In cognitive analytic therapy (CAT), change in therapy is understood to depend on the effective use of a reliable human relationship within which hope and morale can be restored (Frank 1961). These are aspects common to nearly all psychotherapies, and for many less disturbed patients nothing more specific is needed. As the extent of personality restriction and distortion increases, however, so the containment of a patient's self-destructive ways of thinking and action, their liberation from restrictive, defensive solutions and the maintenance of the working relationship of therapy become more problematic. For these patients, who form the great majority of those receiving formal psychotherapy, CAT makes considerable use of writing.
The time spent in the presence of the therapist is a small proportion of a patient's life, especially when therapy is time-limited, as is the case in CAT, where 16-24 sessions is the usual duration. The vital work of therapy must be to focus upon fundamental issues, be memorable and of high emotional impact. Recording the specific understandings arrived at by patients and therapists in writing and diagrams, and using written materials to guide reflection and exploration, are important elements of the approach. They support therapists in the provision of intense, reparative, non-collusive relationships. They represent psychological tools through which patients expand their capacity for self-reflection and control.
The human genotype has not changed for at least 125,000 years. Over this period, man's unique symbol-making and symbol-using capacity, manifest in artefacts and in speech, has been applied to the physical world, the social world and the process of thinking itself. The additional development, only 10,000 years ago, of external written symbols resulted in a massively accelerated rate of growth in the accumulating storehouse of knowledge. As a result new kinds of minds in new kinds of people have emerged.
In some ways the development of the individual recapitulates this evolution. The emotionally various and intense interactions between infants and their caretakers