E149 | Cognitive Analytic Therapy (w/ Hilary Beard)

Hilary Beard is a psychotherapist at the South London and Maudsley NHS trust. She is a practicing CAT therapist and trainer. She was a founding member of the Association for Cognitive Analytic Therapy (ACAT) and was the chair for ACAT from 1994 - 1997. 

Interviewed by Dr. Alex Curmi. Dr. Alex is a consultant psychiatrist and a UKCP registered psychotherapist in-training.

If you would like to invite Alex to speak at your organisation please email alexcurmitherapy@gmail.com with "Speaking Enquiry" in the subject line.

Alex is not currently taking on new psychotherapy clients, if you are interested in working with Alex for focused behaviour change coaching , you can email - alexcurmitherapy@gmail.com with "Coaching" in the subject line.

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Episode produced by Ellis Ballard and Alex Curmi. 

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Transcript

Speaker: [00:00:00] Welcome back to The Thinking Mind, a podcast all about psychiatry, therapy, mental health, and related topics. One of the biggest debates within the psychotherapy world is whether or not you should focus on practicalities of helping someone with their mental health, like their thoughts, patterns, their specific behaviors, their coping strategies, stuff like that, or whether or not he should focus on depth.

Early life experience, childhood unconscious processes. This is the classic debate between cognitive behavior therapy and psychoanalysis. And every form of therapy has to kind of address this dichotomy to some degree, in part to address this tension, a GP with an interest in psychotherapy named Anthony Ryle developed his own kind of therapy in the late seventies and early eighties.

And this was called cognitive analytic therapy, otherwise known [00:01:00] as cat. Cat Therapy was distinctive because it had all the practicalities of something like CBT. It was collaborative. The therapist and client work together in a time limited way, usually for 12, 16, or 18 sessions, which made it much more friendly for the NHS.

And this therapy focuses on practical things like patterns of thinking and behaving. But it also didn't shy away from depth. For example, how early life experiences can cause us to replace certain patterns over and over again in our lives. In particular, Kat uses the concept of reciprocal roles, which will also talk about on this podcast.

I've always been totally fascinated by Kat, but I've never gotten an opportunity to learn more about it until now. This week on the podcast we are speaking with Hilary Beard. Hillary is a psychotherapist for South London am mos the NHS Trust. She has worked closely with the late Anthony Ryle. She's a practicing cat therapist and has trained people on how to use this [00:02:00] therapy.

She's a founding member of the Association for Cat Therapy and was the chair of the association between 1994 and 1997. You can tell she's incredibly passionate about this model and how it can help people. We talk all about this therapy today, and I think the nice thing about this conversation is besides learning about cat, you can draw out a lot of principles which apply to lots of different kinds of therapy as well.

I learned a lot from this conversation. I hope you guys do too. Otherwise, I, I hope everyone is doing well. I'm in total disbelief that's, we're already getting towards the end of the year. It feels like 2025 has absolutely flown by. We do have some exciting podcasts planned for the end of this year and the beginning of next year, so I'm looking forward to sharing those with you.

As always, you could send any feedback or questions to Thinking Minds podcast@gmail.com. Thank you very much for listening, and now here's today's conversation with Hillary Beard. [00:03:00] Hillary, thank you so much for joining me today. 

Speaker 2: It's a pleasure. 

Speaker: For the uninitiated people who have never heard of cats before, can you tell us what is this therapy in simple terms?

Speaker 2: It's a time limited therapy that emanated from an attempt by Dr. Anthony Ro to meet the huge need within the NHS to offer a sensible, respectful, thoughtful form of psychotherapy that could be accessible to a wide range of people. Diverse difficulties from straightforward difficulties to much more complex difficulties, but taking into account the constraints of working within the NHS where resources are really compromised.

Speaker: So what was the situation like before Kat? What were the accessibility problems? 

Speaker 2: Well, when Dr. Anthony RA started, there was no psychotherapy service within Geis in St. Thomas' Hospital for adults at that time. So he started off the psychotherapy service [00:04:00] and through his experience, slowly created the approach of cognitive analytic therapy.

