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Introducing Cognitive Analytic Therapy
Introducing Cognitive Analytic Therapy

Principles and Practice of a Relational

Approach to Mental Health

Second Edition

Anthony Ryle* and Ian B. Kerr

*Deceased
This second edition first published 2020
© 2020 John Wiley & Sons Ltd

Edition History
John Wiley & Sons Ltd (1e, 2002)

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Library of Congress Cataloging-in-Publication Data

Names: Ryle, Anthony, author. | Kerr, Ian B., author.
Title: Introducing cognitive analytic therapy : principles and practice of
a relational approach to mental health / Anthony Ryle and Ian B. Kerr.
Description: Second edition. | Hoboken, NJ : Wiley, 2020. | Includes
bibliographical references and index.
Identifiers: LCCN 2019058760 (print) | LCCN 2019058761 (ebook) | ISBN
9780470972434 (paperback) | ISBN 9781119695165 (adobe pdf) | ISBN
9781119695134 (epub)
Subjects: LCSH: Cognitive therapy.
Classification: LCC RC489.C63 R955 2020 (print) | LCC RC489.C63 (ebook) |
DDC 616.89/1425–dc23
LC record available at https://lccn.loc.gov/2019058760
LC ebook record available at https://lccn.loc.gov/2019058761

Cover Design: Wiley

Cover Image: © Jose A. Bernat Bacete/Getty Images

Set in 9.5/12.5pt STIX Two Text by SPi Global, Pondicherry, India

Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY

10 9 8 7 6 5 4 3 2 1
 v

Contents

List of Figures vii

About the Authors ix
Preface to the Second Edition xi
Preface to the First Edition (2002) xvii
Acknowledgments xix
The Structure of the Book xxi

1 The Scope and Focus of CAT 1

2 The Main Features of CAT 9

3 The CAT Model of Development of the Self 31

4 The CAT Model of Abnormal Development of the Self and Its

Implications for Psychotherapy 55

5 The Practice of CAT: Selection and Assessment of Patients for Therapy 75

6 The Practice of CAT: The Early Reformulation Sessions 95

7 The Practice of CAT: Later Phases of Therapy, Working at

Changing and Ending 121

8 The CAT Model of Therapist Activity and of Supervision 141

9 CAT in Various Conditions and Contexts 161

10 The Treatment of “Severe and Complex” Personality-Type Disorders 225

11 The “Difficult” Patient, Contextual Reformulation, Systemic Applications,

and Reflective Practice 265

Afterword 283
Glossary 287
vi Contents

Appendix 1: The Psychotherapy File 291

Appendix 2: Cognitive Analytic Therapy (CAT) Competences for Individuals
with Personality Disorder 297
Appendix 3: Personality Structure Questionnaire (PSQ) 311
Appendix 4: Repertory Grid Basics and the Use of Grid Techniques in CAT 313
References 315
Index 351
 vii

List of Figures

2.1a Key formative RR for Bobby. 26

2.1b Key RRP enactments. 27
2.2 Rating sheet for target problem procedure 1 for Bobby. 27
3.1a CAT-based sketch of normal development of the Self through healthy early
infant-caregiver interactions (RRs) shown here in a ‘nuclear’ family type
setting and in a particular sociocultural context. 33
3.1b Their subsequent ­internalisation as formative RRs within
the growing child (by permission Bevan Fidler). 34
4.1  CAT-based diagrammatic sketch of damaging and abnormal
development of the Self. 57
6.1 Part diagrams: sequences illustrating traps, dilemmas, and snags. 106
6.2 Types of cores in sequential diagrams. 111
6.3  (a–c) Beatrice—Self states sequential diagram. (a) Initial depiction
of formative reciprocal roles. (b) Mapping of key reciprocal role
procedures leading to a similar state of “deep sadness.” One of these
involves enactment of a situational RR of ideally loved to ideally
loving (c) mapping the outcome of key reciprocal role procedures
which reinforce original formative RRs and depicting also two
Self states (SS 1 and SS 2) and highlighting a key dialogic voice
using an asterisk. 111
6.4  (a) Depicts formative reciprocal roles; (b) mapping of most
common coping procedure (effectively a “trap”); (c) further mapping of a
“dilemma” leading to a briefly enacted RRP (effectively a “snag”) undermined
by a critical voice; (d) depicting possible further RRP enactments (from the
parental/culturally-derived pole of his formative RR) toward Self and/or
others. 115
7.1  Self states sequential diagram for Rita showing reciprocal roles.
B, D, and F represent childhood-derived roles which, when
activated by experiences, perceptions, or memories of A, C, or E,
lead to flashpoint X followed by either rage or the dissociated
alternative coping zombie state. The consequences of these would be
typically “rejection” and having “needs unmet” which in turn would
reinforce underlying formative RRs. 134
viii List of Figures 

8.1 Sequential diagram for Grace. 151

9.1 Simplified SDR/map for Susan showing key formative RR and key RRPs. 168
9.2 SDR or “map” for Tamara. 182
9.3 SDR/map for Alan. 193
9.4 (a) Key formative RRs for Sarah. (b) SDR/map for Sarah. 203
9.5 The client in the sessions. 219
9.6 The therapist in the sessions. 220
9.7 A problematic sequence (RRP) of thoughts, emotions,
and behaviors (a “trap”). 220
10.1  (a–d) Stages in construction of a stereotypical BPD-type diagram.
(c) illustrates likely dissociated Self states and (d) introduces a description
of typical staff reactions around such patients and illustrates a rudimentary
“contextual reformulation” (see Chapter 11). 236
10.2a Deborah—grid of self-descriptions. 240
10.2b Deborah—grid of self–other relationships. 240
10.3 Narcissistic personality disorder: the two common Self states. 244
10.4  (a–c) Stages in constructing a stereotypic NPD-type diagram showing
(a) underlying (formative) RRs, (b) typical initial coping RRPs and typical
Self states, and (c) potential Self states, defensive RRPs and (situational)
RR enactments, including potentially with staff and others. 246
10.5 Olivia—sequential diagram (revised and simplified). 251
10.6 Sam—final Self state sequential diagram (revised and simplified). 253
11.1a Schematic patient SDR or map showing (formative)
RRs and consequent RRPs. 270
11.1b Schematic rudimentary contextual reformulation showing patient
SDR or map and outline possible therapist and staff team (situational)
RR enactments toward patient RRPs. Some of these staff RR enactments
may be derived in part from their own formative RRs. 271
11.1c Schematic extended contextual reformulation showing added layers
(like “onion skins”) of interactions arising from possible service context
and broader social and political context. 271
11.2a Initial description of patient’s formative RRs. 272
11.2b Simple contextual reformulation showing patient RRPs and staff team
reciprocal (situational) RR enactments and the split between these.
Some of these enactments may have partial origins in
formative RRs of staff. 273
11.3a Initial SDR or map for Paula showing her formative RRs. 276
11.3b Initial SDR or map showing subsequent RRPs and consequences. 276
11.3c Initial SDR or map showing additional tendencies to dissociate or
“fragment” into at least two Self states (broken ellipses). 276
11.3d Contextual reformulation showing (situational) reciprocal role
interactions between staff and patient with subsequent splits
within staff team. Some of these situational enactments may
have partial origins in staff formative RRs. 277
 ix

