Lloyd, J. and Pollard, R., 2012. Letter from the Editors. Reformulation, Summer, p.5.
Many of us, both in the NHS and other services and in private practice, will be reading this 38th edition of Reformulation feeling the effects, both personally and via our clients, of the continued assault on public services, employment and life prospects as a result of government policies that give prizes to the very rich while further penalising those who are the most economically and socially disadvantaged. Few people can dispute that deteriorations in mental health occur when people experience incessant struggle without apparent hope, both within wider society at a European level and, for many of us, in the beleaguered communities we live in. Many of us are experiencing yet further constraints at work with the ever-present threat or actual effect of cost savings and redundancies, making it more and more essential to demonstrate our ‘clinical effectiveness’ with fewer resources and according to measures that often bear scant relation to clinical realities. For those of us working in private practice it can mean higher overheads coupled with a reduced and more uncertain income, or an increase in both the number and complexity of referrals as the reduced NHS services can no longer offer therapy to the majority of people who need it.
Our work as CAT therapists is embedded within this environment as we witness the procedures that many people are activating in order to manage as well as they can the effects of what is happening to them. We too may often feel pressurised into proving we can build ever more bricks with ever less straw. We are particularly keen to hear from anyone in the CAT Village who is engaged in therapeutic work with people who may be seen as being at either end of the economic reciprocal roles; e.g. investment bankers and people who have become bankrupt.
This edition focuses on particularly considerate and kind approaches to people who encounter distressing, at times nigh on impossible, obstacles to achieving well being. These approaches are not wishy-washy, however, but practical and supportive within a containing CAT structure. The varied articles offer a mix of practical interventions, thoughtful reflection and further development of CAT ideas. Nicola Coulter and Sophie Rushbrook’s paper on working creatively with dreams in CAT is a particularly good example of integrating ideas from the Gestalt tradition into CAT in a sensitive way that engages with the client’s present emotional and relational state. Similarly, Jane Bradley’s paper on using a hopeful SDR (map) for clients experiencing high levels of emotional distress, demonstrates a sensitive awareness of the risks of clients feeling overwhelmed and discouraged by a conventional SDR and the need for a gentle and compassionate re-kindling of realistic hope that they can attain a more fulfilling life. Alex Perry’s stimulating and well researched paper on CAT with people who hear distressing voices takes a dialogic and trans-diagnostic approach that both de-pathologises the experience of hearing voices and shows how these experiences can be reformulated and addressed within a CAT framework.
An article by Cynthia Gil-Rios and Jane Blunden describes a dilemma in their supervision group that demonstrates how hard it is for us all, as therapists and supervisors, to work with people when the issues they bring to therapy are deeply resonant with our own unresolved dilemmas and vulnerabilities. CAT has a robust presence in services for people with Eating Disorders, so Amy Wicksteed’s review of this work and her own clinical experiences of using CAT, will be particularly helpful for many readers working in this area as well as for those working with other clinical groups where problems with food and eating are a concern.
There are also two papers submitted by the editors. Having our own papers published in the journal we edit might seem like Narcissus getting trapped by his own reflection in the pool, but Reformulation seems the right journal when we, like other authors, write for the CAT community. The first paper, by Rachel Pollard on Bakhtin’s concept of Great Time, explores how we construct what it means to be human, how we restrict meaning and the dangers of being overwhelmed by too much meaning, echoing a theme developed in Jane Bradley’s paper. The second paper, jointly written by Hilary Brown and Julie Lloyd, addresses some of the problems and limitations of the cognitive model underpinning the Mental Capacity Act when it comes to the ambiguities and uncertainties of applying the MCA in real life. The paper illustrates how CAT’s relational concepts of Reciprocal Roles, Traps, Dilemmas and Snags can be very usefully employed to understand and find a way through the complex, muddled situations that we are often confronted with.
We are delighted that Rachel Pollard has joined us to share the task of editing. Rachel is well known to many of you, particularly for her interest in Bakhtin. Her recent book ‘Dialogue and Desire: Mikhail Bakhtin and the Linguistic Turn in Psychotherapy’ (published 2008: Karnac), which embeds dialogism in Bakhtin’s wider philosophy, serves to clarify what can otherwise be confusing concepts. Rachel’s creative use of dialogism, her love of language and her sustained experience of CAT means that she has been able to jump right into this new editing role with ease and thoughtfulness.
Editors: Julie Lloyd and Rachel Pollard
Assistant Editor: Tony Ryle
Editorial Advisors: Jason Hepple and Annie Nehmad
Reflections on a Dilemma in a Supervision group: Caught between a Rock and a Hard Place
Gil-Rios, Dr. C., M., and Blunden, Dr. J., 2012. Reflections on a Dilemma in a Supervision group: Caught between a Rock and a Hard Place. Reformulation, Summer, pp.23-25.
Sleep Tight: Working Creatively with Dreams in CAT
Coulter, N. and Rushbrook, Dr S., 2012. Sleep Tight: Working Creatively with Dreams in CAT. Reformulation, Summer, pp.7-12.
Using a Cognitive Analytic Therapy approach in working with Eating Disorders: Reflections on Practice
Wicksteed, Dr. A., 2012. Using a Cognitive Analytic Therapy approach in working with Eating Disorders: Reflections on Practice. Reformulation, Summer, pp.26-31.
What is the 2005 Mental Capacity Act and how can CAT help us to make sense of the decision making process at its heart?
Brown, H. and Lloyd, L., 2012. What is the 2005 Mental Capacity Act and how can CAT help us to make sense of the decision making process at its heart?. Reformulation, Summer, pp.35-42.
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