Krakow Conference Presentations

Krakow 2011 Conference Presentations 

Plenary Session Presentations

CAT as an integrative approach     Mikael Leiman

Before CAT received its brand name it was a brief integrative psychotherapy. In terms of theory, Anthony Ryle integrated psychoanalytic object relations  conceptions with George Kelly’s personal construct theory. This integration was mediated by the practice of using repertory grids in assessing the clients’ ways of construing their interpersonal relationships as well as their relationship to themselves. Sharing grid results with clients at the beginning of therapy evolved into the unique practice of early reformulation that related the presenting problems with underlying patterns of reciprocal relating to self and others. Early reformulation using portable descriptions, a flexible “push where it moves” strategy of working, and emphasizing the role of accurate self-observation as the fundamental vehicle in changing problematic patterns of action (the three R’s) can still be regarded the heart and soul of CAT.

What happens when you actively make maps together?   Steve Potter

Actively mapping, side by side with a client brings in play cognitive, emotional, physical, interpersonal and transformative processes.  It is an activity which acts as a magnet to enactments and takes us to the heart of the mechanisms of change in CAT. In this session we will create a small theatrical simulation of a typical multiple positions CAT diagram after looking at one or two video examples of making maps.  The focus will be on the idea of shimmering, shaking and hovering in what the Irish CAT community call the Okay position in order to tolerate and learn from anxiety, unsettled emotion and ambivalence.

Variations in length of CAT

a. Mini-therapy        Ruth Carson 

A mini therapy is an extended two and half hour session with a focus upon diagrammatic reformulation only.  It can be followed by a single review session or by work in groups or coaching.  It is useful for people wanting to take a look at the different ways of functioning, review life experience, have a taste of what a therapeutic process might be like or prepare for therapy.  It challenges the therapist to be more active and puts the spotlight on active mapping techniques.

b. Eight Session CAT       Annalee Curran 

I would be aiming for this to be an informal, experiential workshop to explore what it feels like working in shorter CATs and what the essence is that one would want to achieve when working with a client for only 8 sessions. It will include discussion, sharing of case examples (it would be helpful if participants could have a case in mind), thinking about ways of working and hopefully also a playfulness to explore the feelings around working in a shorter framework.

c. Sixteen session CAT  Alessia Sogni 

The therapy with a client with compulsive eating behavior and difficulties in recognizing and managing emotions will be presented. Attention will be focused not only on the client, but more on the therapy process, that in sixteen sessions has involved the use of several tools in different parts of therapy. Each one has been important to build the therapeutic alliance and to improve the relationship. A mid therapy set back was the chance to discuss the shift between what happened in the room and  outside session and to recognize what was the process  linked to it, in a context of shared exploration and understanding that lead the client to accept, recognize and tolerate herself.

 d. Longer CAT – A Therapy in Three Acts       Liisa Uusitalo-Arola 

A therapeutic relationship with a young woman suffering from serious self-state shifts and self-destructive behavior is reviewed. The relationship spans over 8,5 years and comprises of three phases of active collaboration. Therapy 1 (2002-2003) was planned to be a 16-session CAT which, because of the client´s situation, was later agreed to grow into a 40-session therapy. Therapy 2 (2006) was a short contact of  three sessions. Therapy 3 (2010-2011) was a 40-session CAT. Changes in the client´s ability and skills to live her life, as well as her developing ability to use therapy within her ZPD are discussed. Could the positive development have been achieved with fewer sessions?

 

What Colour is your CAT?  vox pop of views about the key elements of CAT

Plenary session abstracts Saturday morning

a. CAT as an integrative, relational therapy     Jason Hepple

b. Integrating the third wave of Cognitive Therapies with CAT  Inigo Toloso

c. Addressing the social dimension in mental health and therapy: a CAT perspective  Ian Kerr

 

Plenary Research Presentation Randomised Trial of the Effectiveness of Cognitive Analytic Therapy (CAT) for the Treatment of Personality Disorder: Clark, S & James, K. Chair: Jason Hepple

Vox Pop of Video Feedback of impressions about the future of CAT from conference participants followed by panel discussion of the future for CAT: one minute addresses from key speakers then open group discussion

Workshops in the Order of Conference Programme

Friday Morning

1. CAT and Eating Disorders

a. CAT: An early intervention approach to Eating Disorders 

Presenter:  Dr   Melissa  O’Shea Contributors:  O’Shea, Melissa (1), McCutcheon, Louise (2), Pradel, Martin (3), O’Keefe, Peter (1), Price, Emily (1).

