Do we allow CAT to have a heart? Is it soft and wet? A Response.

Dunn, M., 1997. Do we allow CAT to have a heart? Is it soft and wet? A Response.. Reformulation, ACAT News Winter, p.x.


Do we allow CAT to have a heart? Is it soft and wet? A Response.

Mark Dunn

These are some thoughts in response to Liz McCormick's article in the last Newsletter.

In talking about the theory and practice of CAT there seems to be a trend towards using the word 'heart' as a metaphor for Jung's 'feeling' function where the word 'head' is used for the 'thinking' function. This is one of the key areas of therapy research and interest - the relationship between thinking and feeling and how they fit together. There is plenty of theorising ('head') about how thinking and feeling fit together, theorising that is debated passionately ('heart') in cognitive and analytical circles. There needs to be more debate in CAT circles.

The physical heart lends itself to metaphor particularly well because it is always involved in the responses of the autonomic nervous system, the system for arousal in the body, by pumping blood round the body at a greater rate. Arousal of course is caused by all sorts of things but most often what is perceived by the mind (for example the need to fight or flee, or sexual arousal). Physical sensations of arousal accompany or become associated with states of mind/self which are associated in turn with particular affects/feelings. In describing these states there is a choice of language, either medical-psychological descriptions or metaphoric descriptions.

When using metaphors, the 'heart' metaphor is an obvious (almost literal) choice as Liz demonstrated in her piece. But it is not the only choice. For example the stomach and intestines (away from which blood flows when aroused) is also much used as a metaphor; eg butterflies of anxiety in the stomach, stomach knotted with anger, feeling gutted with loss, bowels turned to water with fear. Other parts of the body also have their associations, eg the eyes, to see clearly into complex things, to see red with rage, to be blind to reality, to see life through rose tinted spectacles. The pain of despair and depression is often associated with the mind which is predominantly located in the head, or to be manic or hysterical is described as losing one's head.

'Heart' can be used metaphorically to describe any attribute or affect as Liz clearly demonstrates, but how helpful is that? Can one not equally say that a CAT therapist needs to have guts, eyes and a clear head? Perhaps it is better to say that CAT therapists need to be able to speak in both psychological language as well as metaphoric language; to know the difference between the two; and to be able to translate between the two.

In a therapy session the therapist needs to be able to think clearly to sort out TPs, TPPs and Exits while at the same time feeling empathically, to resonate with the core pain or its hiddenness. Both are required to do effective therapeutic work. Liz seems to be suggesting that metaphor is the best way to convey feeling and that without it therapists become prey to over-thinking.

The debate for me is more about the place and uses of metaphor in the practice of CAT- when is it most effective, how much or how little, whose metaphors etc. It is a complex debate which includes 1) descriptions of the nature of psychological reality, for example 'personification' in descriptions of self states (what is the difference between using the phrase "your 6 year old inner self, Mary, who is frightened of grown-ups" and "the reciprocal roles of abusing to abused"). This is in effect pretending that there are entities in the mind; 2) TPPs rendered as poetry (such as in the dilemma "either heaven or hell" or "bliss or combat"); 3) the use of fairy tales in creative writing to vision Aims and Exits.

At the same time one is hoping to use the patients' own language which is often neither metaphoric nor psychological. From the first session the patient is being taught and to a certain extent restricted to the language of the psychotherapy file. This is an excellent simple cognitive language and it helps the patient to think more clearly, to be more cognitive (also to think more clearly about feelings). Does it resonate with or access feelings? Not in my experience. That tends to happen with the Reformulation's empathic description and feeding back of core painful-event disclosures (using 'feeling' words) and is deepened by metaphoric descriptions of coping. We hope the two languages will go hand in hand but often end up fudging the issue, going one way or the other depending on the patient's responses - some are more comfortable with metaphor, others with psychological language. 'Filespeak' is a clear and simple language that can describe thoughts, feelings and actions. What then is the point of metaphor? Do we need it? How does it help?

The following diagrams demonstrate the translation issue. Which is more effective / helpful? Does it matter? Is it simply a question of style? Is it only necessary to be able to do such translation when writing up a case for accreditation?

The original question 'does CAT have a heart' raises other issues for me. If CAT doesn't have a heart, is 'heartless', then from who or where is it missing? From the model, the therapists, the training courses, the trainers? The model might simply be described as accurate description of intra and interpersonal procedures operationalised towards change and therefore having no need of such a notion. The model might be described as 'heartless' in that it is brief with a generally nonnegotiable ending. If heart is not in the model it must reside in the therapists and trainers and the practice of therapy. How might one recognise a therapist with a 'heart' or a 'heartfelt' approach? How might one describe such a person - she's got it, he hasn't, she might develop it etc. I feel that the idea of 'heart' is helpful but needs to be carefully defined by debate. For me it points to the transcendental / spiritual / metaphysical / imaginational elements of relating both to oneself and to others, elements which are not a core part of the model of CAT but which are increasingly important to both patients and therapists. The question for me is can they be integrated or do they have to stay outside the frame of CAT.

Fig 1.

Mark Dunn

Full Reference

Dunn, M., 1997. Do we allow CAT to have a heart? Is it soft and wet? A Response.. Reformulation, ACAT News Winter, p.x.

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