Cognitive Analytic Supervision

A relational approach

Deborah Pickvance

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138837782
• eBook ISBN: 9781317506102
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Cognitive Analytic Supervision: A relational approach is the first book to present a cognitive analytic perspective on psychotherapy supervision. This edited collection of original chapters reflects the ways in which CAT therapists and supervisors have developed the model and used it in diverse settings. It is a significant contribution to the literature on relational psychotherapy supervision, written by established CAT supervisors, trainers and therapists who, together, have an enormous amount of professional and clinical experience.

The book covers important areas such as:

the relational theory and practice of CAT supervision

a cognitive analytic conceptualization of narcissistic difficulties

intercultural issues in supervision (based on CAT training experience in India)

ethical and clinical dilemmas in supervision

supervision of consultancy work

Cognitive Analytic Supervision will be of interest to CAT supervisors, therapists and trainee supervisors, as well as supervisors and therapists working in other therapeutic models, in particular those with a relational approach. This book may be a useful bridge into relationally informed supervision for therapists who do not have an explicitly relational focus.

Section I
CAT supervision

Theory, process and evidence

Chapter 1
CAT supervision

A relational model

Deborah Pickvance

CAT supervision has been practised for many years, but it was not until 2011 that the first attempt to describe a theoretical framework for it was published. Marx (2011) showed how CAT supervision could be understood in terms of CAT concepts. This chapter offers a further, new perspective on CAT supervision, presenting it as a relational approach to psychotherapy supervision, which incorporates the relational principles of the CAT model. The chapter also looks at three other approaches to relational supervision – psychoanalytic, integrative and cognitive – and compares these with CAT supervision. Lastly it considers ‘parallel process’, a supremely relational process in supervision, and recasts this concept in CAT terms.

Relational models of psychotherapy and supervision

The word ‘relational’ has been used so widely in psychotherapy that it risks losing meaning. In a helpful attempt at clarification Paul and Charura (2014) propose that three principles underlie relational approaches to psychotherapy: social and individual life are understood using relational concepts; relationships are central to the development of personality, the sense of self and the problems which bring people into therapy; and the therapy relationship is fundamental to the therapeutic process. Models differ in the emphasis they give to each of these principles, for example some focus on therapeutic process and say little about relational factors in the development of personality. However, most relational models of psychotherapy agree on some key features of therapy: the co-creation of meaning and experience, the importance of the intersubjective space between therapist and client, the increased engagement of the psychotherapist in the therapeutic dialogue, and the importance of affect (Gilbert and Evans 2000).

Similarly, relational approaches to supervision share an emphasis on the importance of the supervisor – supervisee relationship and on experiential processing and learning in supervision. However, they differ in their view of other aspects of supervision, for example the use of self-disclosure by the supervisor and the extent to which supervision has a therapeutic dimension.

It is important to note that explicitly relational models of supervision are not the only ones to focus on relational aspects of supervision; pan-theoretical models of supervision also do this. Developmental models of supervision, for example, often describe how the supervision relationship changes at different stages in the development of the supervisee from novice to experienced clinician. Hawkins and Shohet’s (2012) seven-eyed process model, while not named a relational model, focuses closely on the supervisory relationship and the therapeutic relationship and they see a good supervisory relationship as central to supervision.

CAT as a relational therapy

CAT is an explicitly relational model of psychotherapy which was developed in the 1970s and 1980s by Dr Anthony Ryle. Psychoanalytic object relations ideas, in particular those of Guntrip, Fairbairn and Winnicott, and cognitive approaches, in particular personal construct theory, were important influences in its early development. Ryle rejected the classical psychoanalytic idea of innate conflicting drives and drew on the findings of infant development studies, which demonstrated the active engagement and collaborative playfulness of infants with significant others (Ryle and Kerr 2002). These findings confirmed the Vygotskian ideas of the child’s active collaboration in the learning process and the important role in a child’s learning of a competent other, who is able to ‘teach’ at a pace appropriate to the child’s development. Integrating Vygotskian activity theory and the Bakhtinian view of the dialogical self, the cognitive analytic model has a concept of a self which forms through interaction with others in an intersubjective environment. The nature of the therapeutic relationship in CAT reflects these ideas: it is a collaborative relationship in which the therapist engages actively and responds flexibly in the unfolding dialogue with the client. The client learns and changes through the experience of working collaboratively with another and by internalising benign reciprocal roles. The focus of therapy is on developing a reformulation of the client’s problems in terms of dysfunctional interpersonal patterns, learnt in childhood and repeated in adulthood, and then on recognising how these are enacted in current relationships, including the therapy relationship, and in relation to the self. The exploration of such enactments within the therapy relationship is an important aspect of CAT. The therapist offers the client an opportunity to change by not reciprocating the client’s dysfunctional patterns, instead facilitating the client to recognise and reflect on these patterns and to develop new ones.