There is growing support for a role for Cognitive Analytic Therapy in the treatment of Eating Disorders.  This is fortunate given the disorder has traditionally responded poorly to a range of therapeutic approaches and has significant morbidity. Further evaluation of the effectiveness of CAT with ED clients and its comparison to alternative models of care is welcome.  The authors will describe the implementation of individual CAT to a public Eating Disorder service for children and young people (aged 0-25 years) in Geelong, Australia.  Both qualitative and quantitative data will be discussed including an evaluation of a measure of therapeutic alliance with clients engaging in CAT and the meaning of this for clients with this disorder.

1. Eating Disorder Service, Mental Health, Drugs and Alcohol, Barwon Health, Geelong, Australia.

2. ORYGEN Youth Health, Parkville, Australia

3. Victorian Centre for Excellence in Eating Disorders (CEED), Parkville, Australia

b.  Case presentation of CAT with eating disorders in Piacenza Italy

Cristina Fiorani, Marisa Poggioli

The case we are presented is an eating Disordered case from Piacenza as an example of the work we have done in PC with Eating Disorders

c. CAT Groups for Eating Disorders combining CAT teaching, mini-therapy and groupwork 

Ruth Carson and Uma Patel

This presentation describes a distinctive approach to working with a variety of eating disorders and obesity.  It involves two initial sessions of teaching the group key CAT mapping concepts directly with demonstrations of how they work from the facilitators.  These initial meetings are followed by each participant having a two hour mini therapy session in order to develop their own ‘life-map’ and therapy map.  They bring these maps to the remaining group meetings and develop maps of different patterns and states in the group.  A goodbye letter from the leaders to the group comes at the end of sessions with a series of follow up meetings after.  In the past two years eight such groups have been run with different types of group membership (high weight, low weight, etc.) with good attendance and outcome.  Ruth Carson is consultant lead psychotherapist and head of service for the Liverpool and Sefton Eating Disorders Service, Merseycare NHS Trust.  Ruth Patel is a clinical psychologist.

2. Creative CAT

a. Playfulness in CAT

Dr Sophie Rushbrook,  Mrs  Nicola  Coulter

We would like to share our ideas and engage in a discussion about using play within Cognitive Analytic Therapy (CAT).  We will look at the implications of using play within the therapeutic relationship; how it might enable us to be in the room with our clients in a manner that enhances the therapeutic bond, developing it more quickly to a deeper, more trusting and meaningful level. Play is an effective therapeutic tool borne out of an ability to practice in a radically genuine manner.  We will discuss how to invite our clients to play, different styles and strategies of play, how it is tailored to the individual client, define two levels of play extrapolated from our clinical experience as well as explore cautionary notes to using play in therapy.  We have been using play in our therapy for many years and our practice is continuously evolving.  The dialogue that we have shared with each other and with colleagues has been the lifeblood of this presentation.  Play in therapy is not a new concept, yet the ideas seem fresh and contemporary.  Our greatest successes with clients are with those we have genuine caring relationships with and the flavour of therapy has invariably focussed on being present to the emotional pain, giving ourselves over to the therapy and having some fun on the way.  When we tell our clients that it was a privilege and a pleasure to have worked with them, it is a genuine statement of fact.

b. Patient’s drawings as illuminators and mediators of change in the psychotherapy process
Anna Kajanne
Words don’t always come easy. In some cases, patient’s feelings and thoughts about their present and previous life experiences may be so mixed up and suppressed that the only way to approach them without further injury to her or him is via a mediating tool. Using  patient’s own drawings in the psychotherapy process can open up a way for the patient together with the therapist to look safely at fearful things in her mind. In the case at hand a female patient’s drawings developed into transitional objects between her and the therapist making it possible for the patient first of all to tell her story through them. Secondly, little by little, in the therapy process it became possible for the patient to play with the figures in her drawings in order to discover her genuine self and to find an exit from her problems. In this paper it is shown how important a part the patient’s drawings may play especially in the beginning of  therapy, if  the patient finds it too difficult to express herself with speech. A three year CAT therapy process of a young woman is reviewed with a selection of the most illuminating drawings that she produced during the process.

c. Integrating visual art in CAT – art making and reflecting images as sign mediated dialogical activity     

