Echoes across the landscape: CAT in my practice, politics and personhood

What follows is a reflective essay originally composed for Cognitive Analytic Therapy (CAT) practitioner training, with the more personal elements now removed for wider dissemination. CAT is a model of understanding our humanity and psychology; it is a therapeutic approach that grounds itself in the relationships we learn, enact and occupy with ourselves and others. If we are treated in ways that are bullying, neglecting or caring, we will duly learn to act in those same ways to ourselves, to elicit and interpret those responses from others and to do to others as we have been done to. This can leave us stuck in cycles that maintain problems and exacerbate emotional and relational difficulties, or to act in ways that seek to so fervently avoid this repetition that we find ourselves in opposing but equally futile positions. CAT argues that the self is dialogically constructed and therefore we cannot understand or help individuals without understanding and utilising relationships. You can find out more here. It certainly makes a lot of sense to me. 

What came before and what happened 

I think I found my occupation because I was seeking connection in ways that allowed me to retain some ability to hide myself and avoid vulnerability; to affirm my own worth through skilfully helping others rather than ordinarily accepting myself; to make sense of an emotional landscape that seemed quite alien and aversive to me. Other psychologists have expressed similar experiences.

In therapeutic practice, my own emotional and relational needs can be in tension with what is required. I sometimes tend to seek to please rather than challenge; solve and be goal-focused, do many things rather than feel one; avoid shame and vulnerability. There are lots of good, helpful things in my practice and there are also areas where I tend to narrow my options.  

It was in this context that I experienced the General Election 2020. I have always valued fairness and social justice, although my explicit engagement in political issues tended to be limited. Possibly emboldened by personal development (and the less inhibited self that encouraged), I engaged much more in the campaign, seeking to support Labour and encourage others into action. I guess there was a pull to fix things, in the face of so many that seemed broken and were affecting the lives of people I worked with and many others that I didn’t. I hadn’t dared hope for a Labour victory, but the resounding loss was deafening and I heard it as a dismissal of the values I held dear; of fairness, compassion and hope. I felt powerless, lost and helpless. The pull to fix it was overwhelming; to fix and move away from the pain. With social media at my fingertips, I reached out in different ways; I wrote a post and shared it publicly. I was trying to say; ‘we’ve got to make connections with people to fix this’. And yet in saying that in the way I did (online, as a ‘known solution’ rather than a dialogue, to people I didn’t have prior relationships with), I actually undermined the exit I was seeking; trying to be a savoir rather than fostering meaningful connection with my own pain and others. I also tried to listen to ‘the other side’; people who had voted for a conservative government. Some comments in reply to each of these were like a stab in the gut. I experienced being positioned as a contemptuous caregiver to a vulnerable and contemptible other and felt repulsed by that. I felt stupid and shameful and questioned my role. I temporarily believed, that by being a therapist in this system that hurt people so much, I was a fraud; helping to perpetuate the damage by papering over the cracks. 

In order to resolve this pain, as is my tendency, I started thinking of ways to fix it. Plans of setting up and joining groups, social action, leaving the NHS, writing a big academic paper on it to theorise the problem away were abound. On reflection, these attempts at connection were actually imbued with a sense of needing to be the special fixer, or thinking that people couldn’t solve their own problems. As time went by, this pull lessened and I was able to process the feeling, to challenge the beliefs more quietly by reaching out to others close to me and resolve to not give up. 

In the following pages, I will attempt to draw out some of the key themes in this experience, and what they might mean for myself, my therapeutic practice and my politics.   

The relationship is key; big bridges and small talk  

It’s something I espouse frequently but this experience cemented my belief that the therapeutic relationship is absolutely fundamental. It is the bridge over which all other change must pass, carrying and bearing the weight of that change. In seeking to validate and challenge on social media, without prior relational connection, I was positioned as a contemptuous caregiver or an emotionally absent advisor. CAT is clear on the value of the therapeutic relationship and that difficult relational events and emotional vulnerability will attract threats to the alliance. 

This experience, therefore, has highlighted to me the importance of continuing to foster and repair the relationship in my practice, and has reaffirmed my endeavours to share that understanding with others. When, in supervision and my own reflections, I sometimes question what I am ‘doing’ in therapy, the defence is that I am using the alliance to test out new ways of relating and resolving; the relationship as a bridge to a new landscape.  Sometimes, I internally criticise that defence, wondering if it’s an excuse for not doing something ‘more active’. Alongside my continued training and supervision, I am coming to see that the opposite might be true; doing might often be a fork in the road that takes us back to where we started; the relational connection ‘in the room’ is where the new road lies. Of course, neither is fully true and to see it as a fixed dilemma wouldn’t be helpful, but I find them useful ideas. 