Speaker: So cognitive and analytic. What do they mean in the context of this therapy? 

Speaker 2: The theoretical basis of it is that there is a profound belief that the patient or the person you're working with knows about themselves and can think about themselves with the right tools, and often because of difficult life events and difficult relationships, perhaps, has never had the chance to develop those tools.

So what Kat tries to do is to take some of the tools from sort of cognitive. Approaches. So the capacity to think about ourselves, for example, in a very basic way, and puts that together with some of the thinking from object relations, analytic theory. So it still respects that unconscious factors influence how we are or less conscious factors influence how we are and puts the two together in a time limited model of 16 to 24 [00:05:00] sessions.

Speaker: Right. So it's kind of drawing on some stuff from CBT where you're thinking about your thoughts with some altitude and gaining some perspective. And obviously the, it sounds like there's the structure of CBT. Yes. And there's also this influence from the depth psychologies, like I guess psychoanalysis more broadly, psychodynamic.

Early life experiences affecting you in some way, how you internalize parental relationships and how that that could be affecting you, and it's kind of fusing those two approaches. Is that right? It 

Speaker 2: places huge emphasis on how we internalize early relationships. And how those relationship patterns then get replayed across life unless we have any chance to revise them.

And that those relationships also include thinking, behavior, acting in the world, thinking about ourselves, how we feel, and that's the more sort of cognitive, behavioral aspect of it. 

Speaker: I've always been fascinated by this idea that people might repeat unconscious patterns [00:06:00] throughout their life. Could you give us a bit of an example of a, a bit of a vignette of what that might look like in a person?

Speaker 2: Well, I think Kat's approach would say that from the womb onwards. Relationships are happening that we are completely predisposed to form relationships even from the womb and the child is born into a world of meaning. So that child's behavior, how they are and how they're reacted to will be immediately begin to form relational pattern.

If that child is lucky enough to be loved and respected and cared for and nurtured, then those relationship patterns will be internalized. They will experience a nurturing, caring, loving other, and feel loved and nurtured and cared for that. If that baby enters a world where perhaps there's poverty and the need to survive, or there's cruelty or any of the other uncaring things that can happen.

That child will begin to internalize a perhaps critical sense of the other [00:07:00] person, or a neglectful experience of being neglected and a neglectful other. So those relationship patterns get laid down from the beginning and then because that becomes who that little one is. That's how their self is formed.

Inevitably, there are ongoing invitations to repeat those experiences because that's all that's known. 

Speaker: I, I'm fascinated by the idea that these early psychological experiences influence our perceptions. Because there's always, you know, in any given situation, there's a whole bunch of information we could be focusing on, and we tend to focus on one small piece of information.

Speaker 2: Yes. 

Speaker: So what I find, for example, if someone has been abandoned in life, they might, in a given situation, focus on any signs of. Coming abandonment as opposed to anything else they could be focusing on. And I think that perception is like that key first step to then the repetition, because that's perception of, oh my God, there's this sign that I'm gonna be abandoned.

Might make them then do something to [00:08:00] either increase or decrease the likelihood of that happening. But. In either case, you're in reaction to that perception that you might not necessarily have focused on so much if you hadn't had that early life experience. So that's a e bit how I think about it. 

Speaker 2: Well, it's, it's how the self is formed.

So if your self is built around abandonment, the only way you can function in the world is inevitably you meet that in other ways. And 

Speaker: you said CATT is time limited and pretty structured. What does it look like if someone did a course of catt? What? What could they expect? 

Speaker 2: Kat is a semi-structured form of therapy.

So there's an overarching structure within which there is enormous potential to use lots of other approaches and techniques to meet the patient where they are or to meet the person where they are. So the structural aspects are that the first few sessions. As a therapist, you are looking to try to notice the relational invitations that the person is making to [00:09:00] you to be a certain way.

And also you are of course gathering history and understanding what relational patterns may have been encountered from birth onwards. So through the history and that person's life story, you are trying to also pick up what may be happening in you, in in the counter ants, in what you are feeling in the presence of the person you're working with.

