How does CAT work?
CAT is a very active therapy, inviting you to be the observer of your
own life and to take part in what needs change. The changes needed may
be small, such as stopping being caught in a trap of avoiding things,
or they may be larger, such as finding new ways of relating to other
people. The first thing that happens with any human encounter is our
reaction to the other person. If we feel warm and happy we are likely
to feel accepted. Conversely, if we feel got at, criticised or
humiliated we tend to feel hurt and misunderstood, we might respond by
being angry and defensive or give up trying and get depressed and
isolated. Many of our automatic responses to other people stem from
patterns of relating in early life.
For example, if you had learned in your childhood that you only
received love and care by pleasing others you might have the belief:
‘Only if I always do what others want will I be liked’ which puts
you in a trap of pleasing others, and can lead to you feeling used and
abused. When you realise you have got used to being in this trap you
can start to notice how often it catches you and can begin to change
what you do and learn to find other more useful ways of standing up
for yourself and relating to others. CAT shows you the way to change
your learned attitudes and beliefs about yourself and others, and
helps you focus on ways to make better choices.
The process of a CAT therapy is to help us look at patterns of
relating, and the effect these patterns are having on our
relationships, our work and the way we are with ourselves. Together
with your therapist, in the safety of the therapeutic relationship you
will gradually develop an understanding of the ways in which you have
learned to cope with what has happened in your life. Often people who
have been through abuse, neglect or trauma feel bad about themselves
and this can affect self-confidence. The active part of CAT helps you
to take part in the process of change in your own way. CAT is a very
creative therapy and the process of understanding and self discovery
may involve painting as well as writing, movement , self-reflection
and learning to self-monitor through journal keeping.
CAT shows you the way to change your learned attitudes and beliefs
about yourself and others, and helps you focus on ways to make better
choices.
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CAT and the Therapeutic Relationship
The one, shared understanding within all approaches to psychotherapy
is of the value of the therapeutic relationship as a way of
understanding a person’s inner world. It is within this confidential
relationship that psychological and emotional wounds reveal themselves
in relation to the therapist and have the opportunity to find
healing. The structure of CAT offers important contributions to this
potential healing journey through relationship. The shared description
of learned patterns of relationship (these are called reciprocal
roles in CAT) and how these patterns of relationships will almost
inevitably be experienced in the relationship between the client and
the therapist. This is called ‘enactment’ in CAT and can be very
powerful and learning experience for client and therapist.
The therapist recognises and names these difficult relationship
patterns as they happen so that you can begin to connect your
cognitive (or ‘head’) understanding with your emotional (or ‘heart
’) understanding. However painful or difficult, this process is
shared and explained, in a mutual and respectful way.
The process of change comes from naming, experiencing, sharing,
recognising and understanding these patterns. Developing awareness
allows new, healthier relationship patterns to be born. The
relationship between the client and therapist itself models this more
accepting and respectful way of relating.
CAT is not
CAT is not prescriptive or pre-designed
it’s not like ‘painting by numbers’
the work is shared collaboratively
right from the beginning you will be involved in your own self
monitoring and diary keeping
alongside the therapist who starts the ball rolling, you will be
describing your own life story and mapping goals for change
It is an individualised programme for uniting each person with their
emotional history in a way that makes sense and out of which is born
the real possibility for revision of old patterns and change.
you can begin to connect your cognitive (or ‘head’) understanding
with your emotional (or ‘heart’) understanding
CAT is not prescriptive or pre-designed, and it’s not like ‘painting
by numbers’
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What problems can CAT help with?
CAT tries to focus on what a person brings to the therapy (‘target
problems’) and the deeper patterns of relating that underlie them. It
is less concerned with traditional psychiatric symptoms, syndromes or
labels.
CAT recognises that people are so much more than their identified
problems or diagnoses and helps each individual find their own
language for what appears to go wrong as well as setting manageable
goals to bring about change.
You might have problems that have been given a name by a health worker
such as depression, anxiety, phobia, or borderline personality
disorder
You might recognise that you are suffering from unmanageable stress or
that you self-harm
You might have problems with substance misuse or suffer with an eating
disorder
You may have a pattern of difficulty in looking after yourself
properly or unsuccessful or broken relationships
You might have long-term physical symptoms that are difficult to
manage and affect the way you feel about yourself and your close
relationships
You might have tried other types of therapy, or different things to
help you cope with your difficulties
Some CAT therapists work with people with eating disorders, those with
addiction problems (like drugs and alcohol), obsessional problems,
anxiety, depression, phobias, psychosis, bipolar illness, and a number
of therapists work with adolescents, older people and people with
learning difficulties and in forensic settings.
