Tag Archives: Therapeutic Alliance

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CAT Across Cultures: Challenge & Encouragement in Equal Measure

Are you using Cognitive Analytic Therapy across languages? With culturally diverse communities? Do you supervise or support such work by other therapists? Do you use CAT consultation in teams where staff get stuck around cultural or religious issues? Have you struggled to incorporate the impact of race and racism in formulations? Does your own heritage and identity figure strongly in how clients engage with you? Has your CAT training sufficiently addressed issues of power?

These can be emotive topics and can evoke powerful responses in us. How do we manage such responses and where can we take these within our CAT practice? 

CAT practitioner Rhona Brown shares some background to Jessie Emilion’s forthcoming training day and why it may be of interest.

We at Catalyse are delighted that Jessie Emilion took up the invitation to lead a day “Exploring Issues of ‘Race’, Culture and Language within a CAT Framework” on 20 July in Liverpool.

Cognitive analytic therapy is of course a radically social model which is explicit about how issues of cultural and subcultural difference are procedurally enacted in therapy. It offers us a way to make the political personal and create shared meaning across cultural divides. Establishing CAT training in Bangalore in India over the last six years, Jessie’s had ample first hand experience of adapting CAT in response to the cultural context in which it’s practised. She also articulates how CAT concepts are shaped by such international experience. Along with Hilary Brown, she published a chapter in Deborah Pickvance’s book, on CAT supervision in the Indian context which brought to life ways in which CAT theory is extending in order to more explicitly realise its radically social basis.

“…through our case discussions, we came to think about dilemmas, traps and snags as being held in the culture rather than exclusively in the individual….. A snag might actually be a prohibition, a dilemma a threat of exile as the punishment for non-conformity and a trap a vicious cycle created by poverty and disadvantage …..The metaphor of the ‘dance’ [in CAT theory] in which each individual seeks reciprocation from others, fails to acknowledge the power dynamics at work in a society. ….The dance does not happen in a vacuum but is structured on the basis of positioned roles, selectively occupied on the basis of class, race, age or gender.”

The Catalyse practitioner training has long included space within its twenty training days to consider what has become known as the “SCOPE of CAT” – social, community, organisation, political and economic aspects. It was a privilege to be able to contribute to these training days for a few years, thinking together with successive trainee cohorts on how to engage with such issues, alongside Deborah Pickvance.

The diversity of perspectives held within CAT’s interdisciplinary community felt like a resource to be mined on these days. We all bring with us our own personal identities, our pre-course experiences, and a range of core trainings with their own professional cultures. We each have our own baseline with regards to culturally competent practice. However to acknowledge areas where we may feel less competent and skilled, or feel perhaps more personally invested, can be a challenge. Starting to unpick some of these issues on SCOPE days always felt like an enriching dialogue, although as a white British facilitator I always felt limited in my capacity to authentically represent the lived and living experience of people of colour.

Diversity in groups we work, supervise and train within gives us all daily opportunities to engage with life experience that’s unfamiliar, but do we have places to take what this can evoke? Uncomfortable reciprocal roles and enactments might arise around ‘silencing-to-silenced’ or ‘privileged and well-resourced to exploited, neglected and marginalised’. Experiencing, or simply witnessing ‘hostile and attacking to harmed’ along racial lines can throw up intense emotions which might be difficult for client and therapist to name if a sense of safety within the alliance is uncertain. Such themes, ever-present for many communities, may more frequently be on the cusp of entering conversations within our consulting rooms in recent times where Trump, Brexit, austerity, #MeToo and Windrush have thrown the impact of power and social positioning into stark relief.

Insidious or more frank psychological sequelae of world affairs impact on all of our lives, illuminating multiple aspects and intersections of identity for both client and therapist. How we as therapists respond when such conversations arise can be crucial to the success or otherwise of a psychological therapy.  CAT gives us various ways to “name it, name it, and name it again”, and experimenting with ways to weave such themes  into formulations, diagrams and letters in authentic ways can be important.  At last year’s international conference in Nottingham, Jessie touched helpfully on putting CAT tools such as mapping to good use by helping to name & navigate ‘gut feelings’ felt by both client and therapist around racism & discrimination.

As team consultants or supervisors, when staff and supervisees share what’s come up in their work around social power and difference, do we feel equipped to respond? At her presentation in Nottingham, Jessie also made the gentle provocation:

“….if issues around race and culture have never come up in your supervisory practice, what’s being missed?”

So, have we had enough in our trainings to feel confident and competent as therapists and supervisors able to engage authentically with such issues, with sensitivity, respect, empathy where possible, and a lack of defensiveness? Perhaps it’s most useful to think about engaging in SCOPE issues as an ongoing learning journey for us all, rather than a certain destination we arrive at by the time we complete practitioner, psychotherapy or supervisor training. As the world and society changes, we and those we work with change, and hence the SCOPE in CAT is never finalised.

In my experience there’s nothing quite like a contained face-to-face dialogue with peers where we can feel safe enough to share both difficult procedures, and also approaches that we’ve found helpful.  Jessie, as a solid ‘more knowledgeable other’ can help take us into an area of more stretch and challenge, also providing an opportunity to develop and take away skills to apply in day-to-day work.  Her experience as psychotherapist, trainer and supervisor lend her many practical tools and resources to share with those attending.  Her training and experience as an interpreter offers an uncommon perspective on language and mothertongue in the nuances of emotional expression and intimacy in therapy. For those considering or already working with interpreters, this specific angle, merged with her CAT lense, may aid in understanding and managing the complexity of triadic relationships.

I expect she will bring to the day equal measures of challenge and encouragement. She herself hopes:

“…we could have an open dialogue about these difficult and complex issues without feeling blamed, frightened or persecuted and that we could use CAT’s mapping and positioning to understand and learn from the discussion”.

The event is open to therapists of all persuasions who are familiar with CAT concepts, plus all within the CAT community, including trainees, supervisors, and those applying CAT skills in case management and indirect work. We hope you’ll join us there.

For more information and to book on to ‘Exploring Issues of ‘Race’, Culture and Language within a CAT Framework’ click on this link.