About the Authors

­ nthony Ryle qualified in medicine in 1949 and worked successively as a founding

A
member of an inner city group practice, in Kentish Town, London, as Director of Sussex
University Health Service and as a Consultant Psychotherapist at St. Thomas’s Hospital,
London. After retiring from the NHS he worked part‐time in teaching and research at
Guy’s Hospital. While in general practice he carried out epidemiological studies of the
patients under his care and the experience of demonstrating the high prevalence and
family associations of psychological distress influenced his subsequent interest in the
development of forms of psychological treatment which could realistically be provided in
the NHS. Studies of the process and outcome of psychotherapy followed, and from these
grew the elaboration of an integrated psychotherapy theory and the development of the
time‐limited model of treatment which became cognitive analytic therapy. He died in
September 2016.

Ian B. Kerr graduated in medicine from the University of Edinburgh. After several junior
hospital posts he worked for many years in cancer research. He subsequently completed
dual training in psychiatry and psychotherapy at Guy’s, Maudsley, St. George’s, and
Henderson Hospitals in London, and with the British Association of Psychotherapists. He
worked for several years as Consultant Psychiatrist and Psychotherapist and Honorary
Senior Lecturer in Sheffield, UK, and then in NHS Lanarkshire, Scotland, UK. He has been
involved in teaching and researching CAT in many settings in the UK and internationally.
 xi

Preface to the Second Edition

This revised edition is being offered given an evident need to update, expand, and clarify
aspects of the first edition which appeared now almost two decades ago, and given a keen
wish by Tony Ryle to do this. Our aim was to offer a summary but comprehensive overview
of the current evolved Cognitive Analytic Therapy (CAT) model, its background and com-
parative context, and of its range of applications, that would be informative and helpful to
those new to the model, to trainees and even established practitioners. Very sadly however,
as many readers will be aware, not long after being commissioned to do this Tony, who was
the senior author and progenitor of the cognitive analytic therapy model, developed a seri-
ous illness from which he ultimately succumbed in 2016. Summaries of his remarkable
creative personality, his career and contributions to the field of psychotherapy and mental
health more broadly have been published in various obituaries which are available on the
internet and in a special issue published in 2018 of Reformulation the newsmagazine of the
Association for Cognitive Analytic Therapy (ACAT) in the UK, also available on-line.
One of the critical tests of the achievement of any remarkable, creative, and charismatic
character, which Tony certainly was, is the way in which their achievement and any model
they may have created survives and prospers subsequent to their death. In this I am very
clear, as are many others, that the current CAT model described in some detail in this vol-
ume is doing just that and that, given its principles and underpinnings, it should continue
to play a major creative and contributory role in the future to human mental health and
well‐being in various ways. That this might occur was one of his principal passions and
aims. Having said that, like many of us he was recurrently saddened and frustrated by the
evident socio‐political direction of the world at large. I am sure his enthusiasm to update
and publish this volume despite his illness also related to a hope that the model might in
some small way contribute to ameliorating and improving this situation. Certainly, the
evolved CAT model seemed to us also to address a global epidemic, including and espe-
cially in more “developed” countries, of so‐called mental disorders in a much more radical,
thorough‐going, and humane manner than currently dominant, more individualistic and
mechanistic paradigms. As such we were sure that if human sense, compassion, and evi-
dence prevail (about which sadly neither author was very confident) CAT will ultimately
be able to offer a great deal, including in ways far beyond its use as a model of individual
therapy, important as that is, into more clearly systemic and socio‐political domains. These
issues and these potential applications are discussed further in the book.
xii Preface to the Second Edition

However, Tony’s death left the final task of articulating and presenting many of these
revisions to myself. These have however all been based on our extended discussions—some
quite animated!—and also on our deep, essential agreement about the core of the model
and what sorts of revisions needed to be undertaken. These have been also based on initial
drafts that we both did and discussed, and on consideration of various review articles and
books containing both theoretical and clinical developments that had appeared in recent
years and presented and/or approved of by himself (e.g. Ryle et al., 2014, Kerr et al., 2015,
Kerr, Hepple and Blunden, 2016; Pickvance 2017; Ryle and Kellett, 2018).
Tony was very clear that he wished the revision to proceed on this basis with myself as
more active co‐author despite his illness. I believe there is nothing in this volume that was
not agreed and decided at least in principle with Tony, although of course its presentation,
expansion, and articulation in many cases has fallen to myself notwithstanding our initial
drafts. I am, therefore, wholly responsible for any serious deficiencies of content or style
related to this. However, I hope that it may still represent an important “staging post” in the
development and evolution of CAT in that it represents the last position and views of its
creator. This should not of course be regarded as any kind of “final word”; and indeed Tony
certainly did not wish this to be the aim. We were both very clear this volume could only
represent a re‐statement, expansion, and clarification of Tony’s own views on the develop-
ment of the model hitherto, aided and abetted in this case by myself. We were clear about
the subsequent need to continue developing the model in a further integrative manner, in
ways which may prove to be quite counter‐intuitive and unexpected. Nonetheless this re‐
statement may be perhaps an important reference point in that process of the development
and of the application of the model by others.
We agreed that there was a need for a revised and updated edition for various reasons.
These include a proliferation of new understandings over the past couple of decades relat-
ing to mental health, treatment for mental health problems or disorders, understandings of
psychotherapy, and in relation to the CAT model itself. These developments have occurred
in fields as diverse as infant psychology, developmental neuroscience, social psychiatry,
through to the social and political sciences, and also developments, for example, in under-
standing of factors, including common factors, relating to process and outcome in psycho-
therapy. Since the first edition appeared there has also been a proliferation of innovative
and humane uses of CAT, some rather unexpected, for example in work with schools, refu-
gees, police and forensic services, in consideration of broader socio‐political challenges
(see e.g. Lloyd and Pollard 2018), as well as for a whole range of mental health problems
(see especially Chapter 9).
Feedback from and reflection on the first edition made it clear also that some clarifica-
tion of fundamental theoretical concepts was needed, as well as perhaps a clearer and in
places a more helpfully didactic presentation of them. Some confusion and ambiguity have
occurred, in retrospect probably largely due to the history and “archaeology” of CAT and
its development over many years. This has resulted in certain key concepts like procedures,
reciprocal roles, reciprocal role procedures, and even repertory grids, being more predomi-
nantly focused on and stressed at different stages in the evolution of the model, and accord-
ingly subtly changing, with these concepts sometimes being used in ambiguous or
overlapping ways for these reasons. This evolution and history has undoubtedly caused
some perplexity, for example to trainees over the years, and has also undoubtedly affected
 Preface to the Second Edition xiii