CAT is mostly offered to individuals, but it can also be used
effectively with couples, in groups and to help teams understand the
‘system’ in which they work.
<
div> CAT recognises that people are so much more than their identified
problems or diagnoses
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Case histories
Karen's story
This is a case history written by Liz McCormick – it draws on
different clients' stories as a way of explaining how CAT works. All
the clients gave Liz permission to use their stories in her self help
book 'Change for the Better'.
Karen was recommended for Cognitive Analytic Therapy after a number of
admissions for overdosing on Paracetamol ? a potentially
life-threatening action.
Her family background was unsettled. She had been fostered at age
four, and then adopted by a couple who split up when she was eight and
she was ‘parcelled around’ to family and friends. Two ‘uncles’
had sexually abused her, she had been made to ‘keep quiet’ by being
offered food. Her experiences of rejection and abuse had left her
feeling worthless and unlovable as if no-one wanted her or loved her.
She had never had the opportunity to develop a language for feelings
and did not know how to say ‘no’.
Karen learnt to cope and survive with her confused and unhappy
feelings in different ways. From about the age of 12 she developed an
eating disorder, one of her patterns was to starve herself ? that way
she felt in control and this gave her temporary relief, but then her
need for food would lead her to binge and she would feel overfull and
disgusted with herself and vomit. In the end neither way helped as she
still felt lonely and at the mercy of difficult feelings.
By the time she began secondary school all her peer group seemed to be
pairing off and it reinforced her feelings that she was worthless, as
if no one really wanted her. All she could identify with were stories
from romantic novels or an idealised longing for ‘perfect care’. In
reaching her mid teens this longing for love and care developed into
a pattern of making intense and immediate relationships with men.
Whenever she met anyone new she ‘fell immediately in love’
idealising how things might be and how this new person might offer her
‘perfect care’. Her desire for closeness made her appear
overwhelmingly demanding and the relationships would end explosively
after just a few weeks when she would be intensely angry at what she
experienced as betrayal and rejection, and would reinforce her
feelings that no-one cared for her and she would make an attempt on
her life. She had had five admissions in two years for overdosing.
We worked on developing the diagram below and this helped her to see
and understand the pattern of responses in relationships that led to
her overdoses. She started to understand how these patterns had
emerged from her early experiences and learning and she began self
monitoring and finding experiences that she could rate as ‘good
enough’ through therapy rather than continuing to seek ‘perfect care
’ that only existed in romantic novels. She also began to untangle
what she was feeling, learning a language of emotions and recognising
the patterns of her emotions involved in bingeing and starving. She
started a feelings diary, slowly being able to describe what she was
feeling when she wanted to binge or starve. Just these few self help
skills helped her to feel more stable and in control.
During the middle phase of her therapy she began to see how her
idealisation of relationships had become a substitute for her grief at
her early losses and how it had prevented her from being able to
recognise ‘good enough’ and that if she said ‘no’ it did not mean
that she would have nothing (when she felt as if she was rubbish and
would always be alone). Her sadness and anger at everything that had
happened in her life sometimes felt overwhelming for her but the
regular sessions helped her to express what she was really feeling
rather than expressing this through overdosing or bingeing and
vomiting.
Life began to stabilise for Karen and she began the work of receiving
‘good enough’ care for herself and found that when she began to say
how she felt, that it did not result in rejection that she feared.
Making sense of Karen's map
Karen’s map describes one of the patterns that she and the therapist
worked out between them. Start at the purple circle:
Karen’s experiences when she was growing up left her with raw
emotions and feelings she could not make sense of, and which were
overwhelming
She needed to get away from feeling like this about herself, and like
anyone else, wanted to have a relationship but
Part of her had learned to behave in particular ways and to expect
others to do likewise (in CAT we call these ‘reciprocal roles’), so
relationships would nearly always take the same course
would become too demanding and the other person would pull away and
end the relationship, or Karen would do anything to keep the
relationship going and suffer abuse rather than be alone
This would leave Karen overwhelmed with anger, grief and betrayal and
the only way to cope with these unbearable feelings was to block them
out by overdosing but this again left her back in silent despair
The light purple squares show some of the changes that Karen slowly
made to find ways out of these patterns (‘exits’ in CAT language).
