Introducing Cognitive Analytic Therapy: Principles and Practice

By Anthony Ryle; Ian B. Kerr | Go to book overview

Chapter 6
THE REFORMULATION SESSIONS

SUMMARY

The early sessions in CAT focus on the joint creation of written and diagrammatic
descriptive reformulations of a patient's overall picture of distress and dysfunction and
its developmental origins. These become central to the subsequent work of therapy.
Reformulations focus principally on the acquisition and enactment of reciprocal role
procedures. A written, narrative, reformulation letter is followed by a diagrammatic
one, although in order to contain more disturbed patients it is helpful to attempt even a
rudimentary diagrammatic reformulation as early as possible. These documents serve as
'tools' which promote a powerful therapeutic alliance by providing a means of under-
standing and mapping an integrated picture of often highly maladaptive role enact-
ments, especially those which may constitute threats to the therapeutic alliance.
Revision of these inevitably provisional documents may well be required during the
subsequent course of therapy. Constructing a reformulation is a clinical skill which
requires practice, supervision and an ability to remain empathic towards the patient
whilst also thinking reciprocally. These principles are illustrated by case material.

This chapter describes the defining activity of the CAT therapist. To those unfamiliar with the approach it will repay careful reading, because the ideas and practical tasks are relatively complex.


CASE FORMULATION AND CAT REFORMULATION

Psychotherapists of all persuasions make case formulations of their patients, a process involving the selection and arranging of data according to their

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