And then around about session four. You gather all that together and write a letter to them, which is called a reformulation in cap terms. But what it's an attempt to do is to gather the person's story, the narrative, what they've experienced, and put it together in a meaningful way in the ways you've been talking, and give it back to the patient to sort of check that you are understanding it appropriately, but you are also picking up those relational patterns and linking that.

To the history. Mm-hmm. And sort of describing it. And sometimes for some people, that's the first [00:10:00] time that they've experienced a gathering of their story in that sort of way. And it's written in a very empathic way that tries to meet the patient where they can hear it. 

Speaker: So the reformulation letter is the therapist's attempt to put into words, okay, this is how I understand your story.

And then giving it back to them. Does this make sense? Have I gotten this right? 

Speaker 2: Yeah. And it's an attempt to have a dialogue. So you check out, do you want anything changed? Do we need to add something? It becomes an exchange alongside that. Another way we reformulate is through mapping. So the relational patterns that I've been discussing and, and talking about, we would map them.

So you might have caring to cared for, or critical to criticized or traumatized to hurt and alone or whatever those relationship patterns are. You would from the first session, begin to try and collect them up together. So you might be working with paper and pan beside each other as you notice these patterns.

To gather them up. 

Speaker: So the [00:11:00] mapping is an attempt to link those kinds of experiences and imprints to the actual behaviors that the client is enacting in the world. 

Speaker 2: It's much more than behavior. It's a whole relationship. So it's the behavior, it's the feeling, it's the perceptions, it's the meanings. It's called a reciprocal role.

Speaker: So someone being hurt and then hurting others is an example of a reciprocal role. Or I've been abandoned and I abandoned someone else. 

Speaker 2: Absolutely. Yes, yes. But of course, for every single person, what that means will be different. So part of what's really important is to catch the person's words and their images and how they describe those roles.

And that's what you put down on the map and you use in the writing. So you're not using professional language or your words particularly. You are using the patient's words. What's meaningful for them? 

Speaker: It strikes me that writing for mental health is a very powerful tool. It is indeed. I, I recommend it a lot to clients.

I've tried it [00:12:00] myself and yet very few therapies actually use writing actively. Most therapies, you know, we call them talking therapies, don't use writing at all, but Cat clearly does in quite a powerful way and it's nice to hear 'cause I imagine it's very effective. 

Speaker 2: Yes. I mean obviously again, everybody is different, but I think for some people to receive a letter can sort of offer evidence that they've been heard and perhaps understood.

Mm-hmm. And that can be very, very powerful. And for people perhaps who experience themselves in a very fragmented way. It can also help sort of gather the fragments of who they are together and perhaps help them think about themselves in a way that they've not thought about before. 

Speaker: Yes, and I guess make those links between, you know, perceptions, behaviors, attitudes that most people, it's very hard to make those links by oneself if you've never had any kind of psychological training.

Speaker 2: Absolutely. Absolutely. And often people who've had very traumatized early life or, you know, multiple foster care placements and things that [00:13:00] they're just not had the opportunity to develop those skills. Mm-hmm. Not had a thinking mind, not having a reflective other to gather themselves together. 

Speaker: So you said around session four there's the reformulation letter, and then you also talked about mapping and what happens beyond session four?

Speaker 2: So the mapping carries on across the whole therapy. The letter also attempt to sort of focus the ensuing work. So part of the letter will be offering, shall we focus on these areas and gathering the person's agreement to do that. So what would happen would be having agreed that, because most time limited therapies work better if there's a focus, so there might be three or four relationship patterns perhaps that the individual feels are really vital to work on, or a particular sort of set of behaviors that they want to change linked to a relationship pattern.

So you reach that agreement and then the ensuing sessions. The person [00:14:00] brings whatever they want to talk about each week. It's an open agenda, but it's the therapist's responsibility to try and relate what they bring to the agreed focus of the ensuing work. And inevitably, those relationship patterns will repeat in the room between you or they will repeat in their descriptions about what's happening in their external life.

