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Anthony Ryle, consultant psychotherapist at St Thomas's Hospital, London, has been developing a innovative therapy called Cognitive-Analytic Therapy (CAT) over the last twelve years, and this book provides a comprehensive introduction to the theory and method that has evolved. This is an important development in applied psychoanalysis in the tradition of time-limited work begun by Ferenczi and Balint (Balint 1972) and will be essential reading for mental health professionals involved in brief psychotherapy.
CAT follows a format of sixteen sessions, the first four of which are aimed at reformulating the patients' problems in terms of ‘procedures’. ‘Procedures’ are the mechanisms by which patients perpetuate neurotic difficulties, thought disorders, dissatisfying relationships and symptoms. There are three sorts of procedures, traps, snags and dilemmas, which Ryle elaborates with detailed clinical examples. Patients are requested to keep a diary during therapy and rate their own progress. With the help of the therapist, they discover how such procedures operated during their past, how they influence their present relationships, and how they are at work in the transference. Such discovery ‘gives back the meaning of past experiences by validating previously disallowed sadness or anger and recruits them [the patients] to active work’ (p. 221). Through this, they gain a ‘powerful sense of personal efficacy’ (p. 220). The remaining sessions are then spent recognising a few specific procedures, called target problem procedures (TPP's), and exploring alternative ways of feeling, thinking and behaving.
It has frequently been noted that many professionals providing therapy in the public sector often mix psychoanalytic, behavioural and cognitive models, usually under the pressure of time and expense (Douglas 1989). Until now the view of Balint and other psychoanalytic innovators has been accepted, namely that there is no adequate metatheory to explain what is special about brief