They look deceptively simple, but summarise important changes that
were hard to make and meant many different things to Karen.
Some clients have written accounts of their experiences of CAT and
have very kindly agreed for them to appear on the website. See:
CAT or Can You Make a Mad Man Sane
CAT and borderline personality disorder
A suitable case for treatment: CAT and diabetes
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Cognitive Analytic Therapy, or Can You Make a Mad Man Sane?
Alan Wayne Whiskerd
Alan has given his permission for us to use his story.
When I was asked to write this, I must admit I was surprised and just
a little bit daunted. What follows is an honest appraisal of what
happened to me and how the process of CAT affected me and my life.
Madness – The dictionary definition features of a variety of synonyms:
deranged in mind, insane, crazy, frenzied, angry, and infatuated. If
that is an accurate assessment, then I suppose I was “mad” because I
was all of those things. But then again isn’t everyone? It is,
though, a question of degrees.
Certainly, I felt and
exhibited the whole gambit of those emotions. My
wife, family and friends didn’t know what to do next. I didn’t know
what to do because I didn’t know who I was or what the hell was
happening to me. I had recently had a liver transplant; a life saving
operation which literally gave me the gift of life. I should have been
on top of the world, “A man barely alive”, who was literally
rebuilt. I had the opportunity to again thrust myself into the
maelstrom of life, to tackle the issues, the injustices to “make a
difference”. I needed to make up for the mistakes of the past. But I
was falling apart, not physically, all well there, but psychologically
and emotionally. I found no solace in simply being alive. What was
the point of life if you didn’t know what the hell to do with it (I
would have used another word other than hell which begins with an “F
”, but sensibilities of one’s audience must play a part).
I was a 51 year old Welshman who grew up in a tough industrial steel
town. I had a brain and “got out” of the expected route of school to
industry and then an early death from some industry related disease.
I went to college and then into the teaching profession. Two wives,
three children, twenty seven years teaching man and boy followed. I
became a head teacher, well liked, respected and good at my job. I had
also, however become an alcoholic. At 47 I was forced out of my
profession through mental ill health, chronic depression and nervous
breakdown, (looking back now it was alcohol related) in short, I
simply could not cope anymore. In April 2007 I was diagnosed with
Decompensated Cirrhosis of the Liver. It was a death sentence; not
that I realised the full implications until later. So began the “war
” as I called it, the battle to survive, I gave up alcohol, battled
the addiction and won. Fantastic health professionals kept me alive
just long enough for the transplant, (I was told I had less than two
weeks if that liver hadn’t become available). Now I had to deal with
God’s intervention? Why me? What about the guy who died? What if it
all went wrong? When would it all go wrong? I had also become
infatuated with a beautiful young nurse. Nothing wrong with that it
happens a lot. But I was married with three children. She had just got
married. I went to the wedding. What was one of the definitions of
madness, Infatuation? Well I was certainly infatuated. When I told her
how I felt, she of course broke off all contact, I was bereft.
Cognitive Analytic Therapy
I had been receiving psychiatric support and counselling from the very
early days post operation. The balance of my mind was disturbed. I
simply couldn’t come to terms with what had happened to me. The how,
what, why, who? There were the questions about me, my life that I
couldn’t even begin to interpret let alone answer. I lurched from one
crisis to another each one deeper, more destructive than the last. At
this point, I was contemplating suicide. Incredible, I had spent the
last year fighting to stay alive and here I was considering taking my
own life. It was at this point that I was referred for CAT. But as
normal nothing is ever straight forward, there was a waiting list. So
I waited. But even as the wait began I started to put all my faith on
this procedure. I had already built it into a life saving event. I had
no idea even what it was all about and although I wanted it to be the
Holy Grail, I did wonder whether this was yet more “psycho babble
bullshit”. As the wait continued my mood swings and behaviours became
more severe.
I had heard briefly of CAT through my contacts with counsellors and a
friend who was a trainee psychologist. My experience of “counselling
” was less than inspiring and I was reaching the point where I
thought that all things psychological was a mythical creation by a
bunch of people who had worked out a better system for printing money
than the Bank of England.
Counselling to me was well meaning people who had allegedly been
trained and who listened to your woes, made warm coo-ing noises, then
told you about their woes, where you then ended up counselling them.