You might encourage them to collect examples of it in a sort of idea of homework and bring that into the room. But you can also bring in any other ways of working that you might have. You can use role play, you can use art materials, you can use creative approaches. Anything that will foster and help that particular individual understand themselves more, and that carries on for the rest of the therapy.

There is a strong emphasis on the use of time because it's time limited, and of course we all have to struggle with time in life, you know, in terms of limitation and loss. So [00:15:00] around about the halfway point, there's always a conscious mention that we have now only so many sessions left and you sort of count down.

And the emphasis there is to help the person bring into the sessions their experiences of limitation and loss. And for many people, that will be the loss of therapeutic relationship and, and whatever that therapy has meant. So that will be a focus, but it should and often does, bring in past experiences of loss.

And there may be an opportunity not to mourn or work through losses that haven't been able to be worked through again, because of the emphasis on that. And then in the penultimate or final session, the therapist writes a goodbye letter to the patient that tries to collect together the experience of working together, what's been possible and what's not been possible, and also invites the person you're working with to write a goodbye letter to you.

And that's exchanged. That is a way of closing the [00:16:00] therapy of summing up. It's like a gift to take away, but it also helps both the therapist and the person you're working with end. 

Speaker: Yes, 

Speaker 2: you have to end because it's not just a fizzling out, it's using the ending, the reality of what that means to that individual.

Speaker: Yes. And again, writing is being used to get some real closure, which can often be lacking in psychotherapy. 

Speaker 2: Indeed, indeed. I mean, for patients that are in the NHS in the current system, they might have had multiple care coordinators, multiple medics, seeing them, you know, they just move from one person to another.

There's very little opportunity to actually think what that means. But also everybody's experienced loss in their life. 

Speaker: Yes. And I think it's always interesting when therapies use the ending of the therapy as a way of starting to learn and orient the person towards endings in general. Because as you said, we all have to deal with endings Yes.

And limitations. The kind of finitude of [00:17:00] life, and one of the things I think people don't understand about therapy is you're supposed to use the ending of your therapy, whatever kind of therapy it is to try and deal with loss in general, because there's such a primacy of loss in life. There is. It's inevitable.

And we all have to, well, we don't, we don't have to learn how to deal with it, but it's good to learn how to deal with it. Is there much of an emphasis in CAT on the client trying out different things in their life in between sessions, on experimenting, homework, that kind of thing? 

Speaker 2: Yes. If that person wants to do that and it fits with what the agreed agenda is, people differ so much for some that's exactly what they want.

For others, it's much more wanting to reflect and think through, and that's again speaks to the sort of intricate approach of cat. Because if you are a therapist that works with the transference and countertransference, you might pick up much more what's happening in the room. Um, so how the reciprocal roles, how those relationships happen in the room, and [00:18:00] you work with that experience.

Or you may be much more trained in more cognitive approaches. You might work more from sort of giving homework and suggesting that. That's from the therapist. Right? But also each patient is different. Not everybody wants to do homework between sessions, particularly if they've had several CBT interventions already.

Speaker: Yeah. So some therapists, some cat therapists might lean towards more the cognitive part. Some might lean towards the more analytic psychodynamic part if you like. 

Speaker 2: That's often how people who are training come in, they lean one way or the other, but through the training, hopefully reach a much more integrated position theoretically, and can offer both.

Speaker: And it's nice that there is a therapy that combines both because they both have such huge advantages. In my view, the structure and the systematic nature of the cognitive approach, I really like. Obviously the depth of the analytic approach is so nice, and a lot of times in the psychotherapy world that feels like there's a kind of [00:19:00] needless tribalism between different schools of thought.

Speaker 2: Indeed. Yes. Which is sad. 

Speaker: So I guess there's a lot of flexibility in terms of the therapist stance when someone's training as a cat therapist. They can be encouraged to develop their own style, it sounds like, 

Speaker 2: as long as it's within the framework of cad, that's the important thing. And 

Speaker: how many sessions does the therapy usually last for?

Speaker 2: It's usually 16 to 24 sessions. There are other approaches. There is an eight session model. It's been done in a four session model, but normally a full therapy would be 16 to 24 sessions. Plus there's usually follow up also. 

