Writing a cat reformulation letterman

Target Problem TP — a problem area which the patient and therapist have chosen to work with throughout therapy. In CAT Reformulation is used to help explain the past and make sense of the present and hopefully will suggest what to modify in order to influence the future.

This sequence of events is circular in nature. But what if a patient and therapist agree on the identified CAT model and disagreement arises during Reformulation?


For Vygotsky the mind or consciousness is not seen as an entity that arises of itself or even as a system that later self-maintains; rather learning and becoming a person occurs in interaction with other people. For example, I am human and at some point you might fear or expect that I too will leave you or make your choices for you.

There is still a deep, sad hole inside you which feels as if it can only be filled by meeting your mother or littermates again. One aspect of CAT that is not easily captured in the above description is the focus throughout on the importance of relationships in our psychological life.

We have wondered whether your sense of longing for puppies and a family of your own now goes back to the feelings of love and security which you lost but want to recover. Vygotskian and object-relations theory see interpersonal experience as the basis for the formation of higher mental structures.

This is what has hurt you most.

I know my colleagues who use a cognitive analytic therapy approach put a lot of stock into letter writing as one of the central interventions. The first few sessions are spent gathering information about the problems that the client wants to focus on, and the life story of the client.

Once these habits, or patterns, have been recognised in the letter they are also represented in a diagrammatic form which is also often created with, and certainly explicitly shared with, the client. From my end I have thought that it has been useful to provide a summary, with more detail than the couple of bullet-points that we usually come up with at the end of the session.

For example a CAT may not be practicable with a patient who wishes to use therapy for a sounding board or who feels it important to be understood but does not wish to alter any of their life procedures. In fact, until recently, your life was rumbling along quite comfortably.

Like good journaling, the meditation of writing a therapeutic letter allows for sustained exposure to my own thoughts and feelings about what it is happening in the therapy room.

You remember trembling as a puppy in his arms when you first met and although frightened and unable to understand his words, their intention felt kindly and his stroke was gentle and reassuring.

Reformulation can be seen here as a form of education with a difference — i. This was really valuable to me as this client has tended not to assert herself in the session and it has been hard to judge my efforts so far. He has proven to be an interesting owner and, unusually for a human, has not only recognised your intelligence and abilities, but has also encouraged and nurtured them.

Further integration of object relations theory and activity theory. This method of guided self-education is similar to some extent to the means in which knowledge and meaning is acquired developmentally during childhood.

Internalisation of language is another important concept from Vygotsky which parallels object-relations theory. It is harder to judge how the message is coming across, compared to meeting the client and observing body language. It is for these patients that Reformulation seems so useful.

You are caught between either living like a human — but at risk of being treated at any time like a dog — or returning to life fully as a dog — but giving up the opportunities you have now and possibly feeling frustrated and unfulfilled.Hopefully we can see from the above that Reformulation becomes an educative tool or a means to induct the patient into an understanding of the CAT model of psychotherapy.

Reformulation: Education, Collaboration or Coercion?

Reformulation can be seen here as a form of education with a difference – i.e. applied to the field of self-knowledge (Ryle ), content from the patient’s life is used to.

At around this time, one of my CAT clients spontaneously wrote me a letter back, in response to my Reformulation letter to him. His letter moved me, and seemed to deepen our therapeutic relationship in a way that no corrections or comments ever had.

Feb 04,  · Letter writing has a delayed feedback quality while also having more of a permanence than conversation in the therapy room.

It can invite perfectionism, as I try to find the right words and think about how this letter may be something more lasting that the client may refer to. Recieving a CAT Reformulation Letter: What Makes a Good Experience?. Reformulation, Winter, p The use of a reformulation letter is central to the CAT model.

A CAT reformulation letter aims to describes the problems, give a brief narrative of the client's life including their early life, and to tease out what these 'habits' were for that person, and in what way they may be creating or maintaining the problems in that person's current adult life.

CAT tools were simplified sequential diagrammatic reformulations (SDRs), which were made in the group; a group reformulation letter and a group goodbye letter.

Writing a cat reformulation letterman
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