So I suppose I wasn’t exactly going in to it in the most positive
frame of mind. However I was now desperate for help. I had realised
that because of everything that had happened to me in the recent past,
my fault or not, I was descending into despair. I was afraid that I
would once again be entering a tunnel that ultimately led to hell
itself.
I wanted a cure for the mental malaise and desperation that I felt.
CAT I hoped could be that cure, the magic bullet. It didn’t cure me.
As time progressed I realised that CAT isn’t designed to do that and
to be fair when dealing with mental illness putting a plaster on it
and resting up for a couple of weeks isn’t an option. In the long
term what it did was to give me the tools to make the magic bullet
myself, to understand; therefore to realise; and to effect the answer.
The course was for sixteen weeks. I have to admit I couldn’t for the
life of me see what anyone could talk about for sixteen weeks but I
thought all would become clear. The initial phase was simply
background building, I told my therapist everything that had happened
in my life half expecting her to hang herself, a la the scene from the
film “Airplane”. That didn’t happen and my perception was that
actually she did care and believed that she could help me come to
terms with my problems, who I was, and how to manage my mental
instability and move forward with my life. That was a key moment, the
creation of the trust that was needed for me to believe that this
process could actually work. I prefaced everything I said with what I
tell you this week I might say the exact opposite next week depending
on my mood. While nothing as extreme as that did happen, I did act and
react according to how I felt at the time. On going events have a
habit of impinging especially when you are trying to reinvent
yourself.
Even from the early stage my therapist understood where I was coming
from. She was intuitive and we quickly established that my current
attitude, mode of behaviour was steeped in the events of the past
especially my relationship with my father and mother. That being said,
the first “eureka” moment was the realisation that my relationship
with my grandmother and her death when I was a very young boy had
critically affected my development as a man and my approach to life as
an adult. I was, as a boy, extremely sensitive, I cried a lot,
actually still do. This didn’t go down well with a steel worker
father who believed your only way to survive was to be hard and
ruthless. I suffered untold physical abuse at his hands. Part of my
problem was that I never sorted out the past with him. I also realised
eventually that, although what he did was wrong, he believed it was
best for me because the world I was born into didn’t take any
prisoners. My Nana was my comfort blanket, she looked after me gave me
love care and protection from the nasty world that I inhabited. Her
death took away the comfort blanket and I was now exposed to whatever
the world, or particularly my father, could throw at me.
It was from this juncture I created my alter ego, to give him a name,
Alan, which was my father’s name. Alan became the hard nosed, forward
driving, ruthless individual who couldn’t be hurt. The little boy
who was sensitive and cried a lot was crushed and submerged beneath my
Mr. Hyde. Don’t get me wrong, it stood me in good stead. I became
immensely ambitious and by and large succeeded. I was a deputy head at
28 and a head teacher at 31. Alan prevailed, I lived and worked flat
out, but when I crashed I did so big time. I had two breakdowns,
severe depression followed and the cycle had been created. I surged to
tremendous highs and collapsed to unbelievable lows. I put this down
to Wayne, the weak little boy who cried a lot coming through. My
therapist worked with me on a simple diagram which had a top and a
bottom. I lived either at the top or in the latter years, more often
at the bottom. The top being Alan’s world which I saw as success and
the bottom being Wayne’s world which was weakness and failure. To me,
I had failed, as a teacher, husband, father and ultimately as a man.
I never lived in the calm waters of the middle; a place where the
qualities of Alan and Wayne could co-exist, even help and support each
other. I likened it to an episode of Star Trek, where Captain Kirk
had been split into two physical beings, by the transporter, each
physically identical. One was ruthless, ambitious and utterly bereft
of compassion. The other was soft, sensitive, loving and
compassionate. The upshot of the story was that neither could survive
alone they could only live as one.
Over the weeks I began to recognise my trigger points. What made me
surf the waves from crest to trough and slowly, almost accidentally at
first, I began to control the intensity of the mood swings. In short
I had become aware of what was happening to me. I used the diagram to
control my emotions, I practised techniques of thinking before acting.
It didn’t always work and I still did things, said things that were
rash and foolish but slowly they lessened and I became more calm in my
acts and deeds.