Speaker: And are there any particular difficulties that you think CAT is particularly well suited for?

Speaker 2: I think generally it's often used in with people who have complex emotional relational needs in the sense that because it works actively and offers tools to help someone understand themselves. People who [00:20:00] struggle with experiencing the world in a very contrasting way, so they may feel that like the world is against them at one minute, and then foster very ideal relationships at the next and move around those different relational sort of patterns.

The tools of cap, particularly the mapping, can help that person gather all the bits of who they are together and begin to look at that in a way that perhaps they've never had the chance to do before. So we feel it's pretty effective and some of the research that's been a possible to be done in in Cap seems to support that.

Speaker: So people who feel that relationships are for them complicated, difficult, they might shift from one moment finding relationships very difficult, very tyrannical perhaps. And then in another moment idealize someone that they're in a relationship with some, something like that. 

Speaker 2: Yes, yes. 

Speaker: And I guess what you're also saying with your point is those.

Patterns reflect a kind of disintegration of self, [00:21:00] perhaps. So if you're seeing others in a really extreme way, chances are you might also see yourself in a very extreme way. 

Speaker 2: Well, I'll pick up two points there. In cap, we talk about how developmentally we experience relationships as someone doing something to us, it's a doing to to a done to developmentally the child then learns the doing to role.

Ultimately that gets internalized in how that person relates to themselves. So if they've had a very critical judgmental other in their lives, it's likely they will internalize that and be very critical and judgmental internally towards themselves or towards others. 

Speaker: Yeah. 

Speaker 2: The other thing I just wanted to pick up there, you said, um, disintegration, but often Kat would say there's not been the chance to integrate at all, right?

Speaker: There's never been the integration. 

Speaker 2: If you have an experience of someone abusing you and disrupting, you cannot think, you [00:22:00] cannot put yourself together or you know you are abandoned one minute and love the next. You can't, as a little one, put that together. 

Speaker: I suppose this integrion might happen if someone has a reasonably.

Stable upbringing, but then they encounter some huge trauma. I suppose that could be like a disintegrating event. 

Speaker 2: Yeah. Yeah. And Kat would respect that also. You know that it's a lifespan approach, but generally still emphasizes how primary early relationships have a flounder influence. Yeah. 

Speaker: And are there any particular problems or perhaps specific diagnoses that you think CAT isn't so suited for that perhaps they would be better off seeking an alternative therapy?

I know it's a controversial question perhaps. 

Speaker 2: Yes, it is. I think cat therapists generally are, will always have a go. We'll always try. I'm not sure it's always enough. 

Speaker: But that depends on the individual rather than any specific condition or diagnosis. 

Speaker 2: Yeah, it relies on the capacity of the person to be able to think about [00:23:00] themselves a little.

So if somebody is, you know, acutely unwell in a psychotic sense. Or if they are in later stages of dementia or under the influence of substances, it's not effective as, uh, but that would apply to most forms of therapy. 

Speaker: Mm-hmm. That's true. 

Speaker 2: We have a term within CAT borrowed from Vygotsky in terms of the zone of proximal development.

So it's trying to meet the patient where they are at this point in their life and help them with what's most important for them now. But some people need longer to process primary traumas going back a long way, or might need a much more CBT approach to focus on a particular symptom because CAT is not symptom-based.

It sees symptoms as a way of dealing with difficult relationships. 

Speaker: I love the zone of proximal development as an idea. I just think it's so useful and it speaks to the fact that when people are thinking about their problems. They often try and [00:24:00] overshoot when they're thinking about the solution. So someone might be having romantic relationship problems and they're dreaming of like the dream marriage, or they want to play piano and they fantasize about playing Mozart, you know?

Just to explain to listeners what using the zone of proximal development, you have to kind of meet yourself where you are and then think, okay, how do I improve 1%? You know, how do I get just outside of my comfort zone and that that is the zone, so to speak. 

Speaker 2: Exactly. Yeah. And that's the attempt of the therapist to position themselves.