Mimmu Rankanen
The traditional analytic view to art in psychotherapy has emphasized the images as symbolic speech, and as means of expressing unconscious conflicts or emotions. The theories and concepts of transitional phenomena and potential space created by Winnicott have had profound influence on the fundamental basis of  how art and it’s meanings have been perceived in psychotherapy. The semiotic understanding of sign mediated activity developed within CAT can broaden and deepen the present sense of those manifold processes present in art making and reflecting the visual art works in psychotherapy.
The aim of this presentation is to view both the material process of art making and the reflective observation of visual images in the light of sign mediation and it’s dialogical nature (Leiman 1992,  1994). I attempt to enlighten the embodied appearance of these phenomena and demonstrate these implications with visual material from experiential arts based therapy group. I will also discuss questions concerning art as a concrete medium for building reflective position and conscious perspective on patients varying reciprocal roles.
Leiman, M. (1992). The concept of sign in the work of Vygotsky, Winnicott and Bakhtin: Further integration of object relations theory and activity theory. British Journal of Medical Psychology, 65, 209-221.
Leiman, M. (1994). Projective identification as early joint action sequences: A Vygotskian addendum to the Procedural Sequence Object Relations Model. British Journal of Medical Psychology, 67, 97-106.

3. Applying CAT

a. Applying CAT to work with families: Working with parents from the CAT perspective:Jenaway, A

b. Psychotherapy file: snags in a Greek experienceAdamopoulou, Garyfallos, Karassavidou

4.  Identity Maps

Experiential workshop in developing skills in using CAT to map identity
Martin E,   Potter S
This workshop involves a brief theoretical introduction to the idea of using CAT to help raise awareness of social identity factors.  We will start by making maps of our early learning stories of nationality and identity in pairs. We will spend some time sharing these and linking them to our collective map (or maps) of European identity and of our international CAT identity.  The presenters will demonstrate their own identity maps and talk about some of the work they have been doing in relation to national and other social identity markers.

Friday Afternoon

1. Innovations in CAT

a. Innovative CAT: defining the boundaries between specialist and generic use of non-verbal mediums.
Stella Compton Dickinson
Introduction The aim of this workshop is to observe, describe and/or explore safely within a CAT group format, a choice of musical, visual and play mediums.As a group and as individuals to discover and define the boundaries of our ZPD in non-verbal expression. The objective is to extend our own range of expression as a resource for ourselves and our clients without fears or threats of exposure.
Method Based on her extensive CAT clinical and group-work experience and her research knowledge in forensic and community settings, Stella invites delegates to attend this workshop as a group experience. To participate in either an experiential group or an observational group. She will guide and support each individual within the group process to explore their non-verbal skills through the use of non-verbal creative mediums, and she will encourage a spirit of collaborative enquiry.
Results: Qualitative results of the objective and subjective experiences will be collated.
Discussion: together to draw out conclusions about the role and value of specialist and generic skills within the CAT model.
The techniques that we used will be discussed.   We will reflect on the challenges of inter-disciplinary working: -for example the CAT therapist with a Nurse or Doctor as group facilitators.   -The impact of specialized non-verbal skills on the patient, the therapist and the process.  Conclusions We will draw conclusions as a Group.