The beginning of CAT relational supervision

Supervision has always been an integral part of the CAT model. While no model of supervision was explicitly articulated in the early days of CAT, the practice was implicitly relational. In the 1980s Anthony Ryle ran two large supervision groups for therapists who came from a wide range of backgrounds. Ryle’s approach was to empower supervisees, to encourage them and to convey his characteristic trust and belief in the potential of others. In this and in other ways the supervision process was congruent with the CAT model. The group was a place for learning, it was busy, members had to make the best use of the limited time available in it and it was characterised by an honest, pragmatic, down-to-earth, non-hierarchical approach.

These first supervision groups, along with meetings about the developing approach, formed a crucible for the model. Ryle led members of the groups in introducing, and experimenting with, new tools such as the goodbye letter and the prose reformulation, always emphasising the need to use the client’s language. Annalee Curran (personal communication) remembers the moment in a supervision group in the 1980s when he reached for an old envelope and drew a procedure on it – the first step in the evolution of the diagram which would later become a central feature of CAT.

The recognition of enactments, in which therapists unwittingly become caught up in their clients’ problematic patterns, was a key element of supervision, and Ryle knew the value of supervision in alerting therapists to this process. He was aware of the impact of the work on therapists, concerned for their well-being and modelled a ‘caring and nurturing’ to ‘cared for and nurtured’ reciprocal role procedure towards them. He was willing to recount anecdotes from his own experience as a therapist, which was helpful and anxiety-reducing for his supervisees. Ryle’s attitude to his supervisees and his attention to the interpersonal dynamics of therapy demonstrated the relational understanding that has always been intrinsic to CAT. In time, the more experienced therapists began to run supervision groups, providing some initial experience in the model to the many health and social workers who expressed interest in it. As in most other psychotherapy models at that time, there was no training in supervision, so the practice of supervision reflected supervisors’ own experience of receiving supervision.

CAT supervision as a relational model

CAT supervision reflects many of the relational aspects of CAT therapy. Six features of CAT supervision mark it out as a relational approach, all of which are elaborated further elsewhere in this book.

