Introduction to Cognitive Analytic Therapy: Principles and Practice

"Well, I got into this really because of the key question: ‘How on earth is it that people change?’ When I was learning as a trainee, I was taught in one particular school of therapy about how change could happen. I then went to another institution which taught me a very different model of therapy. And in both cases, each of the two schools spent a lot of time slagging off the other school, saying, ‘No, no, this is not like this, it’s like that.’ In each case, they said there’s no way change would occur if you used the other model. But my experience was that actually change occurred in both models. I thought, what on earth is going on here? It lead me to my own research, which actually tries to identify the common factors that bring about change. But what Anthony Ryle did was very much the same. He started from the same position, which is: ‘Hey, there are lots of schools of therapy which can be helpful. Can we not distil the really important bits from all of them?’ He tried to pull together ideas from cognitive therapy, about our thoughts and how we think, together with dynamic therapy, which is based on psychoanalysis but has been changed over the years, to being more about the models we have in our head of relationships. “CAT tries to help you to understand why you are behaving in ways which actually defeat yourself” So, he’s putting together how we form relationships with others—and in particular how the models in our head, often derived from childhood, influence how we relate to each other in the present—together with how we think—the cognitive bit—into a formulation of the problem. Central to cognitive analytic therapy is a formulation which you draw up collaboratively with your patient as to what’s going on. A systematic analysis of the patterns of behaviour that people get into. Here’s an example. I’m exhausted. Each time I get home from work, I’ve got my kids screaming for food in the car. At that point, I feel as if I’m a bad mother and a bad, selfish person because they are crying, and instead of being at home I’ve been out at work all day. Say I then start making a very nice homemade quiche or something, which they turn their noses up at. I then scream at them because they’ve turned their nose up at it, and they get all upset. What they want is a beef burger. And I then decide that proves what a ghastly mother I am, which makes me strive even harder to do even better next time, which is to make an even better meal for them, which makes me even more exhausted. It is actually completely dysfunctional, because what I’m trying to do is solve a problem—my belief that I’m a bad mother and a bad person—using old patterns and ways of thinking, and not really attending to what’s going on in my own life. So, in that sense, I am perpetuating, despite the best of intentions, dysfunctional ways of behaving. So what Cognitive Analytic Therapy (CAT) does it to try help you to understand why you feel like your own worst enemy and you’re behaving in ways which actually defeat yourself. Yes and no. Again, behaviourism is an important school within psychology. When I first trained in clinical psychology back in the 1970s, we only had two or three main set of theories to draw on. One was psychoanalysis, which I won’t go into now, and the other was behaviourism, which really says that what we need to do is to look at what people do, and change the consequences of what they do or the rewards they get to change their behaviour. In some situations, that works very well. But in the 1970s, people started thinking that we actually needed to add in the way people think. And so Cognitive Behavioural Therapy (CBT) was a combination of the behavioural ideas with the cognitive ideas. Increasingly now, cognitive therapy is popular rather than cognitive-behavioural. But going back to CAT—that is combining the cognitive bit and the psychoanalysis bit, and actually there’s some behavioural therapy in there as well, and there’re some systems thinking in there as well. So, cognitive analytic therapy is at least four different theories, buried in together and centralized by trying to formulate it for the individual patient."