2. Creative use of CAT

a. Creative use of CAT tools with young people
Ms Lee Crothers,  Dr Emma Burke,  Dr Jennifer Wood
Working with young people, especially those with complex problems, challenges the idea of delivering ‘traditional’ time-limited therapy. Many young people find thinking about themselves in a different way difficult and bewildering. Factors such as age, developmental functioning, experiences of trauma and disadvantage, comorbid mental health problems, antisocial behaviour, and the ability to manage strong emotions, all affect their capacity to engage in a “talking therapy”. These factors call for flexibility and creativity on the part of the therapist. This workshop aims to assist clinicians to think about providing therapy in a “youth friendly” way that is engaging, fun and effective.  Discussion will centre around the versatility of CAT and how it can be modified to include more creative practices while maintaining it’s core principles.
Case examples will be used to highlight how CAT tools, such as diagrams and letters, can be adapted creatively to form a shared understanding of reciprocal roles and unhelpful procedures.  A number of creative strategies that assist young people to reflect and adopt “the observing eye” will be presented. These will include visual resources, humour, metaphor and other materials. This workshop will include an opportunity to explore creative ways of using CAT tools to “makeover” a diagram or reformulation. We hope that participants will feel more comfortable incorporating creative approaches into their CAT practice by the end of this workshop.
b.  “A Game of Two halves”
Dr  Nick Barnes
This project is about the development of a CAT-informed piece of therapeutic work that has moved away from the more formal therapeutic space, and taken the opportunity for engagement out onto the football pitch. In seeking to find a forum that is sufficiently engaging for young people who find themselves at risk of exclusion from education, the project aims to work in the “Zone of Proximal Development” – taking a distinctly outreach approach, hoping to reach “hard to reach” young people.
The project aims to work with a group of 12 to 14 young people, selected from different educational settings in the borough, who are encouraged to become part of a team (group) for a period of up to 12 weeks. The work is all based around and delivered through the language and actions of football. The young people may reflect on the teams that they support, the players that they admire, and gradually start to transfer some of that reflection onto themselves – either individually or as a team. By using reciprocal roles that can emerge from the professional game – idolised to idolising, admired to admiring, dismissive to dismissed – there is a chance to help the team start to think about their own reciprocal roles – both on and off the pitch.
The work only just starts in the 12 sessions of the project; mentors are provided from each educational setting so that the ideas and suggestions (skills) developed from the project can then be rehearsed (practised) back in school – with the aim of supporting re-engagement with education and enhancing the opportunities for social inclusion.

 

3.  A team approach to using CAT with severe mental health problems

Andrew Chanen and Louise McCutcheon

The Cognitive Analytic Therapy (CAT) model can be used to assist teams to work collaboratively and effectively with severe mental problems such as psychosis and personality disorders. The presenters have been using CAT in their team for more than 10 years; as an individual psychotherapy, as well as to inform their thinking of team dynamics and as the common language for care-planning/case management and general psychiatric care. This workshop will briefly describe the work being done in the Helping Young People Early (HYPE) program at Orygen Youth Health, as a prompt for group discussion about a range of questions, such as:
How can CAT be used to deliver ‘good enough’ interventions to those usually excluded by traditional psychotherapy services?
Can CAT provide a useful framework for teams working with severe mental health problems?

How can time-limited and brief Cat interventions be helpful for clients with severe MH problems?

4. CAT and Varieties of International Training

a. On becoming a CAT therapist – Developing reflections during CAT training 2007-2010 in Finland

Tikkanen, Soile

Leiman (2010) has conceptualized core of the therapeutic change process in terms of the subject’s changing relation toward the problematic experience and current object of observation from object position to subject position. The aim of this preliminary study is to explore whether this model is applicable in analysing the personal and professional development of trainees of CAT therapy. The written case material from essays and written reflections on CAT training, seminars and ongoing client work was gathered during the 3 year CAT therapist training of the YET07-12 group in Finland. This material was analysed by the tools of dialogical sequence analysis (Leiman, 2004; 2010), which allows formulating the subject’s changing dialogical positions in relation to the object of observation and addressee.
Individual cases and case excerpts are chosen to illustrate the trainees’ development during 3 years in relation to CAT theory and tools, self as a therapist and work within the client –therapist -dyad. The preliminary results indicate that this is a promising approach in conceptualizing the development of reflective stance, observer position of the CAT trainees and also in describing the individual developmental paths. The results will be discussed in relation to implications for future CAT training and in terms of the application of DSA methodology in written case material.

 