the way in which practitioners and supervisors, who would have trained at different times,
have understood and used these concepts and how they work with the model. Although we
are clear that the underpinning, relational, core concepts in CAT have remained consistent
for many years, we have therefore revisited these and, we hope, helpfully clarified, ampli-
fied, and restated these in the early chapters of this revision.
As regards the enduring fundamental core of the established CAT model, Tony clearly felt
increasingly that this was still essentially embodied in the “Procedural–Sequence Object–
Relations Model” (PSORM) notwithstanding various later refinements and enrichments, for
example by Vygotskian activity theory and Bakhtinian concepts of a dialogical self, and by
diverse, for example more “here and now,” clinical and other applications. The PSORM of
course implies a clear presentation and understanding of early developmental internaliza-
tion of (formative) reciprocal relationships (reciprocal roles, akin to although differing signifi-
cantly from internal objects), and an understanding of and stress on how, on this basis, we
subsequently develop and enact patterns of coping and responding (reciprocal role proce-
dures). We were both rather concerned that the important interest in more recent years in
systemic or “contextual” role enactments in the here and now (including also therefore more
“situational” RRs) can potentially lead to loss of focus on deeper, historic internalized RRs
and their consequences for the patient or client, given that these are of fundamental impor-
tance in clinical presentations and in therapy. Indeed, at times in therapy they may be the sole
focus of activity. These issues are again addressed in the early and then later chapters.
I have felt rather freer to expand as I saw fit concepts or sections for which I was origi-
nally largely responsible, for example consideration of psychotic disorders, “contextual”
and systemic approaches, and the clarification and presentation of “Self” as an “organizing
construct” within CAT. These have appeared to be of some importance and were develop-
ments that Tony also contributed to and fully supported, both in discussion and having
read and approved various publications up to 2016—where some of these various changes
and clarifications were first mooted. We also both felt the section on sex and gender‐related
issues (Chapter 9) needed to be expanded considerably given important developments over
recent years in this challenging and complex area, and we have attempted to do this with
the assistance of others who are acknowledged in the text.
We were both keen to expound clearly the importance of the socio‐cultural and political
dimensions of mental health, which is implicit in the model and its applications, notwith-
standing Tony’s, and my own, frustration and sadness at many socio‐political develop-
ments in the world at large. As therapists we can all too often only bear witness to these and
it can feel very hard to influence them helpfully. However, we both felt that a model such
as CAT can and should helpfully offer humane and compassionate, while scientifically
valid, understandings of mental health and well‐being much more broadly. We have been
very clear, therefore, and unapologetic about a need to locate the model in a broader con-
text, both scientifically and clinically but also socio‐politically. We also felt it important
to attempt to locate CAT broadly within the extensive field of “brand name” therapies,
the distinctions between which, as discussed, are frequently spurious and appear to
relate sadly more to professional narcissism, parochialism, and campanilismo. These con-
siderations and views will be evident yet again in this edition, as they were in the first.
Hence the book is, and aims to be, more than simply a summary of key features of CAT as
a model of therapy and of its applications.
xiv Preface to the Second Edition

Having said this, Chapter 9 in this edition, which aims to overview clinical uses and
applications of CAT, is considerably expanded given a considerable increase in these, and
also given the continuing and often quite acrimonious debate with regard to classification
and nosology in the field of mental health. Challenging currently dominant but flawed
paradigms (notably those of a largely more individualistic biomedical and/or cognitivist
persuasion) and reconceptualizing disorders and how we might help treat them is an
important part of what any good and evolving model should offer. However, it is still avow-
edly not an explicitly “how to” kind of chapter giving detailed descriptions of treatments by
various specialist authors. Such a volume or volumes are undoubtedly needed but this was
certainly beyond the remit or feasibility of a one‐ or two‐author volume.
But even in the writing of this more summary book we have depended greatly on the
work and input of others. Tony would have been the first to acknowledge and celebrate the
fact that we all stand “on the shoulders of giants” and of many others, and depend on their
very various contributions. In a very real, and dialogical, sense there is no such thing as
completely original or independent work. Many others who are cited in the text have con-
tributed to the model, its underpinning theory, and its range of applications over the years.
By way of example the articulation and presentation of the very first specifically CAT vol-
ume was apparently greatly aided and abetted by Professor Glenys Parry, who has contin-
ued to be an active champion of the model in different ways over the years since then.
At a personal level it has been an honor and privilege to undertake the final work of this
revision, although this has also felt to be, perhaps unsurprisingly, a challenging and quite
arduous undertaking. In many ways it has felt a weighty responsibility to re‐state and update
what was essentially Tony’s life’s work, although the development of the model was assisted
increasingly by various others who are cited in the text. It has also inevitably felt a rather
poignant and solitary undertaking at times, despite helpful discussion with various current
colleagues, in the absence of Tony’s “larger than life,” innovative, critical, and at times impa-
tient presence and input. It would have been good at various moments to have been able to
“chew things over” with him as I and many others would have done in the past.
This revised edition has unfortunately been delayed by the inevitable distractions and
intrusions of life, both personal and professional. This has included, sadly, a protracted but
morally unavoidable involvement in campaigning in support of “whistle blowers” in the
face of some serious incompetence, victimization, and cronyism within and around the
NHS in the UK. But I have also been guilty of some procrastination, a tendency to unhelp-
ful over‐inclusiveness, and aspiring to imagined perfect outcomes; all of this Tony with his
talents was much better able to transcend, to “see the wood for trees” quickly, and to express
his views articulately—if sometimes very forthrightly!
As regards terminology, we have in this revision on the whole, as noted in the previous
edition, referred to “patients” rather than “clients,” although we use the term interchange-
ably. We recognise an increasing tendency and preference among many colleagues, espe-
cially non‐clinical, to use the word “client” possibly given some of the arguably paternalistic
and disempowering associations of the word “patient.” Possibly in part due to our own
medical trainings and background we continue to take a view that the word patient has also
an honorable history and associations implying notably a vocational and not essentially
commercial responsibility to those who are in distress and are suffering. Indeed, the roots
of the word lie in the Latin verb patior (I suffer). In our experience, too, people seeking help
 Preface to the Second Edition xv

