Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?

McCormick, E., 1995. Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?. Reformulation, ACAT News Summer, p.x.

Do We Allow CAT To Have A Heart - And If We Do, Does This Make It "Soft And Wet"?

Liz McCormick

This title and question comes from a debate circulating within CAT about a possible 'split' between 'head' and 'heart . Some practitioners believe such a dichotomy to be false and non existent, others are concerned that CAT could become,or is becoming too abstract and intellectual,loosely defined as 'heady', thus losing 'heart', and demanding theoretical rather than practitioner competencies.

Because I've been interested in the heart for a long time both as a pump and as an image I've elected to offer some ideas about how we might reframe the concept of heart for use in our work in CAT, a heart which is neither the head nor the heart of the perceived split. I have only recently focussed on a reframed idea of the place of the heart in therapy, so my ideas in this paper are in their beginning phase.

Generally I see 'heart' as something central warm and human, which serves the circulatory needs of the whole, and which is to do with forms of communication as well as relating and which is potentially unifying.And I'm going to talk generally about heart first, before focussing on four specific aspects of heart..

I am suggesting that a recognition of the concept of 'heart' and an understanding of its value and how to keep it beating, is of importance for all therapies. This is especially so today as therapeutic interventions and the training of therapists are under such scrutiny. We all acknowledge how difficult it is to assess the successful ingredients of a therapy, and CAT is more available than most. But as so often happens when under pressure to achieve outcome or cost effectiveness , the less easily defined areas tend to go to the wall, and those that can produce statistics and studies rise. The price can be in terms of relationship. I am aware of how few therapists speak out for the heart both because they are unsure in what language to present it, and for fear of being seen as soft and wet, inferring non professional and weak.

It is also perhaps important for CAT to consider seriously its view of 'heart' because , and I am drawing from Tony Ryle's words at the last AGM, in CAT we CAN hide ourselves behind structure and activity, behind the busy-ness of complex diagrams and clever reformulations that can be more a defence for us, than of help to the patient. And I would like us all to have a choice in this.


HEART = Essence, interiority, central, life, spirit, chief thing, affections, courage.


The word 'Heart' is embedded in our language. Long before the heart of Harvey that I call the 'worker heart', we understood 'heart' to be both the magnificent central pumping station that lived within our chests, and to be something to do with our feelings that caused this heart to react. A body/mind link that has engaged the poet's pen and the composer's ear for centuries. Thus we speak of being broken hearted, when suffering loss; hard hearted when defending against pain; lionhearted when being brave; wearing our heart on our sleeve when being vulnerable or exposed; softhearted when giving in. We speak of our hearts like no other part of our anatomy. Our heart sinks in disappointment; leaps into our mouths in anxiety; our heart soars with pleasure, sings with joy; is darkened by fury. And we lose heart when things we have worked hard for feel as if they are slipping away.


The heart has long been associated with love: "The heart has its reasons that reason knows nothing you love by reason..?" Blaise Pascal.

We use heart to describe a central place, the fulcrum, the fount. To get to the heart of the matter, the heart of the issue,is to get to what really matters and has meaning. And heart can be seen in a wider context as something universal, something that unites and joins us all in the common purpose of being human. The heartbeat of this universal heart, seen in Transpersonal Psychology and in religious systems as being sacred and of ultimate value, offers a wellspring and continuity for the human spirit.

Images of heart, whether visual and ancient such as the sacred heart of religion, or popular heart shapes carved on trees or entwined in love letters, or those that speak directly to the heart strings via music and poetry, seem to have the power to communicate some profound timeless essence which can elicit change in consciousness as well as healing.

When we lose collectively the value of an image of the heart as a useful and potent symbol of meaning it becomes demoralised and polarised.

Thus we have in CAT terms a dilemma:

EITHER the image of the pump, masculine, mechanical, the heart we nave learned to control with diet and jogging whose heartache is soothed by betablockade, the heart we can take out like the engine of a car,and repair, bypass, scrape out , replace,swap. And the boast of cardiology is that a patient can be home within the week of a coronary artery bypass graft. (we are only just learning about post bypass pump depression and psychosis.)