b.  On becoming a CAT-therapist – a retrospective evaluation of CAT-training
Ehrling, L
c. Teaching CAT in India  
Ms Jessie Emillion, Professor Hilary Brown
This paper describes a pilot project introducing CAT thinking to students in Bangalore who were coming to the end of their training as clinical psychologists and counselors and proposes ways of taking CAT forward in India,- including the practical issues that may arise in the context of accreditation and the development of an appropriate infrastructure.
But the work also affected us profoundly and we hope to convey that by giving an honest account of the teaching, its challenges, the learning that took place across cultures, languages and religious groupings and of our struggle to engage across these divides. Because we were working with a large group we broke the teaching up into different kinds of experience,- including role plays, shared reading and critiques, case based learning alongside more traditional theoretical teaching. We worked very consciously with the differences in the room, including our own, and sought to make unspoken cultural values and norms explicit in our management of the group dynamics. For example we explored how the “self” is constructed in the many “mother-tongues” present in the room rather than assuming that the western dialogic would be universal.
Our goal was to move away from a medical model of mental illness, personal distress and addiction, towards one that embraced the notion of reciprocal roles in a society in which many of these are fixed and sometimes even forced. We were very aware of, and made explicit, the reciprocal roles we entered into as “teachers” and how these reflected intergenerational, and gendered, assumptions that might also be being interpreted through a “colonial” lens. We challenged and were challenged about the western individualised model of personal distress and an eastern more communal and familial understanding while also acknowledging the pace of change in India, the booming economy and the shift in intergenerational attitudes.
The relational stance within CAT brought many social questions to the surface. How, in societies that have extreme inequalities embedded in them, can individual distress be understood and worked with through one-to-one talking treatments? When gender, race, class/caste and disability converge to create unbearable suffering, how can individual workers step in to mitigate this? When dilemmas are embedded at the cultural level how can “exits” be opened up for those who have stumbled? How can CAT thinking also be brought to bear on the way the very institutions that are designed to support oppressed people, address their “problems” without adding to their stigmatisation? Is it possible to align CAT with a powerful commitment to human rights?
The students travelled a long way in four weeks, but as teachers from the UK, (one Asian and one white) we learned as much from them as they did from us and it is this learning that we hope to share through our paper.
d. The development of CAT in Poland  

Kasia Wenderlich and Dorota Plonska
From CAT Skills to Practitioner. A short account of CAT developing in Poland. Some of the challenges in developing CAT in a different language in a new country where participants have existing models and traditions.

Saturday Morning

1. ‘Three Lives of CAT:  How far can we stretch the CAT Model’

Aileen Garrihy,   Anita Turley,  Doreen O’Rourke
Aileen Garrihy will consider how dream exploration within a CAT framework, can enhance understanding and integration of difficult emotional experiences.
Anita Turley will explore how the CAT framework can be adapted to usefully work with adolescents.  Working with adolescents brings different challenges, and she will present what components of CAT are particularly useful in working with these challenges.
Doreen O’Rourke will explore the position of CAT in relation to chronic pain therapies, and will discuss using mindfulness within the  CAT framework with chronic pain sufferers.

The last 30 minutes will be spent discussing the common theme of versatility and the use of the main CAT ingredients in our work.

2. THE APPLICATION OF 8-SESSION CAT IN PATIENTS WITH MULTIPLE SCLEROSIS

a) CAT in patients with multiple sclerosis     
Dittopoulos   I.
Why psychotherapy in MS patients? The reason to treat multiple sclerosis patients with psychotherapy is that, firstly it improves the neuronal network which is directly affected by multiple sclerosis and secondly that it improves reactive depression which is reported in up to 50% of patients. Why CAT in MS patients? CAT is a brief and effective psychotherapy that can be used in patients with multiple sclerosis.
b) Evaluation of Cognitive-Analytic-Therapy (CAT) outcome in patients with Multiple Sclerosis (MS) with various psychological problems.  
Garyfallos G.
Objective: To investigate the outcome of CAT in a sample of patients with MS and various psychological problems
Method: The sample of the study consisted of 30 patients with MS who attended the Community Mental Health Center of Northwestern District of Thessaloniki, Greece claiming for various psychological problems and for whom it has been decided to be treated with CAT, 8-sessions once per week. The Minnesota Multiphasic Personality Inventory (MMPI) and the Eysenk Personality Questionnaire (EPQ) were used as evaluation instruments at the intake and at the 2-month follow up after therapy termination
Results: On the 2-month follow up 20 patients who completed the therapy and attended the follow up showed a statistically significant improvement on the majority of the clinical scales, on the sum of the clinical scales, on some of the research scales of the MMPI as well as on scales N and E of the EPQ
Conclusions: CAT is an effective, brief psychotherapeutic technique for various psychological problems of patients with MS
c)  A case report    
Adamopoulou A.
This is a case of a 30 year-old man who suffered from MS since the age of 24 and who manifested personality problems, such as avoidance and lack of relationships with others. He was offered CAT, 8-sessions once per week and his improvement was sustained in a one-month follow up.