from clinicians and other health professionals are not always comfortable with the word
client. However, times change and with them connotations and usages of terminology,
including of diagnostic “labels” (see Chapter 9), and we recognize it is inevitably hard to
know where consensus will lead.
We have also in this edition deliberately drawn back from use of the term “intervention”
which we felt has become increasingly and excessively used as a synonym for “treatment” or
“therapy.” While the word may make some sense as a high‐level, collective descriptive of treat-
ment approaches, it still to our mind carries unfortunate mechanistic and militaristic echoes
at best applicable in health care in, for example a “doing to” public health context, but not we
suggest as a description of any collaborative, humane, relationally based treatment, far less
psychotherapy. Unfortunately, in an era of increasing “commodification” of health care and of
staff it also carries for us a quasi‐commercial and mechanical resonance invoked by phrases
such as “delivering interventions” which we felt sat uneasily with our therapeutic position and
aims. Again, however, we recognize that word usage changes and it may be our views are
effectively already superceded and redundant, and that the word already means something
different, perhaps regrettably, to a present generation of health care professionals.
We both sincerely hoped that this reworked and revised edition would be welcome and
helpful to a range of people, both fellow mental health professionals and others, and I
hope, despite its delayed and rather complicated coming into being, that this will prove to
be the case. I very much hope that it may also contribute in some way to a more meaning-
fully relational and compassionate moving forward for us all much more broadly. This was,
I am sure, another deeply felt aspiration and hope on Tony’s part.

Ian B. Kerr—Whangarei, New Zealand–Aotearoa (2020)

 xvii

­Preface to the First Edition (2002)

This book offers an updated introduction and overview of the principles and practice of
cognitive analytic therapy (CAT). The last such book appeared over 10 years ago and was the
first systematic articulation of a new, integrative model which had been developed over a
period of many years. Although there have been two specialist volumes since then (Ryle,
1995, 1997a) it is significant that a restatement of the model and its applications is now nec-
essary. There are many reasons for this. They include the fact that as a young, genuinely
integrative model (as acknowledged in the influential Roth and Fonagy report (1996)), it is
still evolving and developing both in terms of its theoretical base and its range of applica-
tions. In this book, a further exposition of the CAT model of development is given, stressing
in particular an understanding of the social formation of the self based on Vygotskian activ-
ity theory and Bakhtinian “dialogism.” We also outline an ever‐expanding range of practical
applications of CAT as an individual therapy as well as its application as a conceptual model
for understanding different disorders and informing approaches to their management by
staff teams. This trend has been described (Steve Potter) as “using” CAT, as opposed to
“doing” it. Newer or preliminary applications of CAT reviewed here include CAT in old age,
with learning disabilities, in anxiety‐related disorders, in psychotic disorders, CAT for self‐
harming patients presenting briefly to casualty departments, CAT with the “difficult” patient
in organizational settings, and CAT in primary care. In part these also reflect theoretical
developments of the model which are also reviewed. Its gradually expanding evidence base
is also reviewed, along with some of the difficulties, both scientific and political, inherent in
research in this area.
CAT evolved initially as a brief (usually 16‐session) therapy. This was partly for pragmatic
reasons and related to the search for the optimum means of delivering an effective treatment
to the kind of patients being seen in under‐resourced health service settings. However, it
also arose from consideration and evaluation of which aspects of therapy, including its dura-
tion, were actually effective. This aspect of research is fundamental to the model and contin-
ues to be important in its continuing evolution. We suggest, incidentally, that a brief
treatment like CAT, within the course of which profound psychological change can be
achieved, genuinely merits the description of “intensive” as opposed to much longer‐term
therapies usually described as such, which we suggest might better be called “extensive.”
Despite the effectiveness of brief CAT for very many patients, it is clear that not all
patients can be successfully treated within this length of time. However, it is also evident
from some very interesting work, with, for example, self‐harming patients but also less
xviii Preface to the First Edition (2002)

damaged “neurotic” patients, that effective work can also be done in a few, or even one
­session. The length of treatment has thus been modified to adapt to the needs of differing
patients. Longer‐term therapy may need to be offered to those with severe personality dis-
order, longstanding psychotic disorder, or those with histories of serious psychological
trauma. Thus, there will be some patients for whom the reparative and supportive aspect of
therapy over a longer period of time may be an important requirement. Similarly, more
extended treatments may be offered in settings such as a day hospital, where the treatment
model may be informed by CAT, as an alternative to offering it as an individual therapy.
A further reason for the present book is the ever increasing popularity of CAT with men-
tal health professionals and the demand from trainees and others for a comprehensive but
accessible introduction to it. The rapidly increasing popularity of CAT with both profes-
sionals and patients is, we feel, a further indication of the effectiveness and attractiveness
of the model. In part, we see this popularity as arising from the congruence of CAT with the
increasing demand for “user participation” in mental health services; the explicitly collabo-
rative nature of the model offers and requires active participation on the part of the client
or patient. This “doing with” therapeutic position, in addition to being demonstrably effec-
tive, appears to be very much more appropriate and welcome to a younger generation of
trainees and potential therapists. This “power‐sharing” paradigm has overall, in our view,
radical implications for mental, and other, health services.
The CAT understanding of the social and cultural formation of the self also highlights
the role of political and economic forces in the genesis of many psychological disorders.
The external conditions of life and the dominant values of current society, internalized in
the individual, are seen as active determinants of psychological health or disorder.
Recognizing this, we suggest that, as therapists, we should strive to avoid describing psy-
chological disorders as simply “illnesses” and should also play our part in identifying and
articulating whatever social action may be called for in response.
The book is the result of the collaborative work of two authors who share responsibil-
ity for the text. Our contributions were different, in part because AR was the initiator of
the CAT model and has a much longer history of writing about it. In so far as this con-
ferred authority it also risked complacency which, he felt, needed to be challenged. IK
brought a more recent experience of psychiatry and psychotherapy in the NHS, reflected
in particular in the discussion of psychosis and of the “difficult” patient and contextual
reformulation. He also wished to emphasize the importance of a full bio‐psycho‐social
perspective. Our longest and most fruitful arguments were involved in writing the theo-
retical Chapters 3 and 4.
 xix

Acknowledgments

We should like to thank the many colleagues and patients who have contributed material
to this book and who have been named in it. There are also innumerable others who have
made important contributions to its production, directly and indirectly, both recently and
over a period of many years. They are too many to name but we should like to express our
gratitude to them collectively. Some of these contributions are referenced, although given
editorial constraints we have been able, regretfully, only to cite books and peer‐reviewed
publications, and material that was directly relevant to points being made in the book. We
apologize to colleagues for omissions or oversights which will inevitably have occurred;
however, our aim was not simply to undertake a comprehensive collation of all CAT‐related
publications. This will be an important task for more specialist review literature and multi-
author books on CAT subsequently. We would like to acknowledge the support provided by
the staff at John Wiley and, in particular, the early encouragement offered by Michael
Coombs who commissioned the first edition, the subsequent support (and patience!)
offered by Darren Read during the initial stages of this revision which he commissioned,
and subsequently helpful assistance by freelance copy editor Caroline McPherson and,
during the production stages, by Rahini Devi Radhakrishnan, under the strategic eye of
Darren Lalonde overall. Finally, we should like to thank our partners Flora and Jane for
making, in various and important ways, the writing of this book possible.
 xxi