If you're too close, you don't get very far. If you're too far away, change is impossible. So it's just outside the comfort zone you exactly as you said it. 

Speaker: And I, and I think the wonderful thing about this idea when you actually apply it is, you know, you think it's hard to get excited about a small improvement conceptually.

Actually when people try it and they apply this idea and improve just a little bit, oh, I used to only be able to do five pushups and now I can do 10. You know, [00:25:00] I'm not ready to be on the cover of a magazine yet. And yet the dopamine gets stimulated. You know, people do feel very motivated even when they see themselves making small steps.

And I think that's especially the case when people have felt very, very stuck for a long time. And actually that overshooting I mentioned before, that fantasy about like ridiculous improvement often keeps people stuck. And then because they see no movement, they feel profoundly demotivated. And then when they just start to see a little movement, they're like, okay, maybe this is a solvable problem actually, even if I'm only making small steps.

It's solvable. 

Speaker 2: And you've just described one of the ways the map would be, so there might be an ideal box on the map, sort of ideally loved to, ideally cared for and, and the aspiration to go up there. But there's always going to be disappointment. You fall back down again and then you get depressed and disillusioned, and then after a while you reach for that unattainable again and you go round and round it.

So we'd map that out, have it on a map, try and [00:26:00] help the person spot when they're going one way or the other. 

Speaker: Yeah, that's very interesting. So what do you find when you're working with people in cat? What does change or improvement or getting better tend to look like in a client, do you think? 

Speaker 2: Um, many and varied, but I think because of cat's emphasis on relational patterns, it would be perhaps being able to avoid or not go too often into certain relationship patterns to sort of find a way out and seek alternative relationship.

Pattern that's more satisfying or, or more successful? Um, one would hope that the experience of the relationship with the therapist gets internalized and extends the repertoire of relationship patterns that that person can carry forth. Or it may be behavioral difference. So you stop moving from one relationship pattern to another relationship pattern.

You go off the Mac if you like. 

Speaker: Mm-hmm. Yeah. It's very easy to conjure [00:27:00] up notions of like unhealthy things to do in a relationship, like suddenly leaving or aggressive behavior, abusive behavior, silent treatment, stonewalling someone. I can think of that quite easily. What do you think? Like better coping strategies.

In relationships look like more mature ways of acting in a relationship? 

Speaker 2: Well, I, I think, again, the way Kat would work with that would be to understand what's behind those ways of dealing with it, and to trace the history of that. You know, if someone's been repeated abandoned by others, it's not surprising that their main route to manage relationships is one with abandoning.

So it's understanding and having compassion for that and helping the person understand that that's a repeat of their own experience, and it's only through that recognition that any change will happen and how that change happened. Again, it is very individual. In ka, we talk about the three Rs, which is reformulation [00:28:00] recognition revision.

You can't get to revision unless you recognize, so it's working with understanding, being compassionate, developing that compassion for the self, perhaps being more able to be alert to not choose people that are likely to abandon you again, and how to know what to recognize. Until you know why you are doing it and what that's about and what the meaning is, you can't revise it.

Speaker: Yeah. I'd like to, um, zone in on what you said about compassion for the self. I've thought a bit about this. I've talked about it on the podcast, written about it, especially when it, as it relates to notions like self-esteem. I don't think self-esteem is just based on self-compassion, but I think it's a really important path.

I often find, and I don't know if you, you find this in your experience, that people are often very hesitant to be compassionate towards themselves for a variety of reasons. For some people it's very frightening. Some people might think that unless they're very self-critical, they won't have like the drive to achieve.

[00:29:00] Certain goals. So I see this in a lot of like higher functioning people. For instance, if, if they were able to be kind to themselves, that will rob them of any drive to actually accomplish things in the world. Is this something you've seen much in your clinical experience? 

Speaker 2: Yes. I, I think why I'm pausing again is, is I immediately think of the relationship patterns behind it.

So if that person's internalized a very striving, perfectionistic approach to the world, again from early relationships where they've only been seen through that lens, perhaps by the caretakers around them, and they've got those message, then that reciprocal role would dominate their personality. So you would be seeking for alternative ways and alternative relationship patterns.

