Keeping cat alive

Ryle, A., 2007. Keeping cat alive. Reformulation, Summer, pp.4-5.


About 70 years ago I was chosen to be the cat in my school’s annual production of ‘Alice’.

This involved my perching on a window sill concealed from the audience by a black plywood board through which were cut out the main features of the cat’s face. There was a light in my cramped space and there were wooden slides pivoted in such a way that each of the features could be either blocked off or opened so that the light shone through. My job was to use the slides to control the appearances and fadings of the cat’s face.

While I played a part in the appearance of CAT I do not think it is any more in anyone’s power to make it fade, thanks to the hard work of all those who built up the organisation and maintain the many teaching programmes. But I do sometimes fear that the light may grow dim and the features become indistinct.

ACAT exists to support both the practice and the theory. Given that CAT as a defined approach has only existed for about twenty years, that it has never had a single academic base and that training has taken place in an increasing number of places it is in many ways remarkable that a coherent body of theory and practice has been established. Inevitably, this has involved to a large extent the passing on of received theories and practices. The continuing the strength of CAT depends upon its evolution and that demands an active debate about ideas, both within ACAT and with others, and continuing research activity. Up to now this debate has depended on a small, but slowly increasing, body of people. I think there is a widespread belief that research and debate are not the business of the rank and file (among whom many complain about our inadequate research base) and I would like to challenge that view.

In reality, we have accumulated much interesting research into the process of therapy, and in respect of outcome the Melbourne study, currently being written up, is probably the best designed RCT of any psychotherapy model. But such specialist, expert research is only one of the ways in which research is needed. Most new ideas come from small scale studies, often involving no more than systematic observation, generalisation and thought. The refining and testing of disprovable hypotheses in the spirit of Popper is a late stage, even in fields far less complex than human psychology.

I believe there are numerous areas where clinicians using CAT could and should be recording new facts and generating new ideas. For example, I would point to the following possible topics and there are doubtless many others:

  1. Case histories drawing attention to new applications in new contexts or to problems which are poorly managed in current practice.
  2. Systematic descriptive studies of particular diagnostic groups.
  3. Participation in ongoing research. One example is the current single case experimental design study of CAT for BPD. The number of people joining this up to now is disappointingly small.
  4. Describing and evaluating the increasing and very important use of CAT as a basis for training and supervising non-therapy staff in various settings. Preliminary studies have been reported and provide a model.
  5. Making use of existing but under-used research tools, such as repertory grid techniques (where John Bristow now offers access to the computer programs and advice) and the States Description Procedure to investigate the nature and effect of interventions.
  6. Giving serious consideration to overlaps with, and significant differences from, other therapy models, for example by reviewing books and papers of interest in ‘Reformulation’.
  7. Keeping up with the literature--our own and in related fields. I did try to review this regularly in ‘Reformulation’; I depended on others sending me references, but only two colleagues ever did. I have therefore stopped, but somebody more actively involved in current practice and with easy library access should surely take it up. (See below – two recommendations)
  8. Refining theory. CAT theory evolved from generalisations drawn from clinical work and from many small scale research studies and from the selective acceptance and critical rejection of key aspects of existing theories. There were few large ‘aha! moments’ but the current theoretical framework is the culmination of a long process of assimilation and transformation. One function of theory is to alert us to phenomena which otherwise we might not see and from time to time new ideas did emerge. For example, when the first ‘split egg’ diagram of a borderline subject was described further recognition, descriptions, and understanding of dissociated borderline structure became widespread, and the theoretical understanding and management of BPD was improved.

But Warning

We do need some prior concepts in order to see phenomena but there is a danger here: As Kuhn (1962) described, the paradigms shared by a scientific community can all too easily lead to the failure to see phenomena contradicting or not encompassed by them. CAT offered a paradigm shift from most of the theories in the field of psychotherapy and it still needs to do so, perhaps most centrally in establishing the social and dialogic structure of human personality in place of the monadic ‘in the head’ assumptions of much contemporary psychology. CAT too might become a restrictive paradigm for unreflective practitioners.

CAT theory is not a doctrine. There is no inner circle of disciples charged with preserving its purity to whom, imitating Freud, I have given rings. Every practitioner has the right and duty to observe and report how the theory makes sense of what they see and how well it guides what they do. If it turns out that they have misunderstood the theory it is likely that so have many others and that the theory needs clarification. If it turns out that the theory is wrong or does not work in some circumstances, then describing this will contribute to its further growth.

Having said all that it should be noticed that 2006 brought two very welcome developments of CAT theory and practice:

Stella Compton Dickenson. 2006. Beyond body, Beyond words: Cognitive Analytic Music Therapy in forensic psychiatry – new approaches in the treatment of personality disordered offenders. Music Therapy Today. Vol 7, 4.

Rose Hughes. 2007. An enquiry into an Integration of Cognitive Analytic Therapy with Art Therapy. International Journal of Art Therapy: Inscape. Summer edition.

Full Reference

Ryle, A., 2007. Keeping cat alive. Reformulation, Summer, pp.4-5.

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