­The Structure of the Book

Chapters 1 and 2 will give a brief account of the scope and focus of CAT and how it evolved
and will spell out the main features of its practice. Most of CAT’s relatively few technical
terms will appear in these chapters; they and other general terms which may have a differ-
ent meaning in CAT are listed in a glossary. In order to flesh out this introductory survey
and give readers a sense of the unfolding structure of a time‐limited CAT, Chapter 2 also
offers a brief account of a relatively straightforward therapy. Chapters 3 and 4 consider the
normal and abnormal development of the self and introduce the Vygotskian and Bakhtinian
concepts which are part of the basic theory of individual development and change.
Subsequent chapters describe selection and assessment (Chapter 5); reformulation
(Chapter 6); the course of therapy (Chapter 7); the “ideal model” of therapist interventions
and its relation to the supervision of therapists (Chapter 8); applications of CAT in various
patient groups and settings (Chapter 9) and in treating personality‐type disorders
(Chapter 10); and the concept of the “difficult” patient and approaches to this problem,
including the use of “contextual reformulation” and use in “reflective practice” (Chapter 11).
Each chapter commences with a brief summary of its contents and includes suggestions for
further reading and references to CAT published work, and to the work of others. In addi-
tion, Appendix 1 contains the CAT Psychotherapy File, Appendix 2 the summary of CAT
competences extracted from Roth and Pilling (2013), Appendix 3 contains the Personality
Structure Questionnaire, and Appendix 4 a description of repertory grid basics and their
use in CAT.
Case material derived from audio‐taped sessions is used with the permission of both
patients and therapists; we gratefully acknowledge their help. Other illustrative material is
either drawn from composite sources or disguised in ways preventing recognition. We have,
on the whole, referred to patients rather than clients, although in this book we use the term
interchangeably.

F
­ urther Information

Further information about CAT and about the Association for Cognitive Analytic Therapy
(ACAT) in the UK may be obtained from the website www.acat.me.uk in the UK, from local
associations in other countries, and/or through www.internationalcat.org.
Introducing Cognitive Analytic Therapy
 1

The Scope and Focus of CAT

S
­ ummary

CAT evolved as an integration of cognitive, psychoanalytic, and, more recently, Vygotskian

and Bakhtinian ideas. It is characterized by a predominantly relational understanding of the
origins of patient problems and symptoms and an explicitly empathic, pro-active, and com-
passionate therapeutic stance, with an active focus on issues arising within the therapeutic
relationship. From the beginning it has emphasized genuine therapist–patient collaboration
in creating and using descriptive reformulations of presenting problems. As such it offers a
respectful, whole-person, “transdiagnostic” approach that represents a challenge to many
prevalent “diagnosis”-led services. The model arose from a continuing commitment to research
into effective therapies and therapy integration, and from a concern with offering appropriate,
time-limited treatment in the public sector. Originally developed as a model of individual
therapy, CAT now offers a general theory of development and psychotherapy with applicability
to a wide range of conditions in many different settings and in various “contextual” and
­systemic approaches.

In order to locate cognitive analytic therapy (CAT) in the still expanding array of approaches
to psychotherapy and counseling and to indicate the continuing developments in its theory
and practice, its main features will be briefly summarized in this introductory chapter.

­CAT Is an Integrated Model

One source of CAT was a wish to find a common language for the psychotherapies. While
there is a place for different perspectives and different aims in psychotherapy, the use by
the different schools of ostensibly unrelated concepts and languages to describe the same
phenomena seems absurd. It has resulted in a situation where discussion is largely con-
fined to the parish magazines of each of the different churches or to the trading of disparag-
ing insults between them. Despite the growth of interest in integration and the spread of
technical eclecticism in recent years, the situation has not radically altered. CAT remains,

Introducing Cognitive Analytic Therapy: Principles and Practice of a Relational Approach to Mental Health,
Second Edition. Anthony Ryle and Ian B. Kerr.
© 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd.
2 The Scope and Focus of CAT

we suggest, one of the few models to propose a comprehensive theory that aims to address
and integrate the more robust and valid findings of different schools of psychotherapy as
well as those of related fields such as developmental psychology and infant observational
research, neuroscience, epidemiology, and sociology.
The process of integration in CAT originated in the use of cognitive methods and tools
to research the process and outcome of psychodynamic therapy. This involved the transla-
tion of many traditional psychoanalytic concepts into a more accessible language based
on the new cognitive psychology. This led on to a consideration of the methods employed
by current cognitive-behavioral and psychodynamic practitioners. While cognitive-behav-
ioral models of therapy needed to take more account of the key role of human relation-
ships in development, in psychopathology, and in therapy, their emphasis on the analysis
and description of the sequences connecting behaviors to outcomes and beliefs to emo-
tions made an important contribution. Psychoanalysis overall offered three main impor-
tant understandings, namely its emphasis on the relation of early development to
psychological structures, its recognition of how patterns of relationship derived from
early experience are at the root of most psychological distress and difficulty, and its under-
standing of how these patterns are repeated in, and may be modified through, the patient–
therapist relationship.
Neither cognitive nor psychoanalytic models, however, appeared to acknowledge ade-
quately the extent to which individual human personality or the “Self” is formed and main-
tained through relating to and communicating with others and through the internalization
of the meanings developed in such relationships, meanings which reflect the values and
structures of the wider culture. In CAT, the Self is seen to be developed, constituted, and
maintained through such interactions.

­CAT Is a Collaborative Therapy

The practice of CAT reflects these theoretical developments. It has been suggested that,
in contrast to the traditional polarization of health care professionals between those who
are good at “doing to” their patients (e.g., surgeons and perhaps some behavior thera-
pists) and those who are good at “being with” their patients (e.g., many dynamic psycho-
therapists or nurses involved in long-term care), the CAT therapist aims to be good at
doing with their patients (Kerr, 1998a). This highlights the fact that CAT involves hard
work and commitment for both patients and therapists, and also the fact that much of
this work is done together and that the therapy relationship itself plays a major role in
assisting change.
The ways therapists interact with and describe their patients is important for the quality
of the therapeutic relationship and transcends the “application” of any particular tech-
nique. Any techniques used, and how they are employed, must convey human compassion,
acknowledgment, and value. CAT therapists therefore encourage patients to participate,
possibly in ways that are challenging, to the greatest possible extent in their therapies. For
many patients this may in itself represent a quite new, or previously “forbidden,” experi-
ence. Such a therapeutic approach may also feel unfamiliar and uncomfortable for many
 ­CAT Evolved from the Needs of Working in the Public Sector and Remains Ideally Suited To I  3

health care professionals. Therapists have usually learned helpful ways of thinking and
being and are, in some sense, experts in activities that parallel parenting or teaching.
But our patients are not pupils or children and their capacities need to be respected,
­empowered, and enlarged through the joint creation of new understandings, challenges
to longstanding assumptions, acquisition of new “coping patterns,” and through a new
relational experience.