OR the oversentimentalised feminine image of the heart, the Valentines Day greetings card, red plush satin hearts in pink or rosy red,surrounded by embroiderie anglais and sequins, slushy, soppy,

We might create a dilemma to work with like this:

EITHER Managed automatic pump cut off from feeling

OR satin cushion,unreal, sentimentalised feeling.

Neither image is related to robust real feeling, to the heart previously described as central, and the heart we need to be unifying in this greater sense is devalued, encouraging rational, quantifiable, reasoning forms of thinking to move into the ascendancy, to take control. And perhaps such polarisation encourages the head/heart split, which might, on a diagram look something like this:


What is missing is an image of a heart that is both strong and vital, complex and central, made of the strongest muscle in the body that is also the most imaginative,sensitive and responsive to human contact.And in CAT terms, an exit by means of a model of both 'thinking in the heart' and 'looking through the eye of the heart'.

So how can a revised concept of heart actually help us as therapists?

Every day we sit in a room with another person and engage with the pain and drama of chronically endured suffering, that at times touches our own. We must supervise and support each other as we do this work,or train others in the ways to become therapists. We have our fine and continually developing theory, but we must also find a way of maintaining our daily heartbeat and pulse rate, as well as drawing refreshment for our minds,bodies and souls, or our tired and overstretched hearts.I believe that bringing in a re evaluation of heart in its fullest sense, might help us to do this.


In his commentary on Kundalini Yoga, Jung refered to 'Annahata',as thinking in the heart-the lifted up heart.This is perhaps a useful image for a heart which meets both thinking and feeling and begins to heal that potential split between head and heart.

Jung writes: 'we may know something for forty years but it may never have touched the heart, it is only when it has touched us in the heart that we really take notice of it" This thinking and looking in the heart may have many properties of value to us. I am going to name and outline just four areas of heart which I think could be allowed to be named as part of CAT.


The word courage comes from Latin through old French and Middle English. From coeur. Courage means:Bravery, valour. self reliance, fearlessness, daring, nerve, boldness, hardihood. spirit.

also: gameness, pluck, spunk, guts, heart.

I think that CAT is a courageous therapy. Our structure helps us to take the courage to work with people for whom a lack of structure would be devastating, both to therapist and patient. The severely damaged patient with poor boundaries and core pain stemming from abuse, annihilation, rejection, abandonment. CAT gives us courage because it gives us the words to name where we are, even when we become the bullying abuser or the negative spider mother for a patient who would scratch our eyes out or disappear into the void.

And after naming it, we need courage because we do not duck out of experiencing the core pain. The enforced crucible of short focussed time means that we get near to it quickly, often just before the end.It takes courage to endure it, whether this means entering it with the patient in the session or enduring it through witnessing the patients life and life effort. I am thinking particularly of Tony Ryle's patient who wrote about the 'day of great human sadness' whose tragic core pain was only available within his writing.

It takes courage to let go of a patient with whom we have shared so much in a short space of time, for whom we fear. And when the structure of CAT holds us in these experiences we feel the 'tough love' of the heart of CAT.


James Hillman writes: ."Imagining with the heart refers to a mode of perception that penetrates through names and physical appearances to a personified interior image, from the heart to the heart ... In this perspective personifying is not a lesser, primitive mode of apprehending but a finer one. It presents in psychological theory the attempt to integrate heart into method and to return abstract thoughts and dead matter to their human shapes."

Through the heart we imaginatively enter anothers world,and invite the telling of their story, and the writing of their story, and we make patterns and shapes in the form of our understanding of sequences. We use our imaginations when we dance on the interface between patient and therapist, as we push where it moves, and move it along. We bring the life story and its learned sequences and patterns into focus. We communicate with dream and symbolic language.

As we tune into the rhythm of an imaginative stream we allow the heart to direct our own creativity, to let us know what questions to ask of whatever image is presented to us. To say:..what is this like;if you could paint or draw this,what image, colour, shape would it have; with symptoms of the body we ask: 'if this could speak, what would it say'.And as well as evoking this personal imaginative language we bring past and present together and move into the would you like it to be, or have been. .what might you do,have done which is different.