This experience has also made me consider how best to channel my political action. Maybe it is the quiet, ordinary connections that are fostered within and across communities that will help us collectively withstand efforts to divide and conquer. I have often said that I hated small talk. I hated going to the hairdressers, avoided supermarket aisle meetings by taking a different route to a spotted acquaintance and used questioning that invited monologues from others rather than engaging in simple conversation. I guess this allowed me to continue to hide my self, to avoid some vulnerability but also any meaningful connection; reducing others to ‘useful objects’ only when I had something important to say or stepped into the helping listener role that I strongly identified with. It therefore positioned me as absent but also slightly contemptuously powerful; to both others and also to my own ordinary human need for connection. I have noticed this has changed slightly over the last few years. Small talk is something that I know I still shy away from while wanting to be more open to. In my practice, this has meant paying attention to moments of less inhibited connection (the walk to the therapy room, the laugh in the corridor), in my life it’s meant not shutting down the chance or ordinary exchanges and in my politics it might mean fostering quiet connections closer to home rather than on the national or overtly political stage; building meaningful relationships to facilitate collective change.  

Honouring pain

The learning that started in earnest with the commencement of CAT practitioner training was, for me, catalysed by the events of the General Election and the emotional experiences that ensued. In some ways, the size of the apparent task (fixing a national political system) meant I was prevented from my usual “don’t feel it, solve it” procedure. This was painful, and although I did make attempts to move away, I felt it more than I might otherwise. I felt physical pain and deep sadness. Yet the pain passed and while it was there, it brought a lot of meaning. This for me is learning it itself; the lived emotional content brought me clarity in formulation and exits, and so the need to facilitate that in my practice is all the more real to me. In a parallel process, this is often what is noticed in therapy; learning comes from shifts in both insight and emotional experience.

I have noticed that since making positive changes to my life, I feel worse. In the sense that, my emotion is more undulating; I have more awareness of feeling uncertain, sad and anxious. On the other hand, I also feel more connected, alive and open. It’s a curious thing, feeling worse yet knowing it’s better. And this brings learning for my practice too- how do we measure helpful therapy? How do we prepare people for what’s to come? How do we ensure that the emphasis is carefully located in a mutually understood, acceptable aim? Making space for and staying with emotional experience is something I tend to value and yet struggle with. I guess this has underlined the importance of connecting with pain, as I am trying to foster in my practice too. Using silence and space to do this rather than explicit meaning-making, being aware of the pull and potential avoidance procedure of tool use in order to facilitate access of emotions and disavowed roles, is something I am continuing to try and facilitate. 

Sometimes all we can do is stand still while the storm passes 

The Zone of Proximal Development is a key concept in CAT and one that I find helpful in my practice. Meeting people where they are and inching towards different ways of being is a process I have engaged in numerous times, and it’s a concept I am using in my own change too. I also think it’s an important idea in the context of these events. My frustration at the outcome of the election left me with a desire to rip it up and start again in whatever way I could. But that doesn’t see the landscape for what it is; it doesn’t see change as so often necessarily incremental. 

In my attempts to connect on social media with others, the pain that their responses evoked in me could’ve elicited even more fervent attempts at changing their views and defending my own position. But at the time all I could do was not move into an attacking role in response to their criticism; anything else would have escalated the situation. All I could do was feel hurt and not retaliate; I just had to weather it.  And sometimes that’s all we can do in therapy too; keep out of the most damaging roles. I guess this has helped me to consolidate the learning of teaching and supervision; feeling what the relational context makes us feel while attempting not to move into a damaging reciprocating enactment. 

Storms are not in our gift to control, but we can use them to predict future weather events. If we seek to hide from their effects; under a tree or house (to avoid or deny our emotional response), we might find ourselves struck by lightning and the harmful consequences trebled. I am not clear yet how to find the middle ground or resolve the tension I feel in relation to the need for big change versus small progress politically. I sense it will be about assertively living by my values, feeling yet weathering the experiences that might come with that and working with others to create incremental change.  