So one of the things you might do is to ask about have they had other types of relationship in their lives, which have been a bit different from that, and try and catch how they would describe that and put that on the. Compassion is again, a [00:30:00] reciprocal role compassionately caring to cared for. If they've not had that developmentally, then of course they won't be able to find it.

So that would be about seeking it in other relationships or within the therapeutic relationships. So everything is relational in cap. 

Speaker: Yeah, that makes sense. Uh, and I find actually, um, although it may not appear like that at a glance. Self-compassion is actually very important for even decision making because if you're kind of not on your own side, in some sense, you're very likely to make decisions that might work against you.

So an example might be, you know, if you care more about your parents' opinion of your career than your own opinion of your career. Then you might become a lawyer because that's what they want for you, and maybe you hate that. Whereas if in those crucial times when you're choosing your career, you actually have compassion for yourself, meaning I value my own opinion of my goals more than anyone else's, then that might lead someone to make a decision that's more a known favor.

Maybe they [00:31:00] want to become a doctor rather than a lawyer. So it's very easy to feel like when you're talking about self-compassion, that you're often woo. And I'm not talking about anything concrete. But actually I find it really, really impacts people's lives in a very concrete sense. How much they're on their own side or not?

Speaker 2: Yes. But if they have not had an experience developmentally of someone being on their side, that won't be internalized. 

Speaker: So Kat is again, emphasizing crucial to have a relationship where they feel like someone's on their side and then they can internalize that. 

Speaker 2: Yes, exactly. 

Speaker: And I guess in rare cases, but severe cases, maybe the therapist might be the client's first experience of a relationship like that.

Speaker 2: Sometimes that's the case. Yes. Because of their capacity to constantly bump into adversity in life. 

Speaker: Yeah. 

Speaker 2: Which is not their fault, but you know, people have often had awful, awful things happen to them. 

Speaker: Can you comment on like, is Cat mostly now carried out in the uk? Within NHS settings, 

Speaker 2: that's the primary place where it's carried out, [00:32:00] but it's also in private practice.

It's in forensic settings, in prisons, in learning disabilities, in, in all sorts of areas. In. Because of its flexibility, you can modify in and, and again repeatedly meet the person where they are. Yeah. So if you have somebody, for example, who perhaps the written word is not appropriate, you can use pictures and images and artwork instead and still use the structures.

So it's very flexible. 

Speaker: And is there such a thing as group cat therapy or is it all one-on-one? 

Speaker 2: It's predominantly one-on-one, but yes, there is group cat. It's been done in, in various places in different ways. Some approaches have been where perhaps people in the group are met individually and have an individual map up to reformulation and then move into a group and share the reformulations within the group, and then the group carries on from there.

Another way it's been done is for the group members to meet immediately together, but the therapists to be [00:33:00] mapping in the room as the relationships begin to emerge from the interaction in the room. So there's different ways of approaching it, but it's predominantly an individual approach. It's also re used in reflective practice groups within the NHS.

Mm-hmm. And in consultancy. 

Speaker: Oh, in like business consultancy and things like that? 

Speaker 2: Yes. That again, that's a branch of it as well, because the way of thinking relationally, you can apply to any groups. 

Speaker: Yes. And you can apply it to different scenarios. So it doesn't have to be a really high stakes mental health scenario, but it might apply well to a group of people working on a team and a startup, for example.

Speaker 2: Yes, because you can sort of think about the relational dynamics going on in reciprocal roles, who's holding which relational pattern and what's happening between you, so, so it becomes a way of thinking about relationships generally. Really? Yeah. 

Speaker: How does, uh, potential therapist go about training in Kaath?

Speaker 2: Um, there's a whole range of training. If anyone is interested, perhaps go on [00:34:00] the Association of Cognitive Analytic Therapy website where there's lots more information. Most people begin by going to an introductory today workshop, usually online, but can be in person as well. They're held in different parts of the country.