­CAT Is Research Based

The historic failure of psychodynamic therapists to evaluate seriously the efficacy and
effectiveness of their work and their resistance to doing so, partly for understandable rea-
sons, led in the past to a lack of serious support in the NHS (National Health Service) in the
UK for therapy in general. It appears also to have contributed, paradoxically, to the current
frequently indiscriminate and uninformed application of an “evidence-based” paradigm,
important as evidence is, that is crude and problematic given the multidimensional com-
plexity of mental disorder and treatments for it, and also given the increasing recognition
of “common factors” in effective therapies and treatments (Castonguay & Beutler, 2006;
Gabbard, Beck, & Holmes, 2005; Greenberg, 1991; Lambert, 2013; Norcross, 2011; Parry,
Roth, and Kerr, 2005; Roth & Fonagy, 1996; Wampold & Imel, 2015). The outcome research
that led on to the development of CAT pre-dated these developments, originating in a pro-
gram dating back to the 1960s that aimed to develop measures of dynamic change. While
the “formal” research base for CAT remains relatively slender (Calvert & Kellett, 2014), the
evolution of the model over the last 30 years has been accompanied by a continuous pro-
gram of largely small-scale but important research into both the process and outcome of
therapy, and also the use and evaluation of CAT in contextual or consultancy type
approaches, and this continues on an expanding scale. In addition, a number of more “for-
mal” randomized controlled trials have been successfully undertaken in recent years, nota-
bly for “borderline personality”-type disorders (see Chapter 10). One consistent research
finding has been the apparently superior effectiveness of CAT in engaging “difficult” or
“hard to help” patients’ of whatever diagnosis, and retaining them in treatment (Calvert &
Kellett, 2014).

­ AT Evolved from the Needs of Working in the Public Sector

C
and Remains Ideally Suited To It

Despite the proliferation of treatment models, a considerable proportion of psychologically

distressed and damaged people in the UK (and in most other “developed” countries, let
alone in the “developing” world) do not have access to effective psychological treatment.
It should, however, be noted that Western models of mental disorders and treatment, of
whatever kind, are certainly not applicable without considerable re-conceptualization in
different socio-cultural contexts worldwide. In many socio-cultural settings, psychological
distress or disorder will be conceived of and responded to quite differently, or indeed not
4 The Scope and Focus of CAT

in “psychological” terms at all. However, the concept of the socially constituted Self
underpinning CAT, and its collaborative approach to meaning-making, may enable the
model to be used flexibly and helpfully in these other contexts (see Chapter 9). Emerging
experience with CAT around the world has certainly been encouraging (see Chapter 9).
Meantime CAT, by providing a therapy that can be offered at reasonable cost, while being
effective across a wide spectrum of “diagnoses” and a wide range of severity, is making a
contribution to meeting the needs of many patients in many, although significantly not all,
Western countries.
Most CAT therapists in the UK and elsewhere have worked in the NHS, or public health
services, as nurses, occupational therapists, social workers, psychologists, or psychiatrists.
We are, for the most part, experienced in, and largely committed to, work in the public sec-
tor. We share a social perspective which assumes that psychotherapy services should take
responsibility for those in need in the populations we serve, and should not be reserved for
those individuals who happen to find (or buy) their way to the consulting room. It does,
however, appear, not surprisingly perhaps, that CAT is becoming a popular model of ther-
apy in the independent sector where, in some countries more than others, many therapists
make their living, and may offer an important provision of treatment. Here, its time-lim-
ited but radical “whole-person” approach appeals to many clients who may have, possibly
serious, psychological difficulties. As a model of brief therapy it is of course, for very differ-
ent reasons, attractive to health insurance companies.
Our own social perspective and sense of commitment is not new. The following descrip-
tion of the NHS was sent to demobilized servicemen in 1950: “It will provide you with all
medical, dental and nursing care. Everyone, rich, poor, man, woman or child, can use it or
any part of it. There are no charges except for a few special items … But it is not a charity.
You are all paying for it, mainly as taxpayers and it will relieve your money worries in times
of illness” (quoted in Wedderburn, 1996.) Despite the chronic underfunding of mental
health services and of psychotherapy in particular, both in the UK and elsewhere, we
believe that these principles can still be fought for and that CAT can contribute to their
realization.

­CAT Is Time-Limited

CAT is undertaken with an explicit focus on time limitation (not simply brevity), and on
what we have previously described as “ending well” (Ryle & Kerr, 2002). “Ending” from a
CAT perspective will be described more fully below in Chapters 2 and 7. Typically, how-
ever, an initial CAT therapy contract would be for 16–24 sessions, given that for many such
a period is clearly clinically effective. A focus on time limitation also helps maintain focus
and addresses the major problem of therapeutic “drift,” or creating an unhelpful depend-
ency on the part of the patient, or indeed a mutual, ongoing narcissistic gratification for
both therapist and patient. In CAT, “ending well” is seen, therefore, as an important aim in
itself. However, therapy may need sometimes to be extended longer term in treating more
disturbed and damaged patients (see, e.g., discussion of “borderline”-type disorders, or
psychosis in Chapters 10 and 9). Therapy may also be shorter (e.g., 4–8 sessions) where the
threshold to consultation is low, for more focal problems, or for less distressed or less
 ­CAT Offers a General Theory, Not Just a New Package of Technique  5

­ amaged patients. Some patient groups (e.g., adolescents) may find longer (or indeed any!)
d
formal therapies hard to engage with, and contracts may need to be modified collabora-
tively and accordingly.