We assume that when faulty procedures are named and revised, that a healthier way of proceeding will be born.In so doing we are evoking the possibility of something other, something not on the rating sheet, and of the reawakening of parts of the patient that have been in eclipse.


The heart as the engine, or power house,the great pumping house of effort. The heart's main function is primarily for effort.In the literal biological sense the effort of the whole body.

Everytime we breathe, think, blink,feel, sigh, run, walk, get cross, feel anxious,feel moved, our heart moves.

The heart of effort we make in CAT is the effort of focus, accurate description, of naming the procedural sequence from out of the chaos of presented material.

We make an effort by having our own personal therapy. When we have dared to give voice to our own locked up pain we know exactly what it is like to sit in the patient's seat. We've felt our own heart beating furiously and in this way we KNOW it in the heart. So when we sit in the therapist seat we know what it is like to bear that vulnerability.So our effort is one which unites our theoretical understanding of reciprocal role procedures with felt life.

The heart can also be seen as a nucleus of the integration of several models of thinking about human behaviour and its development, as well as our own responses of thinking and feeling. We call CAT theory and structure the scaffolding upon which our relationship with the patient takes on the flesh and blood.

And moving into a wider dimension of heart, the universal heart, integration which allows a freedom from the tyranny of survival procedures that create the "adapted self" then allows space for 'real self' experience. And for the possibility of something 'other',whether it is an experience of 'self' of spirit, or of God..


I see this as the lifeblood of the work. It is the ingredient that brings juice to lubricate the machine. And the love I mean is compassion. A genuine feeling for the dignity of a fellow sufferer; And CAT, with its emphasis on collaboration makes us all fellow travellers on life's road.

We need compassion in order to share pain with feeling but without getting lost in it,and we need compassion when we find people tedious, difficult, or nearly impossible, when we are tired and fed up or have just had a row with someone we love. It is the juice of compassion which lubricates rigidity and dryness, when all we can see is repeated procedures and vicious circles, whether our own or another's.

It is this kind of heart which, by its ebb and flow and its capcity for stillness gives us time to see clearly what we are doing, what traps or dilemmas we get caught into ourselves.

It's the voice that says: 'wait a minute ; ' give me a break','does it have to be like this?'. Which asks for help and reaches out to others.

There is no copyright or patent on love. In psychology we tend to fear it. It gets pathologised and negated as libidinous drive and in love's name many narcissistic power plays and seductions are played out. Love has been abused by the 'guru' and 'saviour' cultures.

And yet most of us know that when patients can receive or give an experience of love, they do well.

In Persuasion and Healing there is the account of a Korean woman who suffered the delusion that her nose was growing bigger, a fear which had made her agoraphobic. After visits to doctors and plastic surgeons she had one hour and a half with a psychiatrist. She left unconvinced, but a follow up call eight months later revealed she had resumed her activities. When asked what had helped her she said ' I loved Dr X. He had a feeling I wanted to talk and he let me talk".


Since one of CAT's hallmarks is naming things,would it be useful, or even a relief for us to name an integrated, 'thinking in the heart' heart of CAT, so that we might look through its eye and benefit from its qualities.

If within a heart that has scaffolding and which is courageous,imaginative and a fulcrum for effort,we are able to offer and receive a form of compassionate love, does this make us soft and wet?

Or do we 'think' that naming it, makes us 'soft and wet'? And if it does, does it matter?


Blaise Pascal, Pensees, 1670.

C.G. Jung, Commentary on the Kundalini Yoga, Spring 1956.

James Hillman, A Blue Fire, 1989.

Frank & Frank, Persuasion and Healing, 1961.

E. Wilde McCormick, Healing the Heart, Optima 1992.

This paper was delivered at the ACAT Conference, February 1995.

Author's note: This piece was written to be read aloud, and not as a piece of writing.

Liz McCormick

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Full Reference

McCormick, E., 1995. Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?. Reformulation, ACAT News Summer, p.x.

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Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?
McCormick, E., 1995. Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?. Reformulation, ACAT News Summer, p.x.


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