1. The use of CAT relational theory The supervisor draws on the relational theory underpinning the CAT model to guide the supervisee in developing the reformulation of the client’s difficulties, to help the supervisee build the therapeutic relationship and work with enactments, to assist the supervisee to work appropriately at each stage of a CAT therapy, and to understand the supervisory relationship.
2. The supervisory alliance In CAT therapy there is an emphasis on building a strong working alliance, on the early establishment of a collaborative relationship and on the therapist’s open, explicit approach to explaining the therapist role and discussing the boundaries and expectations of therapy. Similarly, the CAT supervisor aims to develop a strong working alliance with each supervisee and with the supervision group, as it is only within this relational context that a supervisee can learn fully from the combination of support and challenge offered in supervision. Thus a supervisor will, from the outset, discuss the aims and scope of supervision, address any apprehensions felt by supervisees and encourage supervisees to be honest and say if they do not understand. The supervisor strengthens the alliance further by being flexible and responsive to the supervisee’s particular learning needs and being willing to talk about past experience relevant to the supervisee’s concerns. In ongoing supervision the supervisor reinforces the supervisory alliance by checking understanding and encouraging feedback from the supervisee and also by being alert to threats or ruptures in the supervisory alliance. If a rupture appears in the supervisory alliance this is an immediate focus of attention. The supervisor takes account of the evaluative aspect of supervision, aware that it can affect the development of a safe, trusting alliance. As CAT supervision usually takes place in groups, the way that a supervisor facilitates the group influences the supervisory alliances among supervisees as well as with the supervisor.
3. Learning in an interpersonal context The Vygotskian view of learning as an active interpersonal process underpins both CAT supervision and CAT therapy. The supervisor ‘scaffolds’ the supervisee’s learning, adjusting interventions to the supervisee’s stage of development (Marx 2011, Ryle and Kerr 2002). The supervisor has an explicit teaching role, conveying the values and methods of the model (Ryle 1990, Ryle and Kerr 2002), particularly in the early stages of learning the model, but this is undertaken in a way that is highly responsive to what supervisees can absorb at each point in their development. The active use of the group context of most CAT supervision provides a rich opportunity for learning from others and in interaction with others.
4. Use of self CAT supervisors, like CAT therapists, need to be aware of personal responses in supervision, including feelings, images, memories, embodied sensations, seemingly stray thoughts or other associations. The supervisor reflects on whether they are manifestations of personal countertransference, countertransference elicited in response to the supervisee or parallel process. The supervisor may choose to share them with the supervisee, aware that such disclosures can strengthen the supervisory alliance and enrich understanding, but should only be made in order to serve the supervisee’s learning needs. The supervisor also encourages the supervisee’s experiential awareness and self-reflection, as these can help access countertransference and shed light on unrecognised aspects of the therapy.
5. Attention to the relational patterns of both supervisee and supervisor As the supervisor gets to know a supervisee, some of the latter’s relational patterns are likely to emerge within the therapy relationship, the relationship with the supervisor or with other group members. The supervisor’s role is to help the supervisee recognise the extent to which these patterns may affect them in the role of therapist. This is not the same as therapy, but it provides a useful opportunity for supervisees to become aware of how their relational patterns influence them – in a positive or negative way − in their professional role. In a trusting supervision relationship a supervisee may volunteer such reflections. The CAT concept of reciprocal role procedures provides an accessible language for describing such patterns in a demystifying, non-blaming and straightforward way.
   Example: The supervisor referred to a pattern within Amy’s practice, namely her reluctance to explore enactments in the therapy relationship. Amy replied, ‘I know, I know I don’t like doing this … I know I am over-protective … It came up in my therapy’. The supervisor and Amy talked about the effect on the client of her over-protectiveness and identified an over-protective – disempowered relational pattern. Sharing this personal source of her countertransference and understanding its potential impact on her client seemed to galvanise Amy into addressing it, and two weeks later she brought a recording to supervision, showing how she had attempted to deal with an enactment.

   CAT supervisors need a good understanding of how their own reciprocal role patterns may impinge on their role, in particular any negative patterns which could affect supervision. For example, an unconfident supervisor who needs to be liked may be unwilling or unable to challenge supervisees.
6. Attention to context CAT has a well-developed perspective on the impact of social and political context on the self, and it views relationships as embedded in a matrix of cultural, social and political influences. Both the supervisor–supervisee relationship and the therapist–client relationship exist within a complex sociocultural context. The CAT supervisor is mindful that these influences may affect the supervision in a range of ways. Influences may be evident in perceived or actual sociocultural differences, such as ethnic origin or class, between the supervisor and supervisee or among supervisees in a group. Such differences can be inhibiting, particularly if not acknowledged; when recognised, they can lead to an enriched learning experience. The pressure of organisational influences on the provision of therapy may be apparent in supervision, for example supervisees may feel insecure, over-stretched or demoralised in their work setting. Again, it is important that the supervisor and supervisee talk about the possible impact of these influences on both the therapy relationship and the supervisory relationship.

Relational psychoanalytic supervision

It is useful to understand the ideas of relational psychoanalysis in order to see the important co...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgements
• List of contributors
• Glossary of CAT terms
• SECTION 1 CAT supervision: Theory, process and evidence
• SECTION 2 Challenges in relational supervision
• SECTION 3 Methods and tools of supervision
• SECTION 4 Supervision in different contexts
• Appendix 1: Resources
• Appendix 2: ACAT Code of Ethics and Practice for Training and Supervision
• Appendix 3: The CCAT – A measure of competence in Cognitive Analytic Therapy (CAT)
• Index