But there was something else that was causing my underlying
instability. In the days of dying, as I have said, I had become
infatuated with a young beautiful nurse. By now she would have nothing
to do with me, understandable when you consider her position. When
you fall in love, however absurd and unlikely, and that love is
unrequited, and you are eventually rejected; the emotional resonance
is huge and destructive. I couldn’t understand what had made me like
this, yes I was ill, yes I was dying but there were lots of nurses
that cared for and helped me, I didn’t fall in love with them. Then,
the second “eureka” moment, which came directly from the CAT,
happened. The nurse, my nurse, was the first one to show me the care
and love that my Nana had done. She was warm loving and made me feel
safe when the “bogey man” was hiding under my bed; the bogeyman
being my imminent death. My love, or what I called love, was simply
the search for the care and warmth that my Nana had shown me. The
little boy who cried a lot and had been crushed under my alter ego had
surfaced and screamed for help. The nurse, however unwittingly, had
answered my call but like my Nana she too was to leave me alone, hence
my path towards self destruction. My understanding of that fact was
the key to what I regard as, and call, my recovery.
I have moved on from those times and I am as happy now as I have ever
been in my life. The two sides of me now co-exist, sometimes there is
friction, but mostly harmony. We both realise that we need each others
strengths. Alan gives the little boy who cries a lot, strength to
face the hardships and problems. Wayne tempers the ambition,
aggression and thoughtlessness of Alan.
The bottom line was the fact that “I” had allowed the little boy,
you remember, the sensitive little boy who cried a lot, to co-exist
with and support the go-getting, hard-nosed ambitious man I had
created. I now ask the question what part the Cognitive Analytic
Therapy played? Firstly, it helped me to come to terms with things I
already knew, but hadn’t accepted. Then it helped me link up the
moment of Nana’s death and its effect on the person who I had become.
I now understood who I was and why I was and how I got there. I wasn
’t the bad person I had come to believe. I was, and am, an ordinary
man with lots of flaws but lots of good parts. The key to it is
accepting all facets of my character and personality, to temper the
highs and lows with the understanding of who I am. (And not to fall in
love with 25 year old nurses!!!)
This may sound like a lot of “Tosh” but it is a genuine attempt to
put into lay mans terms the effect that Cognitive Analytic Therapy had
on me. As the recipient, in the end I think I have gone a long way to
resolving the issues; but it was the facilitator, my therapist, who
made me ask the questions, face the facts and address the behaviours.
Without it, at the risk of being melodramatic, I may well have taken
my own life.
a key moment, the creation of the trust that was needed for me to
believe that this process could actually work
I now understood who I was and why I was and how I got there
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Borderline Personality Disorder and Cognitive Analytic Therapy – a
personal account
Here I aim to talk about Borderline Personality Disorder (BPD) and how
Cognitive Analytic Therapy (CAT) can help you make important and
lasting changes to your life, and what to expect during the therapy
process. It has been my experience that there is so much jargon and
confusing information for BPD and sexual abuse, particularly on the
internet and the information is aimed at therapists and health
professionals and not patients. I hope that by reading this you will
come to better understand BPD, the therapy process and how this
impacts you and your endeavour to seek lasting change and inner
healing.
The term Borderline Personality Disorder is used by health
professionals to describe people like us, who have difficulty in
relationships and suffer with depression, f
eeling anxious, feeling
very angry “rage” and directing the pain we feel either at others or
inwardly at ourselves through self-harm. There is nothing borderline
about you. I know being diagnosed with BPD can be a scary prospect, as
the symptoms described are all of the things that you detest about
you or are too scared to confront. It can also be freeing, I know when
I started therapy it felt good to name and recognise how I was
feeling and to know that I was not a “freak!” Borderline Personality
Disorder is actually more common than you think, and is nothing to be
ashamed of.
When I was first diagnosed I remember feeling angry and hurt, as I
felt they had just stuck a label on my head. Now I realize that it is
my choice to either live up to the description and diagnosis and
behave as they describe, or work out ways of changing how I respond in
situations, but more importantly work on changing how I feel about
myself on the inside. You have that choice too.
There are many studies into BPD and exactly what causes it and there
are some conflicting results, but most people who have BPD suffered
greatly as children, and this is something all health professionals
agree on. From the time you are born you are like a sponge, taking in
information from the world around you. As a baby you are completely
dependent on your parents and need them in order to get all of your
needs met. We can only view the world based on what we experience. We
take in from the world words and ways of behaving and beliefs about
ourselves based on how others treat us. If you were abandoned as a
child, as I was, you might grow up believing that you are not loved
and unlovable. If this is then confirmed like it is when you are
abused then you grow up feeling that you are bad, relationships will
always be bad, you don’t deserve to be happy, and it was your fault.
