To write or not to write that is the question?

 To write or not to write that is the question?

As I continue onwards in my CAT journey, I have been reflecting on the process of writing reformulation and goodbye letters in the context of working in a busy private practice. My clients and I have had moments of real joy when letters have elicited ‘understanding to understood’ in the therapy room. The joint authorship (literally writing them out together) of target problems procedures in session has led to rich discussions and ideas. Reformulation letters have given us an anchor point to return to if we discover that the direction of therapy has drifted. At a professional level, the discipline of ensuring each of my clients and I have an agreed and transparent formulation is invaluable. I cannot say that this always occurs in my work outside of CAT. Goodbye letters can enable acknowledgement of the unfinished work of therapy and the feelings that rise when goodbyes are imminent. For me personally, there is a real satisfaction when my client and I read through a letter together and we both recognise that together we have created something which distils both their experience and learnings and my reflections and wonderings, self and other relating together on a page.

Despite all the obvious benefits, I confess to conversations with CAT colleagues where we have acknowledged the impact of our own enactments upon writing letters- our search for the ‘perfect’ letter- the attempt to have everything clearly articulated only to find the words won’t form to express what we want to say; -the frustration at how long it can take despite the idea that it can be short- our concerns that our letters sometimes carry much meaning for us but have little visible impact for those we work with. The reality too is that in private practice there can be constant competition for our time and being focused enough to set aside time and write is not always easy-avoidance procedures are decidedly appealing.    Letter writing is also unfunded work and that causes difficulties as the proportion of CAT clients in one’s practice increases. I’m discovering that CAT itself is a therapy that requires more unpaid time outside the therapy room than most other therapeutic models I work with, a ‘boutique’ therapy as one CAT colleague described it. I wonder whether other private practitioners internationally find the same? I wonder too whether I am not the only one who has been at times been tempted to slip into ‘CAT informed’ work, creating maps but not writing letters.

Nonetheless when I step back and use my observing eye, I remain committed to the process of letter writing. I see the importance of the letters, the need for therapy to be a relational dialogue in multiple sensory domains; verbal as we speak in the therapy room, visual in the maps and diagrams, written in the letters. There is also something very important about adhering to a model which is effective and not watering down the tools and processes within it across time. Hopefully the next years will bring further research around CAT and we will be better able to measure the effectiveness of the different components. I am also inspired by how I see other CAT clinicians generating different ideas for the letter writing process; joint authorship of letters; letters written entirely in session; letters exchanged via e-mail with changes made by therapist and client; and letters that are recorded in auditory formats. Possibly the way forward is to talk with each other, allowing ourselves to experiment a little and find a way to make letter writing work for us and our clients, whatever setting we work in.

I am looking forward to comment and discussion.

Dr Louise Smith      Auckland    New Zealand 

 

ICATA Official Documents

pdf_icon

Constitution

pdf_icon

Training Guidelines

pdf_icon

Ethical Guidelines

Contact information

Please send all general enquiries here
See our contact page for further information