 

3. CAT in the world of Psychiatry

a. Working with the ‘difficult’ patient: the use of a contextual cognitive-analytic therapy based intervention in improving team function in a routine psychiatry service setting   
Authors: Bruno Biancosino, Rosangela Caruso, Anna Clara Morelli, Maria Giulia Nanni, Luigi Grassi
Presenters for this workshop: Dr. Bruno Biancosino, Dr. Rosangela Caruso
Introduction. The term “difficult patient” does not refer to a definite diagnostic category, but it is used to indicate a heterogeneous group of psychiatric patients – with diagnoses ranging from ‘neurotic’ through to complex psychotic disorders – perceived as significantly more demanding, dangerous, difficult to empathize with and likely to polarize the staff. The clinical management of difficult patients is an important issue which exposes mental health teams to increased levels of frustration and stress.
For these reasons, the aim of the present study was to investigate whether a Cognitive-Analytic therapy (CAT) based training intervention directed to a mental health team dealing with difficult patients, reduced the professional burnout symptoms, improved patients’ service engagement  and  increased the levels of team-cohesion.
Methods. Twelve mental health staff members from different professional and educational background (3  psychiatrists, 8 nurses and 1 social worker) took part in this open-label study carried out at a Rehabilitation Unit, Clinical Psychiatry, University of Ferrara and Department of Mental Health. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ)  before (T0) and after (T1) the CAT training intervention, and at 30-day follow-up (T2).
Results. A significant decrease were found, at T2, on the  MBI Emotional Exhaustion scores,  the SES Availability subscale,  the GEQ Attraction to Group-Social and Group Integration-Social; while the MBI-Personal Accomplishment scores increased from baseline.
Discussion. The findings of this study suggest that CAT-based training intervention – as an integrative and relational model helpful in promoting the development of a team common language and a shared therapeutic model – has had a positive impact on mental health team workers across several areas. Specifically it has shown the potential to enable mental health professionals to deal with difficult patients more effectively, by facilitating team cohesion and patient engagement to service and reducing burnout levels among mental health team members.
b.  CAT with Psychosis
Ian Kerr

 

4. Research workshops

a. Using case formulation by DSA in analysing parent development – a case description
Soile  Tikkanen, (presents the research project that has been worked on in collaboration with prof. W.B. Stiles, & prof. M.Leiman)
This study explores the therapeutic potential of the diagnostic procedure in child neurological assessment using psychotherapy process research methodology. Parent development was tracked across 9 consecutive encounters during the assessment of a four year old girl who was referred to the child neurological team due to contact and communication problems. All parent-professional dialogues were transcribed and analyzed using dialogical sequence analysis (DSA)(Leiman,2004;2010), which is a set of conceptual tools for studying utterances derived from cognitive analytic therapy. The initial case formulation for the problematic reciprocal pattern that was named “controlling in relation to defiant and uncontrolled”.  Parent development in finding alternative patterns to excessive control was traced form initial session to 3 month follow-up. Development from disowning the impact of their own actions and mainly seeing the problem as belonging to the child into a more flexible and self-related understanding of the problem were shown.  The use of the case formulation in analysing the fluctuation of development within one session and the internal dynamics of a network meeting within the same case will be shortly presented and discussed. Short description of presenter(s) ) Soile Tikkanen is a clinical neuropsychologist specialized in developmental psychology and a CAT therapist, supervisor & trainer. She is working as a researcher on her doctoral dissertation on Parent development in clinical child neurological assessment process in the department of psychology , University of Eastern Finland, Joensuu.  Type of workshop:  oral presentation and discussion
b. Researching the reformulation in Cognitive Analytic Therapy  
Dr Lawrence Welch
This presentation will give the results of my PhD mixed methods research on (1) the reliability and validity of the reformulation and (2) the process of reformulating. Four experienced Cognitive Analytic Therapists were asked to select the first patient on their clinic list, tape record the pre-reformulation sessions and write a reformulation.  They then listened to each other’s tapes and wrote an additional three reformulations on the taped sessions.  After an analysis of the differing approaches to reliability and validity to case formulations, I applied four tests to reformulations: word length; external judges ratings; qualitative analysis; quantitative analysis using the Structural Analysis of Social Behaviour (Benjamin, L.S, 1974) and give the results in this presentation.  In the second part I summarise the findings of qualitative interviews with the four therapists discussing the process which informed their thinking about these reformulations.  Five main themes or ‘domains’ emerged: getting to know the patient; formulating; reformulating intersubjectively; writing the reformulation; reflecting and learning.