This is then how you see the world, and because the world is not safe
we devise ways of protecting ourselves, we put up defences and learn
how to act “normal” or how society expects us to even though we feel
empty on the inside. We want and need to feel safe, but never do. We
push people away when we want them close. The very thing we want we
either push away through fear that the other person will reject or
hurt us, or we become attached to that person and overwhelm them so
they back away and reject us. This then confirms what we believe about
ourselves and the world, and so the cycle continues.
During abuse we manage and cope with it in different ways. A common
way to cope is to go somewhere else in your head and pretend it’s not
happening. This is called dissociation, it happens to everyone at
different stages in their lives. Did you ever go on a journey in a
car, where you know the road well and get to the other end and have no
recollection of parts of the journey? That is dissociation and thank
God for it, it protected you and me when things happened that were out
of our control, things that were too painful for us to cope with as
children. The problem is our brain doesn’t realize that we are safe
now, and during times of extreme stress and anxiety we switch off.
We feel like we aren’t real – I know that when I switch of my face
goes numb and I can’t feel a thing. One way I used in the past to
make myself feel again was to cut myself, when I cut I felt release, I
could feel again. It can be really hard to stop cutting, and people
who don’t understand us think it’s a way of seeking attention. There
are other ways of coping with these unpleasant symptoms, but
ultimately you have to want to change for you, and seeking therapy is
a good start.
People who have suffered as children, especially abuse, have
difficulty relating to others and to themselves. This is because when
you are abused your boundaries are trampled on; your personal space is
invaded. As you try to cope and make sense of all of this you create
ways of coping ways of protecting yourself. The legacy of what
happened to you as a child, if left undealt with will continue to
manifest itself in your adult life, in your interactions and
relationships with others but more importantly in how you think or
feel about yourself. This bears much weight because your self-image or
lack of it, is what leaves you vulnerable to abuse from others. It
may not be abuse of the same kind you endured as a child; it may be
that you learned as a child that if you behaved in a certain way you
would escape the inevitable abuse “if I am good then……. won’t
happen.” This continues into your life now so you try to please
others all of the time and so conform to their wishes even if you don
’t want to.
You will find it hard to think about yourself and care for yourself,
because you believe you don’t deserve it on one hand, but on the
other hand crave affection, acceptance and intimacy. The problem is
you have no clear sense of who you are because you have had to learn
to respond to the world around you, rather than being centred and
assured on the inside. This means you are constantly changing in how
you act or react with others, in psychology they call these changes in
mood “state changes.” Boundaries are an important way of defining
where you end and the other person begins, people like us cannot do
this because we have no clear sense of who we are because who we are
is defined by outside experiences.
The good news is, you can bring about lasting change, it won’t be
easy and you really have to commit to it and stick at it. Therapy won
’t change you – only you can do that – but it can give you a safe
place to learn to look at yourself and reflect on your life with
someone who understands your inner world and will support you.
There are many different models in psychology that are based on
different theories. Cognitive Analytic Therapy is what is known in
psychology terms as “integrated,” meaning it takes parts from all of
the main schools. What this means to us patients is our therapists
will be able to use lots of different tools to help us in our
endeavour to understand ourselves.
Before you start therapy you will be assessed, this means meeting your
therapist to see if you can work together, and it gives you a chance
to ask any questions you might have.
I remember when I first started therapy, I was scared of what my
therapist might “do” to me, and I was so concerned with what CAT was
and refused to let her alongside me. CAT focuses a lot on the
therapeutic relationship, and anything this might bring up for you
will be looked at, as it is a magnified version of what happens in
other relationships you have in your life.
It’s a funny kind of set up really, your therapist won’t talk about
their own personal lives, but that’s because the therapy is fo
r you.
There is also no contact outside of sessions which last for 50mins.
Your session will always be on the same day and at the same time each
week. The relationship you have with your therapist is an important
part of the process, and in time you will grow to trust the
relationship and what it stands for. CAT is a time limited piece of
work and can last for 24 weeks there is then a follow up each month
for 3 months. And yet even though this all seems rigid and calculated
in my experience my therapist has provided me with the most sincere,
honest and caring relationship I have ever experienced. There are
limitations to what she can offer me, but what she can offer me is a
place and space to look at myself and try to make sense of my inner
world so that it holds less power over my life, with her alongside
supporting me and helping me to look at things in different and new
ways.
