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Louise Johnson, 2013. Reflecting on my first placement - A CAT understanding to illustrate learning. Reformulation, Winter, p.9.
I am a first year Psychologist in Clinical Training from the University of Leeds. Recently, I have completed a six month placement based in an adult mental health service in Harrogate, North Yorkshire. I was fortunate enough to be supervised by Dr Haydee Cochrane (Principal Clinical Psychologist and Cognitive Analytic Therapy Practitioner). I can distinctly recall my first correspondence with Dr Cochrane. Her first welcoming email read; ‘I am currently in the last phase of my accreditation to become a Cognitive Analytic Therapist (CAT) supervisor so I hope you like CAT!’. My thoughts were ‘What on earth is CAT?!’. I had never worked with CAT before and promptly went to the library in search of some texts.
Whilst the book was helpful, my real learning started on placement. I was given my own clients for CAT treatment, under Dr Cochrane’s supervision. As my placement was coming to an end, it was a University requirement to reflect upon our new learning. As CAT had really been the basis of my learning on the placement, I felt the Sequential Diagrammatic Reformulations or CAT map would be a novel way of illustrating this. Furthermore, it was a way for me to reflect upon my anxieties before the placement and the new confident approach I had reached by the end.
I drew out two Maps; pre and post placement. Before the placement started, I recall having a particular view about what a therapist should be ( ‘all curing, all knowing’) and also what a client should be (‘rescued and cured’). During supervision, I came to realise that I had struggled to ‘challenge’ clients because of my concern that it may be detrimental to the therapeutic relationship. However, without any challenging or taking a curious stance in sessions I quickly came to realise that there was no change within clients. My self-self reciprocal role was of being perceived by clients as ‘judging and critical’, which made me feel ‘self-doubting and anxious’. In not challenging or questioning clients’ belief systems and self-concepts, my limiting reciprocal role enactment was reinforced.
The intervention that enabled me to exit these unhelpful procedures was supervision. We discussed how challenge brings about change and actually strengthens the therapeutic relationship. A new helpful procedure was born! The learning here is that challenging clients is a necessary aspect of CAT and helps creates the possibility for client change. Furthermore, a therapist is rarely (if ever!) ‘all knowing and curing’, but rather ‘helpful, curious, challenging and honest’ which creates space for a client to feel ‘heard, hopeful and supported’ in their efforts to change for the better.