Book Review - INTRODUCING COGNITIVE ANALYTIC THERAPY PRINCIPLES AND PRACTICE: Anthony Ryle and Ian B Kerr

Boa, C., 2002. Book Review - INTRODUCING COGNITIVE ANALYTIC THERAPY PRINCIPLES AND PRACTICE: Anthony Ryle and Ian B Kerr. Reformulation, Autumn, p.33.


This is a most refreshing and readable update of CAT principles of theory and practice. I found its style much more lively and accessible than the original 'blue book' yet the content is as comprehensive and practical as the earlier version and the book is generously sprinkled throughout with illustrative and relevant case studies.

Those new to CAT will find the history and underlying philosophy well covered without its being tedious, and the basic principles of practice wonderfully clear. There are good chapters on writing reformulation and creating SDR's, including the rationale for doing them well - and collaboratively - while as an 'old hand' I was greatly impressed with the concise coverage of current ideas from evolutionary psychology and development of the self processes. This is a subject of particular interest to me but writing about it is usually dense and longwinded, whereas in these chapters some very complex ideas are put across with the lightest of touches eliciting, I hope, a useful curiosity and desire in CAT practitioners to learn more about how we come to experience ourselves - especially ourselves in relation. This, of course, elaborates the ideas of Vygotsky and Bahktin, which are so much part of current thinking in CAT.

I had rashly agreed to lead a seminar on Vygotsky and Bahktin as applicable to CAT and suddenly found myself floundering. It was with no small measure of relief that I picked up the new Introduction and turning to the index fell upon multiple references that promised to, and did, fulfil all my needs.

And this is what I find most useful about the new book. If I want to refer to a particular subject - not only CAT specific - an excellent index guides me to the relevant pages, and they are invariably relevant. Several times I have done just this and then have found myself reading on, as if caught up in a novel, because the writing is so clear and the subject matter developed into its related areas with a seamlessness that is seductive.

We are reminded that CAT has a major contribution to make in many settings, and that it can be helpful in addressing and treating a broad range of problems or difficulties, including psychologically unsophisticated patients and the so-called personality disordered. This section of the book is particularly helpful and comprehensive in its coverage of disorders commonly presenting to psychotherapy departments and of treatment recommendations including generous acknowledgement that other therapies can be useful in conjunction with or complementing CAT.

A restatement of object relations theory, incorporating Vygotsky's theories of social and historical formation of higher mental processes, especially of sign mediation, and of Bahktin's theories of the role of the interpersonal and internal dialogue, is particularly helpful and informative for those of us struggling with these concepts.

We are reminded too that CAT arose out of an attempt to evaluate the validity and effectiveness of existing psychotherapy models and of how this should be a fundamental aim of our own work. Whilst it is acknowledged that traditional research methods in this field are subject to all sorts of difficulties and discouragements, it is of utmost importance that we are not discouraged but that we continue to self evaluate and challenge our practice.

And again it is re-stated that what is most distinctive about CAT is ultimately something deeper than details of practice. It is expressed in three distinct but in fact closely related features, namely:

in its having been developed with the aim of offering a treatment which could realistically be provided within the NHS

in the collaborative, non-hierarchical nature of the therapeutic relationship

in the inclusion, in descriptions of the psychological processes which therapy aims to change, of the reciprocal relations between the individual and others.

If there is to be a criticism it could only be that the new book expresses a rather over-positive view of the effectiveness of CAT. I have a difficulty here in that I tend also to be over-positive about CAT. At its most basic level I believe it to be a "safe first intervention" for persons who may or may not be able to cope with the intensity of its impact, while for countless others it is indeed capable of removing the "road blocks" that threaten to frustrate their life potential.

Also missing perhaps is real acknowledgement of the socio-political context in which so many of our patients struggle to live as individuals. The ever increasing pressure of the market economy on the provision of health care in general and of a value-free approach to emotional distress catches us all in a web of power play and threats to our livelihood, with concomitant constraint to the development of psychotherapy, even CAT, as a truly 'caring' profession, whether as art or science.

Cherry Boa

Full Reference

Boa, C., 2002. Book Review - INTRODUCING COGNITIVE ANALYTIC THERAPY PRINCIPLES AND PRACTICE: Anthony Ryle and Ian B Kerr. Reformulation, Autumn, p.33.

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