Introducing Cognitive Analytical Therapy Anthony Ryle and Ian B. Kerr Chichester: Wiley Press, 2002. pp. 265. 16.99 (paperback). ISBN: 0-471-89273-4

Cognitive analytical therapy (CAT) is becoming increasingly popular in clinical practice, especially in treating patients who receive a diagnosis of personality disorder. This book introduces the principles of CAT, provides a practical description of the tools and techniques involved and explains its relevance to a wide range of mental health problems. I approached the book as someone who has researched the cognitive processes involved in psychological disorders and begun to carry out cognitive therapy in a clinical context. I wanted a better understanding of how cognitive processes might be conceptualized within the context of interpersonal relationships. Like cognitive therapy, CAT is a time-limited psychotherapy that involves the collaborative formulation of current psychological problems in the context of present experiences and past events. Both CBT and CAT also involve active challenging of pre-existing ways of relating to the world, both using techniques of exposure, cognitive reappraisal, problemsolving and role-play. It could be argued that CAT differs from CBT in that its main focus is on relationships, or “reciprocal roles” rather than on the link between thoughts, emotions and behaviour. According to CAT, “the ‘permeable’ self is seen to have been formed in, and to be maintained through, interactions with others; the internalized relationship dialogue from the past is constantly expressed in, and may be maintained or modified by current relationships” (p. 200). In practical terms, people act out different roles in different situations based on earlier relationships, and CAT helps the patient identify, control and modify these roles both within and between therapy sessions. Introducing cognitive analytical therapy is organized in a user-friendly manner. It first describes the way in which CAT is used within a clinical context, and then explains the main principles of the therapy and their theoretical foundations. Subsequent chapters explain key components of CAT such as the assessment interview, the formulation process (which is in the form of a letter and a diagram of sequential stages), the use of the therapeutic relationship, including the “goodbye letters”, that the therapist and patient exchange, and the role of supervision. The last three chapters explain the use of CAT in a range of client groups such as anxiety disorders, eating disorders, substance abuse, psychosis, personality disorders, and “difficult” patients. The end of the book includes a glossary of the main terms, a summary of the evidence-base and the “Psychotherapy File”. The Psychotherapy File is an extended questionnaire given to the patient at the start of therapy to allow them to identify key problems in their life (“dilemmas”, “traps” and “snags”). Dilemmas reflect apparently irresolvable decisions that are couched in dichotomous terms (e.g. “Either I look down on other people or I fear they look down on me”). Traps are vicious cycles that perpetuate interpersonal problems (e.g. “Feeling uncertain about myself I try to please other people, but this means other people