Power and vulnerability; helping and being helped

Power is inherent in the narrative I have shared. Many voters had experienced years of being side-lined and unheard. My interpretation is that their own vulnerability was flipped into the powerful defeat of a party who explicitly offered the hope and compassion they lacked. I felt completely powerless in the face of a powerful other (government/ other voters) and was also positioned as a contemptuous powerful other in my attempted response to my own pain. This experience made me question my position in my own therapeutic practice; a sudden realisation that despite all attempts at collaboration, as a therapist I will often be in the top role – the powerful other. I wanted to rid myself of that, it felt so abhorrent. However, with some processing, I recognise that power and powerlessness are inherent to mental health problems and resolving them; all therapy involves power, just as all parenthood does. And care is provided in that context, imbued with whatever intentions and roles that have come before; damaging or helpful. This has led me to try and be more open with myself about my position in therapy; an acknowledgement that power is an issue to be actively considered. Alongside that acknowledgement is a need for awareness and recognition of the pulls that are exerted, the specific position that is being occupied as the powerful or disempowered other. The need to encourage an equalisation of power, an openness to be moulded by one another in therapy; to be open to power shifting and maintain an awareness of the procedures by which that occurs and their meaning. 

Politically, it has made me think about how supporting others’ equalisation of power is crucial; not helping people from a powerful position, but facilitating their empowerment in ways that they ask for, rather than ways I feel are necessary. 

Not throwing the baby out with the bathwater 

A metaphor I have found helpful is not to throw the baby out with the bathwater. The meaning I take is of not seeing all procedures as needing extinguishing; of valuing skills alongside seeking some change. The symbolism helps; the baby is the vulnerable self; it needs taking care of as much as it needs to grow. It is a message I have tried to share in my practice; encouraging people to see their problem procedures as originating from good, helpful places (for survival, when other options weren’t available). It can be hard for individuals to consider having to ‘give up’ old patterns. It can be useful to explicitly state, in dialogue and on the map, highlighting that this is not a forced choice. CAT recognises the need to maintain hope and value the good, helpful aspects in one’s reformulation.

In the anger I have felt towards our political system, I have felt a pull to smash it all up (metaphorically, not Guy Faulks-esque); to seek to go outside it into direct action, activism, disowning democracy as something inherently broken. There are lots of things that have pulled me away from that. One of those is this idea, that we can retain what’s good while seeking to change what has become unhelpful. In using this idea, I have come to think that I can continue to be a therapist in this system while assertively yet compassionately affecting change and that I can continue to act as a democratic voter while working with others to disrupt the societal patterns that keep us stuck. In all cases, this seems to be helpful in maintaining a sense of hope. 

Mountains and plains

I love running in the hills. The challenge, the hardship, the achievement, the expanse of nature. In this, I feel my existence is confirmed and yet also eradicated. My presence there – in the gaze of such massive structures - is everything and yet nothing and I find that very grounding. I am also aware that this echoes some potentially unhelpful patterns; of big solutions, striving over connecting, stark dilemmas. The exits of these will not involve climbing up more metaphorical mountains; more self-improvement, fixing or achievement. They will occupy a different landscape; the plains of the savannah rather than the peaks of the highlands. With this in mind, new ways of being can be tried out; relaxing, feeling, making space for and voicing needs, acceptance rather than improvement. The mountains exert a strong gravitational pull, though, and frequently I find (with humour, often) that my exits were being subverted by a well-trod procedure. Be the best at dealing with uncertainty, to share my personal understanding as ‘the solution’ for all, to only voice my own pain when I thought it would help others to hear it; maybe other practitioners share these experiences. Trap doors litter the escape routes. And so, when I find myself feeling uncertain, messy, not knowing, not solving, being with something unclear, I know I have taken a step onto the plain. I know because it feels different and I don’t know what to do about it. Those moments in my practice where I don’t know what to do and where it feels messy and unresolved, rather than presenting a problem that I have already figured out. Being aware of times where therapy feels too familiar, too achieved, and knowing those are times I might want to explore more. Politically too, I guess seeking to change things might also mean navigating new territory that won’t feel comfortable. In all these cases though, I am also trying to hold onto the knowledge that my skills can help me navigate a new landscape as well as the old. I might need new equipment and things might look very different, but I am the same traveller. 

Have I got there and where am I going next?

This piece of writing doesn’t reach a natural conclusion; we travel north, we do not reach it. To hold up a fully formed solution to these experiences would be again to subvert the learning made. The value of any therapeutic journey is in the process as much as the content. I guess I am seeing that more for myself and my politics too. Being with the mess, honouring pain, navigating in new ways yet with the same body, mind and values are all things I want to hold onto. And yet I also want to try and hold onto those ideas lightly too. Because when I feel like I’ve arrived it’s probably a sign that I’ve stopped moving. And when I feel like I’m stood still, it’s probably a sign that I am taking the biggest steps into new landscapes.