The structured and boundaried relationship that CAT creates means that
your therapist will be able to look at your life with you, without
getting hopelessly lost, in a place where he/she can be of no help to
you. After getting to know each other normally around the fourth
session, your therapist will work with you on a “reformulation” of
your life so far. Your therapist will write you a letter, in it will
be a snapshot of how things are for you and what the difficulties in
your life are, as you have shared with your therapist. It will
describe patterns and problems which you feel stop you from getting to
where you want to be in your life, and your therapist may set some
goals around these so that the work you do in therapy has clear
direction, as it is a time limited piece of work.
During therapy you therapist will use maps and diagrams as a way of
thinking about cycles you get into, this is done with you in the
sessions and can be added to as therapy progresses. You can then take
the map away with you each week and use it to see if there is a
pattern to how you relate with people in your life. In my experience
the maps provide a new way of thinking about my life, almost like I
can observe my behaviour and the behaviour of others. The map also
lets me understand why this behaviour is happening.
Towards the end of therapy, your therapist will spend time with you
looking at the goals you set at the beginning and you both talk about
how well therapy has or hasn’t worked for you. On the last session
you will both read each other a “Goodbye” letter. This is because
ending any relationship is difficult, but the therapeutic alliance you
have both worked so hard to create can be difficult, as you feel
unsure about embracing your new life without the weekly support of a
therapist. There will then be a follow up appointment monthly for
three months after.
In my experience real therapy is pure unadulterated hell. As I said
before you really want to have to change for you and in order for it
to work you must make a real commitment. CAT certainly doesn’t have
all of the answers, but will help you to work out what is right for
you. There were times when I really wanted to quit, but I stuck with
it and I am glad that I did. Change doesn’t happen overnight but CAT
can help you to begin.
I hope that reading this has helped you feel less unsure about CAT and
starting therapy. And I hope you find the courage to embrace therapy
in a way that has real meaning. And I hope therapy helps you to
continue on your journey in life in new ways. You cannot change your
past, or cure the pain completely, but you do have the power to take
control of your life and get to where you want to be, and therapy
really can help you to start over with a different perspective of
yourself and your life.
I wish you success in your therapy journey.
It can be really hard to stop cutting, and people who don’t
understand us think it’s a way of seeking attention
The good news is, you can bring about lasting change
your therapist will be able to look at your life with you, without
getting hopelessly lost, in a place where he/she can be of no help to
you
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A suitable case for treatment: CAT and diabetes
Geoff Woods
Geoff has given permission for us to use his story.
I was first diagnosed with type 2 diabetes 10 years ago. After trying
to lose weight almost all of my adult life I suddenly lost around two
stones for no apparent reason -something was wrong. After talking to a
couple of health conscious friends I was still none the wiser. Did I
feel overly tired? No! Did I go to the loo a lot? No! So I quickly
ruled out the possibility of diabetes. As a last resort I visited my
GP who after a couple of tests discovered I had sky-high blood sugar
levels. It was a couple of years after first being diagnosed with
diabetes, and after trying to control the illness first with diet,
then with tablets, that my nurse said that I really should start
injecting insulin. I’m sure I looked depressed ? I was dreading this.
My nurse must have noticed how down I looked and suggested I might
benefit from a course of CAT. I agreed it was worth giving it a try.
The therapy began ? the first hour seemed to last about ten minutes,
and I can remember thinking while I was walking home from that first
session that we didn’t touch on my diabetes. I realised later we were
looking at the bigger picture, and at some point in the therapy I
realised it was making me think much more deeply about myself.
So, my diabetes had been handed to me by ‘the great spirit’ at a
time in my life when everything was going wrong. I had just lost a
very (up till then) successful photography business. I had also lost a
very beautiful house to the bank, and my child and her mother left to
move to Brighton. I was left on my own in a city once full of
friends, to try and survive in a field of ghosts.
During the time of my therapy I started to move and work in the world
of filmmakers. This, for anyone who is not aware, is a minefield of
the world’s most screwed up people, most of whom have located
themselves in Brighton. Consequently one of the first things I
remember therapy addressing was how to avoid ‘self-sabotage’,
especially in the company of people in this industry. The fruits of
the therapy were immediately apparent when I was on the verge of
walking out on a feature film production as director of photography.
Needless to say, I’m now extremely glad I didn’t. I began to see how
self-sabotage did not serve me. Even though the feelings to do the
same today are just as strong, I can handle t
hem much better. I have
to now find a balance between walking away from every situation that I
feel is unjust or makes me angry, but without letting people walk
over me. And I believe what I have learnt has contributed to the fact
that I am now a writer/director/producer of my first feature film.