­ AT Offers a General Theory, Not Just a New Package

C
of Techniques
The book aims to describe and illustrate the methods, techniques, and tools developed in
CAT and its underlying theory. While largely concerned with individual therapy, applica-
tions and uses in other modalities are considered, as are the wider implications for psycho-
therapy theory. While some CAT techniques could be incorporated in other treatment
approaches (and vice versa), the model and the method involve much more than simply
application of a range of disparate techniques. Psychotherapy patients can make use of a
great many different psychotherapy techniques and there would be no point in simply
offering a new combination of these under a new label. So why do we need theory?
One robust finding from psychotherapy research is that therapists employing some clear,
credible theory generally do much better clinically (Castonguay & Beutler, 2006; Gabbard
et al., 2005; Lambert, 2013; Roth & Fonagy, 1996). And in health care more generally, plau-
sible, humane, and scientifically-based theories are also much more likely to facilitate
effective treatments, including those with a major psychosocial component. Another
robust finding is that the patient’s perception of the therapist as sympathetic and helpful is
associated with a good outcome (Castonguay & Beutler, 2006; Gabbard et al., 2005;
Greenberg, 1991; Lambert, 2013; Norcross, 2011; Roth & Fonagy, 1996; Wampold & Imel,
2015). In one important recent study, the strength of the therapeutic alliance in working
psychologically with patients suffering from psychotic disorders was noted to be the key
predictor of outcome, including prediction of adverse outcomes in association with a poor
therapeutic alliance (Goldsmith, Lewis, Dunn, & Bentall, 2015). This being so, a major part
of any therapy model must be concerned with how to achieve this and achieve a strong
“therapeutic alliance,” given that the central problem for many patients is that they are
often unwittingly damaging or disruptive in their personal relationships and, mostly for
very good reasons, are mistrustful and possibly destructive of offers of help from others.
Working successfully with these enactments is never easy but becomes increasingly impor-
tant and difficult as more disturbed patients are considered. Being helpful means more
than being nice, indeed it may frequently involve being very challenging. However, in CAT
this would always be undertaken in a benign, non-judgmental manner, even when clearly
drawing attention to the unhelpful consequences or effects of problematic enactments on
others, including on the therapist. This would be undertaken always with at least implicit
reference to previously agreed reformulations (maps and letters). This also has the effect of
depersonalizing and externalizing (or “defusing”) any problematic enactment beyond the
immediacy of the therapy relationship and, hopefully, restoring a collaborative dialog.
Such therapist “challenges” would be undertaken, therefore, in the context of, and contrib-
ute toward, a positive therapeutic alliance. This is aided in turn by working through and
resolving such potential ruptures (“tear and repair” episodes) by means of the tools and the
relational style of the therapy (see Chapters 2 and 8).
6 The Scope and Focus of CAT

A crucial quality required, therefore, is to respect the patient enough to be honest.

Techniques need to be understood in relation to the complex human issues that are at the
heart of therapy. Those used in CAT, whether adapted from other approaches or specific to
CAT, have, as their main aim, the development of the patient’s capacities to know, reflect
on, and ultimately control and replace unhelpful and distressing thoughts, actions, and
experiences, and to benefit from the internalization of a benign, healing therapy experi-
ence. Other tools and techniques are designed to maintain the therapist’s adherence to the
methods and values of the approach (see Chapter 8). These provide a framework within
which a sincere and often intense working relationship can flourish. Practice embedded in
theoretical clarity must be combined with accurate empathy and compassion if therapists
are to be able to reach and maintain an understanding of their patients’ experiences and at
the same time be fully aware of their own role in enabling and encouraging change. These
may also assist in the inevitable dangers of collusion, whether with a patient in therapy, or
with pressures imposed by the context of service provision. The latter may include, for
example, pressures to get through waiting lists, avoid risks, or to achieve immediate, but
frequently superficial, clinical “results.”

­CAT Has Applications In Many Clinical and Other Settings

Overall, CAT by now offers, in our view, a robust, comprehensive framework within which
various helpful clinical treatments may be offered, and which also offers a means of re-
conceptualizing many challenging problems (e.g., dementia, the “difficult” patient, “per-
sonality disorder,” psychosomatic disorders, psychosis, and so forth; see Chapters 2 and 9).
We note that, inevitably, further major conceptual and clinical challenges exist for CAT, as
for any other current model, some of which are addressed elsewhere in the book. This book
is primarily addressed to those in training or already working therapeutically with psycho-
logically distressed or disturbed individuals, but also to those colleagues who, while not
“doing therapy,” have important clinical and other (e.g., managerial, judicial) responsibili-
ties. We believe that psychological and relational understandings should play a larger part
than is now the case throughout health services, such as the NHS, and beyond. This would
include management of groups such as psychiatric patients with major mental disorders,
forensic patients, the “mentally handicapped” or “intellectually disabled,” and also, for
example, in schools and in other social settings (see Chapter 9). We believe that psycho-
therapists should ideally play a central role in supporting and training staff in these fields.
In all these fields experience is accumulating of applying CAT, and the model appears to be
accessible and useful to many patients and clinical staff (see Chapters 9 and 11). While both
psychodynamic therapies and cognitive therapy have contributed historically to these
fields, neither, in our view, adequately conceptualizes or mobilizes the therapeutic power
of the relationship between patients and those looking after them in a way that is clear,
structured, and, above all, clinically helpful. Importantly, CAT also appears to offer an
effective, relationally underpinned, structured, and containing framework within which
health professionals frequently feel empowered and “liberated” to enact, properly and
safely, the care and compassion that most bring to their work. For many this may be
repressed and disallowed in many present day, commodified, and highly defensive health
 ­CAT Has Applications In Many Clinical and Other Setting  7

care systems (see Lees, 2016; Lowenthal, 2015). Nonetheless, these qualities are recognized
to lie at the core of any effective health (or social) care (see Youngson, 2012). We believe
that CAT has a major generic contribution to make in these areas, offering a distinct, coher-
ent, and teachable model of social and interpersonal development, interaction, and well-
being that can enable individuals, staff groups, and services to respond helpfully, rather
than react collusively, to their patients, and which may also have important applications
outside clinical practice (see Chapters 9 and 11).
 9

The Main Features of CAT

S
­ ummary

Cognitive Analytic Theory (CAT) theory focuses principally on the way in which early
­relational, including socio-cultural, experience is internalized in the developing Self as a
­repertoire of (“formative”) reciprocal roles (RRs) and the emergence of “responsive,” “coping”
patterns or reciprocal role procedures (RRPs). These are also understood to incorporate inter-
nalized values and beliefs. Theory also addresses the ways in which this possibly damaged
repertoire of RRs and RRPs is enacted and repeated in current relationships, in self-manage-
ment, in problematic symptoms, and on the ways in which they may prevent revision of dys-
functional or unfulfilling ways of living. More severe and complex developmental damage
may result in a tendency to dissociation and fragmentation of the Self into disconnected Self-
states, with loss of Self-reflective capacity and enactment of frequently extreme and desperate
RRPs. Successful therapeutic change is understood in terms of change to these deep structures
and processes, and subsequently to socio-relational context. This body of theory has evolved
from the earlier Procedural Sequence Object Relations Model PSORM. This was modified by
the introduction of Vygotskian and Bakhtinian ideas on the social and dialogical formation
of mind and the Self, although it remains the foundation of CAT. The practice of CAT is based,
for good theoretical reasons, on a collaborative and empathic therapeutic position. The thera-
pist adopts a whole-person, “transdiagnostic” approach aiming firstly to acknowledge and
validate a patient’s presenting problems and story. The therapist aims to make joint sense of
these with the patient, and to create, as quickly as possible, a jointly agreed provisional narra-
tive and diagrammatic reformulations (as a letter and a “map”) of their story and of their
difficulties. These will aim to describe, non-judgmentally, apparent historic relational origins
of RRs, of subsequent, often dysfunctional and symptomatic, RRPs, and the ways in which
these may be played out currently, including importantly within the therapy relationship.
Therapy subsequently involves describing and helping to revise and change these key RRs and
RRPs (seen as “target problem procedures” or “key issues”), and, if helpful, resultant present-
ing problems (“target problems”), and to help create more fulfilling alternative or modified
RRs and RRPs (“exits” or “aims”). Therapy will also aim at gradually making joint sense of, or
“working through”, both historic issues and current difficulties in living. This later period of
therapy may involve use of complementary techniques such as “no-send” letters, behavioral

