Cognition Analytical Therapy (CAT) Flashcards
What is CAT?
Cognitive analytic therapy (CAT) is a time-limited therapy informed by cognitive–behavioral therapy, psychodynamic psychotherapy, and more recently the work of Vygotsky (Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar]). It is a relatively new therapeutic model, developed initially by Anthony Ryle (1990; Ryle & Kerr, 2002) specifically in response to the needs of the National Health Service (NHS) for treatments of short duration. CAT is structured, consists of clearly specified procedures, and can be applied to a wide range of conditions in many settings (Denman,2001Denman,C.2001.Cognitive–analytic therapy.Advances in Psychiatric Treatment, 7:243–252.[Crossref],,[Google Scholar]; Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar]). The empirical status of CAT is best described as emergent. There are currently no high-quality efficacy or effectiveness studies and few process studies of CAT.
The reformulation letter
A central feature of CAT is the reformulation of patients’ presenting problems. The termreformulationis based on the assumption that patients already have their own understanding of their experiences, including problematic ones. Reformulation denotes the transformation of this understanding into a more explanatory and useful form, in collaboration with the therapist (Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar]). This is considered a particular form of education aimed at extending patients’ self-knowledge (Bruner,1986Bruner,J.1986.Actual minds, possible worlds,Cambridge, MA:Harvard University Press.[Google Scholar]; Ryle,1994Ryle,A.1994.Persuasion or education? The role of reformulation in cognitive analytic therapy.International Journal of Short Term Psychotherapy, 9:111–118.[Google Scholar]). Therapists explain this aim, and an important feature of CAT is the reformulation letter, written by the therapist. In the letter, given to the patients at approximately Session 5, patients’ life histories are retold, emphasizing personal meanings and emotions and showing how present ways of living represent the strategies developed to cope with early life. It is stressed that the letter is a provisional one and open to revision by patients.
experience of being seen by a thoughtful other with sustained attention
The experience of being seen by a thoughtful other with sustained attention is believed to be uniquely powerful, so the process is expected to raise patients’ morale and strengthen a working alliance. Offering an understanding of dysfunctional interpersonal processes, even before patients can fully grasp them, appears to provide a secure context for the therapeutic work and facilitate an increased awareness of feelings and access to memories (Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar]).
understanding of dysfunctional interpersonal processes
Offering an understanding of dysfunctional interpersonal processes, even before patients can fully grasp them, appears to provide a secure context for the therapeutic work and facilitate an increased awareness of feelings and access to memories (Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar])
meaningful story out of jumbled accounts
The development of a meaningful story out of jumbled accounts can contribute to developing personal meanings, essential for the achievement of psychological well-being (Crits-Christoph,1998Crits-Christoph,P.1998.The interpersonal interior of psychotherapy.Psychotherapy Research, 8:1–16.[Taylor & Francis Online],[Web of Science ®],,[Google Scholar]).
a document to keep and return
writing the reformulation in a letter provides patients with a document to keep and return to as they wish (Burns-Lundgren,2004Burns-Lundgren ,E.2004.Review of “Writing cures: An introductory handbook of writing in counselling and therapy.”Reformulation , 23 ,http://www.acat.me.uk/library_pages/?type=198.[Google Scholar]).
At the end of therapy, the therapist and patient exchange “good-bye letters.” The aim of the therapist’s letter is to represent the progress made in therapy and offer a realistic view of their relationship with the patient. In the same way, the patient’s letter, always suggested but not always produced, invites accurate reflection on the therapy (Ryle,1990Ryle,A.1990.Cognitive analytic therapy—Active participation in change: New integration in brief psychotherapy,Chichester, , UK:Wiley.[Google Scholar]; Ryle & Kerr,2002Ryle,A.andKerr,I. B.2002.Introducing cognitive analytic therapy: Principles and practice,Chichester, , UK:Wiley.[Crossref],,[Google Scholar]). It is hypothesized that these good-bye letters help patients cope better with termination and provide a record of the therapeutic process that they can keep through follow-up and beyond.