I can’t remember at what stage in the therapy we tackled the issue of
diabetic control or rather the lack of it, but I do remember slowly
realising the major importance of food. Now I must say at this stage
that food has never been a big deal in my life. I have never been into
junk food. However, as I was now taking insulin, what I ate, how much
I ate, and when I ate became very important to me. I just thank God I
never had a sugar craving!
It seems to me now that the structure of CAT was working so well that
I could not tell (moment by moment) whether it was my well-being or my
aspirations that were being addressed. Essential seeds were sown – I
learnt a lot about myself ? about day to day management, as well as
the long term. About my position in the small world and my place in
the big world. Understanding my depression and handling it were part
of the solution.
A real life example might help to illustrate this. A couple of weeks
ago I was about to film two major scenes of my film. The night before
I had a meeting with my sound engineer and first assistant director.
After they left, an overwhelming wave of self doubt and depression
swept over me. But I knew how to handle it, respecting my body I ate
good food, respecting my mind I got some quality sleep using a
technique I have learnt, knowing that in the morning I would be the
strongest man in the world. I was and everything was fine.
The dubious attribute of having a so-called creative mind comes with
all sorts of non-optional extras, which if controlled can be a
wonderful thing. If not, they may just destroy you. I have had many
friends who have destroyed themselves. Couple this mind with a
degenerative illness, and being a single parent, you can really do
with help sometimes. Especially in my case, every now and then, you
have to stop writing your new film script or studying the latest
movements in art.
And look after your teenage daughter, be there for her for a long
time.
And look after myself.
I was left on my own in a city once full of friends, to try and
survive in a field of ghosts.
the structure of CAT was working so well that I could not tell (moment
by moment) whether it was my well-being or my aspirations that were
being addressed
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What Are CAT Sessions Like?
You will usually meet for between four and 24 weekly sessions,
typically sixteen, but this will be agreed between you and the
therapist.
The first few sessions are the ‘reformulation phase’. You have the
opportunity to speak openly and in confidence about what is happening
in your life, about your own personal history and life experiences. As
well as things going wrong in your life there are always some things
that have gone right. The therapist will encourage you to name what
works well and what areas have given you happiness and satisfaction so
that you do not feel you are the sum total of the parts where things
haven’t gone well.
You may be asked to complete a questionnaire called ‘The
Psychotherapy File’ which divides commonly experienced difficulties
into Traps, Dilemmas, Snags, and Unstable States of Mind. Examples are
given within each grouping such as: “I act as if ‘either I keep
feelings bottled up or I risk being rejected, hurting others or making
a mess’.” There may be other questionnaires to help you look at
mood shifts or symptoms. All these papers are ways of helping to focus
accurately on exactly what sorts of thinking or behaving contribute
to things going wrong.
After the first session you may agree with the therapist to monitor a
particular symptom or mood.
At around session 4/5 the therapist will read to you a ‘Reformulation
letter’ which is a written account of the understanding shared
between you and the therapist about the problems that have brought you
into therapy, how you have tried to cope with them, and what you are
trying to change by coming into therapy.
The therapist will work with you to map out your problem patterns on
paper. This can help you develop your capacity to think about yourself
and understand why you may repeat patterns which cause you distress
but find hard to stop.
The active therapy that continues works towards helping you build
recognition of the patterns of relating, thinking, acting and feeling
that you want to change. The therapist might suggest ways of
monitoring these patterns in between sessions, and you and he or she
will look out for these patterns happening within therapy itself. CAT
is an open and ‘up-front’ form of therapy, where the therapist
shares their thinking with you explicitly. There are no hidden
theories or secrets in CAT. The therapist is actively involved in
treatment, and will encourage you to be the same.
The therapist will work with you on looking at how you revise your
patterns but they will understand the difficulties involved in change.
One of the strengths of CAT is that the letters and maps will help
you to continue working after the regular therapy sessions have
finished.
CAT recognises that finishing therapy can be difficult, especially if
endings in your life have been difficult in the past. The last three
or four sessions are used to think back over the course of therapy and
at the ending of this therapy relationship. The therapist will write
a ‘goodbye letter’ and will invite you to do the same.
You will usually be offered a follow up appointment at two-three
months after the end of your regular appointments.