Saturday Afternoon

1. The conversational process in CAT

a. CAT and use of the Counter-Transference or ‘What the client makes you feel in the session is usually the client’s business’ – Tony Ryle

Dr Jason Hepple
CAT has always put the therapy relationship at the heart of the dialogical process underlying the CAT model and method. The concept of enactment of reciprocal roles in the relationship between client and therapist, and the making explicit of this process using CAT tools and insights, has been linked to good therapy outcomes and the avoidance of therapeutic rupture and disengagement. CAT has the concept of elicited counter-transference which may be either empathic / identifying (taking the same pole of a reciprocal role) or reciprocal (taking the reciprocal pole), but there has been little development in the CAT literature as to how these concepts can be used sensitively and flexibly in therapy. Often the feelings elicited in the therapist are momentary, powerful and experienced in a non-verbal and embodied way, making the therapist feel off-guard and unsure how to bring them into dialogue without actually making matters worse in terms of an enactment that may threaten the therapeutic alliance. The talk will focus on the description of techniques and opportunites for the real-time use of the counter-transference in CAT. Techniques covered will include: ‘Having feelings for the client’, ‘Defend yourself from a bottom role’ , ‘Indirect questioning to name uncomfortable top roles’ and ‘Counter-transference in supervision’.
b. CAT as a language and use of metaphor
Donald Bermingham
The task for a new student of CAT is likened to learning a new language. They begin by learning a few words eg “reciprocal roles” “target problems” and progress to being able to speak and write in the language of CAT.The ultiate goal is to hear what is said and reformulate it in CAT language and this requires being able to think in CAT language and at this stage the student has reached fluency.
Metaphor enriches the dialogue and aids understanding of this new language.  Metaphors generated by the therapist aid the patient who is also trying to learn this new language but it is the metaphors generated by the patient that enrich the specific dialogue of that therapy.  Finally a case rich in dialogue and metaphors generated by the therapist and by the patient will be presented.

 

2. Social and Political CAT

a. Can making a CAT map of a global conflict help understand our responses to war and peace?

Steve Potter and Julie Lloyd
This workshop will explore how active use of CAT maps can help understand our complex responses to globalised warfare.  We will very briefly review some of the mapping techniques, introduce concepts from peace psychology and conflict resolution citing some of the work we have done and see if our own responses to the conflict in Libya (as a representative example of global conflict) can be brought into dialogue in a useful way using a shared map.    If it can, we think this has useful implications for conflict resolution.  We are running a whole day workshop on this theme in London in partnership with Conflict Research Society, Goldsmiths University and ACAT on the 15th of October 2011.  We are hoping to have a mix of international conflict resolution researchers and CAT practitioners at this event as well as though generally interested in peace psychology.
b. Racism in the consulting room, myth or reality?    Workshop based on paper co-authored with Naison Msebele published in Psychoanalytic Review August 2011
Hilary Brown
This paper explores how racial difference, that is being white as well as being black, taps into ingrained patterns of binary thinking that generate anxiety and give rise to painful projections. As Tony Ryle (2010 p6) reminded us, CAT theory reflects the notion that “social relationships are replicated within the structure of the self” and race is a therefore a critical fracture line that is continuously being reproduced.  White people in particular tend to draw a veil over race as if to disavow their part in the racial hierarchy that pertains in our society, and as a way of trying to manage the unhelpful meanings and associations they have absorbed as part of our/their enculturation (Ryde 2009 p22). Speaking openly about these issues might seem to cross a line that exists to keep things pleasant on the surface, but it is our view, paradoxically, that being explicit might help us to think in less “black and white” terms and to feel more confident about supporting black patients and black colleagues.  CAT provides useful tools for naming and understanding these dynamics.

3. USE OF SELF IN CAT PRACTICE – the embodied nature of reciprocal roles

Angela Mohan

Reciprocal roles formed in the emotionally imbued early relationships are of necessity embodied. Attention to sensations and feelings in their “lived body” can help the CAT therapist to elicit the client’s roles and to avoid collusion in CAT practice. This workshop will review the embodied aspects of roles and use experiential exercises to heighten awareness of bodily sensations and feelings within roles.

4. HOW TO ENJOY WRITING A PROSE REFORMULATION

Elizabeth Wilde McCormick
Writing is a powerful form of communication and conversation and is one of CAT’s unique therapeutic tools. The CAT reformulation and goodbye letter offer a real connection between patient and therapist and both documents live on in black and white after meetings have been completed. But many of us experience snags or difficulties when faced with making the draft of the reformulation letter in preparation for sharing. This experiential workshop will offer creative ways of loosening the soil around writing so that we may enjoy opening to our own creative process and that of our patients.

 

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