Curiosity and CAT

Ryle, A., 1998. Curiosity and CAT. Reformulation, ACAT News Spring, p.x.

Curiosity and CAT

Tony Ryle

It is about twenty years since the first papers anticipating CAT were published and thirteen years since the first workshop was run. Satisfaction with the speed with which the use of the method has spread and with its developing organisations and trainings must, however, be tempered by one regret : 90% of the CAT literature is the work of only two authors and the yield of published research remains scanty. Psychotherapists are notoriously intellectually lazy but we should be different, for CAT was the product of research. Not of research that was either large scale or particularly original, but research as systematic enquiry which demanded conceptualising what it was one was trying to do. It was from thinking about how to define the aims and how to measure the effects of dynamic therapy that CAT emerged.

We need research and conceptual argument if CAT is to remain a developing model and method rather than a box of tricks packed into a small time frame. As regards concepts, when will someone produce a serious critique of some aspects of CAT? And, as regards evidence, we need to back up more thoroughly our belief that it works and we need more information about how it works. While some formal research in academic settings is now happening, a great deal of clinically based, less formal inquiry and audit could be going on within the context of services offering CAT.

A Few Ideas

Many CAT practitioners have experienced receiving both CAT and dynamic therapy; how do these experiences differ? I asked the trainees on the first advanced course this (anonymously) but I only received four or five (very interesting) replies. Someone could try again. On a similar issue, many CAT practitioners continue to practice both in CAT and in another mode of therapy; how do they do it? Do they switch between different, dissociated self states? Do they arrange the chairs differently? Does cross infection occur in either direction? Given that CAT is a framework within which many different interventions are used, what aspects of the framework do they discard when in their other mode (apart from the time limit)? If the other mode has useful techniques, are they ones that could be incorporated within CAT (meaning deployed with the aim of procedural revision)? To me, CAT is a method based on a theory of personality and a theory of change, and I would find it impossible to think differently. However, presumably there are, for example, therapists who are Jungians on Mondays and Thursdays and CAT therapists on Tuesdays and Fridays. Accounts of how this is done would be of real value.

Opportunities for research often present themselves but are not taken up. For example, the recent advanced course in London introduced two innovations, one was a long term personal CAT for the trainees, and the other was the requirement to do one 36 session CAT. As far as I know (and I hope I am wrong) no systematic inquiry into the experience of giving or receiving the long term CAT is being carried out. Thus nothing is really known about it beyond the vaguest impressions. As regards the 36 session CAT, a perfect opportunity was presented for research into the effect of duration on outcome, requiring only that therapists treated randomised cases of matched severity in both 16 and 36 session frameworks. As it is, we will be no wiser.

Similar opportunities exist or will exist for simple, randomised controlled trials wherever CAT is provided alongside psychodynamic or cognitive behavioural therapies. It requires no more than a common assessment procedure and an agreement on which cases are acceptable to both. It is even valid to allow patients to choose between the methods, randomising only those with no preference (see 'Patient preferences and randomised clinical trials' by C.R.Brewin and C.Bradley, British Medical journal, 1989, 299, p 313). Crude outcome measures such as administration of the Beck Depression Inventory before and after therapy, and the short forms of the Inventory of Interpersonal Problems and the General Health Questionnaire, are undemanding and acceptable to most patients. Records of the use of services before and after the intervention are valuable but are more difficult to collect. There are also services which offer long term therapy as well as CAT, presumably they could describe clearly what they believe to be the indications for long term therapy. Presumably they also accumulate waiting lists; randomising half the patients to CAT (after which long term therapy could still be offered) would clarify the indications for long term work, would probably save some therapist time, and might demonstrate different effects for the two treatments.

These are only a few ideas, there are lots more floating around in the 150+ CAT heads about which we hear nothing. It is probably the case that because clinical loads are always pressing, research and thinking are given low priority, but this is neither sensible nor economical. I wish that there were more risk of curiosity killing this CAT.

Tony Ryle

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Full Reference

Ryle, A., 1998. Curiosity and CAT. Reformulation, ACAT News Spring, p.x.

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