the symptoms and not with the underlying dysfunctional processes. It was not, I would argue, the ‘illusorily close association of practice and theory’ that undermined the psychoanalytic enterprise, it was the combination of sloppy thinking, whereby observations created or selected by theoretical presuppositions were enshrined as evidence for a poorly articulated body of theory, and of authoritarian arrogance which disallowed criticism from within and discounted knowledge from other sources. What is left of psychoanalysis after Fonagy’s critique? The assertion that psychoanalysts ‘know both much more, and much less, about the mind than is codifi ed in psychoanalytic texts’ and the suggestion that creative modifi cations of technique should be approached not in the shadow of a ‘Freudian superegoish father, but from the (Fonagyish?) perspective of a benevolent figure who encourages playful engagement with ideas’(p41-42).

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Full Reference

Tony Ryle, 2005. CAT Publications Update. Reformulation, Autumn, pp.28-29.

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