How and when did CAT begin?
Cognitive analytic therapy (CAT) developed from the interplay of two of Dr Anthony Ryle’s main interests during the 1980’s in the UK. These were firstly, the development of a common language for the psychotherapies. Secondly, he was interested in identifying distinctive problematic patterns of interaction, early in therapy. He aimed to describe these patterns in plain language, in a joint endeavour between therapist and client. Together they could use pattern descriptions to evaluate progress throughout, and at the end of therapy.
The first interest brought people from different traditions and different professions together under the cognitive analytic therapy banner. The second interest gave rise to a rich therapeutic mechanism of change, resulting from sharing a compassionate prose description of problematic patterns. CAT terms describes these as target problem procedures. The therapist would produce the prose description based on what the client had shared over early sessions and the relationship they were building. The written description took into account the person’s personal history. It also described ways these patterns might be enacted in the therapy. The therapist would share it with with the client by reading it out loud. Alongside the prose description, CAT also made use of diagrams to help summarise important relational roles and target problem procedures. These acted as a visual representation of key patterns.
What were the key influences on CAT?
Ryle was an early exponent of psychotherapy research. He developed empirically derived conceptual tools of the reciprocal role (RR) and reciprocal role procedure (RRP). He developed these from George Kelly’s Grid and personal construct theory. Ryle used RRs and RRPs as a way of organising the client’s experience of making meaning in their lives. The concept of reciprocal role patterns described some of the complexity of psychoanalytic and object relations theory in a clear and accessible way. The idea of the procedural sequence described the repetition of unhelpful and unconscious patterns of interaction. Ryle developed a practical means of putting the two together in one model.
This gave rise to a versatile form of therapeutic formulation including both the more analytic way of seeing object relations, combined with a more cognitive understanding of problematic patterns being replayed. This reformulation could describe and explain the individual’s internal emotional landscape, the history shaping this, and problematic patterns arising. Additionally it provided an account of how relational dynamics lead to patterns being perpetuated in the present. Such patterns could be seen in interactions with self and others.
Other theoretical influences that have informed the CAT approach include Lev Vygotsky’s Activity Theory, in particular the concept on the Zone of Proximal Development (ZPD), and Mikhail Bakhtin’s writings on dialogism.
How has CAT developed over the years?
Since Ryle’s early work, the cognitive analytic therapy model has developed further in collaboration with many others. He and a number of colleagues wrote a more comprehensive account of the model’s development to mark thirty years of CAT. The authors also described CAT’s evidence base at that time. They outlined ways in which it had been applied in many different areas beyond individual therapy. You can read ‘Cognitive Analytic Therapy at Thirty’ at this link. ACAT also keeps an updated list of publications on CAT’s evidence base which you can visit through this link.
Therapists now use CAT in group therapy, and as a model for consultation and contextual reformulation with teams. Additionally CAT is used as a useful framework for understanding and working with organisations. A brief application of CAT for aiding awareness of work-related patterns helps to enhance professional development. In recent years, research has found that CAT-based guided self help delivered through NHS Talking Therapies services (previously IAPT) is as effective as CBT-based guided self help.
Anthony Ryle died on 29th September 2016. His colleague Ian Kerr wrote a more detailed account of his life and contributions. You can read ‘Tony Ryle: A personal appreciation and obituary’ at this link.