And then there's several routes, but essentially it's a two year part-time training, which enables you to then practice cap within your core profession. Those trainings are in various places in the uk intakes every year or every two years. Then for those that want to develop CAT further and deepen their understanding, there's a further two to three year full psychotherapy training in cat, which enables UK CCP registration as a CAT psychotherapist at the end of it.

So it's like a two level training. 

Speaker: Do you feel like training and working as a CAT therapist has changed you personally, how you might think about your own personal relationships and go about things in [00:35:00] your own life as well? 

Speaker 2: Indeed. I think one of the things that I hear trainees say, and I would echo it myself, that once you have understood Cat's way of talking about relationships and relationship patterns and reciprocal roles, it's impossible not to think in that way.

Speaker: Yes, I often warn people who are thinking about training and. Psychotherapy in any, you know, tradition. If they're gonna do any reasonably rigorous training program, it will change your life and sometimes not in ways which are easy or pleasant. Obviously it's super helpful, but it's kind of more of a lifestyle choice.

In a lot of ways 'cause it's gonna make you aware of things that if you take them seriously, they're very difficult to ignore about sort of the way people work and relationship dynamics like you said. 

Speaker 2: And, and I would say that it has to change if, if you're wanting to be a therapist, you need to be able to change.

And personal therapy is an important part of any of, of, of CAT training as well. Because for us to be able to work with. Many different patients. We [00:36:00] need to know what our dominant reciprocal roles are and how that may be replayed in the room so that we can be thoughtful about that and not misuse our relationship patterns with people that we're working with.

Personal therapy is a very, very important part of the, the training program. 

Speaker: Currently. Psychotherapy in the UK as opposed to other countries is a unregulated profession, which means technically, legally. Anyone can call themselves a psychotherapist without having to do any training whatsoever or doing very minimal training.

And of course, training programs will range from one or two day events to 3, 4, 5 year, six year courses. Can you comment on that? Do we need to be thinking about regulating psychotherapy as a profession in this country? 

Speaker 2: I think it is being thought about again, it was thought about a few years ago and, and set to one side, but it is being thought about.

Certainly it's being discussed with the new KCP at the moment. I think it's back on the agenda. I think it's very problematic that people can set [00:37:00] themselves up and declare themselves therapists without any sort of training and, and very worrying phenomena. However, I think also my hope would be that there is a flexibility in any regulation, because what I also wouldn't want would be a prescriptive, ized, rigid approach to regulation, which would shut down more diverse forms of psychotherapy.

As I repeated say, people are so different, they need different approaches. 

Speaker: Yes, that's true. And I find even though approaches can seem quite different, they have like a lot of common elements. So. I study humanistic therapies, and of course often we use different language, but clearly we're focused on developing self-awareness, developing an idea of, oh, how do I relate to people very commonly?

What are my patterns? How can I make different choices? Why might it be the case that I've gotten to this place? Again, different language, different techniques, which might make it suited for different people, [00:38:00] but there's a lot of like fundamentals in most psychotherapies, which are very consistent in my experience.

Speaker 2: Yes, yes. And that's also been supported by some research, hasn't it? So yes. 

Speaker: Are there any books you could recommend? To serve as a bit of an introduction to CAT or the CAT way of thinking about things. 

Speaker 2: Yes. There are several introductory texts which I would strongly recommend. Again, I would just encourage accessing the Association of Cognitive Analytic Therapy website where there's a list of all those books.

There are two introductory books at the moment, if not three, which are a good read. There's also a self-help book called Change for the Better by Elizabeth McCormack, which if somebody is wanting to sort of experience the way Kat thinks is a lovely way in it, I, I would strongly recommend that. 

Speaker: And is that like a workbook that people actually have activities they can do within the book?

Speaker 2: Yes, but it's written from a, a cat perspective. Yeah. 

Speaker: Wonderful. I'll put those in the description. Hilary, it's been so lovely to talk to you. Spend some [00:39:00] time with you and learn some more about Kat. I feel a little bit more knowledgeable now. I'm a bit outta my zone of proximal development now, and uh, thank you so much for coming on.

Speaker 2: Well, thank you very much indeed for inviting me.