Introducing Cognitive Analytic Therapy: Principles and Practice of a Relational Approach to Mental Health,
Second Edition. Anthony Ryle and Ian B. Kerr.
© 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd.
10 The Main Features of CAT

experiments, “empty chair” work, art or music therapy, or more formal trauma processing
work. All of these activities would be undertaken, however, in the context of prior reformula-
tions. Therapy will also aim from the beginning to pick up ways in which the therapist will,
inevitably, be implicated in (reciprocate) the frequently distressed or desperate enactments of
a patient’s RR repertoire, and how this may lead to misunderstandings or ruptures. A key task
of therapy is to address and resolve these, assisted by the jointly agreed “map” and letter.
Importantly, the therapy relationship aims to offer a new experience (a new “situational” RR)
of being listened to non-judgmentally, contained, and empowered, rather than colluded with
or against. This experience is understood to be gradually internalized and healing in itself. For
more damaged and distressed patients, this aspect of individual therapy may be important
over a longer period. It may also be helpfully complemented or consolidated, depending on
context, by other approaches such as group or social therapy. Focus throughout, however, is
maintained on time limitation and “ending well.” This is marked by the exchange of summary
“goodbye” letters that reflect on therapy and the future from the perspective of both patient and
therapist. Therapy would always be undertaken in the supportive context of, at least, peer
supervision given the ever-present likelihood of unwitting collusion with the patient’s rela-
tional repertoire, and the inevitable risks of professional stress and “burn out.” CAT-based
approaches are also being used increasingly to address problematic systemic, organizational,
and indeed socio-political dynamics arising both in clinical settings and beyond.

This chapter will offer an overview and definitions of the key theoretical concepts of CAT
and of the key features of CAT as a model of therapy. We will offer a summary of the his-
torical development of CAT in so far as this is relevant to an understanding and apprecia-
tion of the current CAT model. This will include some consideration of other models from
which, and alongside which, it has evolved and with which it continues to share certain
commonalities (see e.g., Young, Klosko, & Weishaar, 2003; Bateman & Fonagy, 2012;
Hayes, Kirk, Strosahl, & Wilson, 2012; Meares, 2012; Leichsenring & Leibung, 2010; and
see overviews in Yakeley, Johnstone, Adshead, & Allison, 2016). We shall illustrate the use
of CAT with a brief case history, while others will be included later in the book to illustrate
different aspects of practice. These will include the extension of CAT into more contextual
and systemic settings, group work, and reflective practice. The focus will be principally on
individual psychotherapy, given that this is where the initial and most current work has
been and is undertaken. Given the evolution of CAT into a, by now widely accepted,
“stand-alone” model of development, disorder, and therapy, fewer references to the ori-
gins and development of CAT and fewer comparisons with other models will appear in
the text than was the case in the first edition of this book. Much about CAT has, however,
remained constant, including the aim of providing effective, evidence-based practice to
those in need, following the original principles of the National Health Service in the UK,
and a recognition of the constraints of publicly funded services. This remains the case
notwithstanding the deeply regrettable and increasing commercialization and commodi-
fication of health care in recent years in the UK and in many other countries. Although
CAT was not defined and named as a separate model until the mid-1980s, it was derived
from practice and research carried out over several previous decades. As this pre-history
explains many of its current features, this chapter will begin by summarizing these
sources. These sections may, however, be reasonably skimmed over by those less ­interested
 ­Backgroun  11

in, or preoccupied by, more detailed aspects of the development of its underlying theory.
Further historical and summary accounts of CAT are given by, for example, Denman
(2001); Dunn (2002); Kerr (2005); Kerr and Ryle (2006); Ryle and Low (2013); Ryle, Kellett,
Hepple, and Calvert (2014); Kerr, Hepple, and Blunden (2016); McCormick (2017);
Corbridge, Laura Brummer, and Coid (2017); and Potter (2020).

B
­ ackground
Several decades ago, there was hardly any evidence to show whether psychodynamic ther-
apy worked, and cognitive therapy was still at a very early stage. To measure the effective-
ness of therapy it is necessary to declare at the start what the aims are. This is a task easily
accomplished by behaviorists where aims are defined as the relief of symptoms or modifi-
cation of behaviors, but more difficult for psychodynamic therapists whose aims are com-
plex and are often poorly articulated, or only emerge in the course of the therapy. One early
pre-CAT study was undertaken to address this problem (Ryle, 1979). This involved a careful
reading of the notes of a series of completed therapies with the aim of finding out how
early in therapy the key problems had been identified. This revealed that most therapies
were concerned with only one or two key themes and that these had usually been evident
early on, often in the first session. It also showed that much of the work of therapy had
been directed to trying to understand why the patient had not revised the ways of thinking
and acting which maintained these problems. On this basis, the “dynamic” aims of therapy
could be defined early on as the revision of the identified, repetitive, or maladaptive pat-
terns of thought and behavior.
Three patterns explaining this non-revision were identified; these were labeled dilemmas,
traps, and snags. These patterns would now be understood as varieties of reciprocal role
procedures (RRPs)—see below. Dilemmas prevent revision because the possibilities for
action or relationships are seen to be limited to polarized choices; the only apparent options
are to follow the less objectionable choice or to alternate between them. Traps represent the
maintenance of negative beliefs by the way they generate forms of behavior which lead to
consequences (usually the responses of others) that appear to confirm the beliefs. In snags,
appropriate goals are abandoned or sabotaged, because (or as if) it is believed that their
achievement would be dangerous to self or others or otherwise disallowed.
Further studies combined ratings of these patterns with the use of repertory grid tech-
niques (Brockman, Poynton, Ryle, & Watson, 1987; Ryle, 1979). (The basic principles of
this technique are summarized in Appendix 4 for those interested.) At the start of therapy,
patients completed such grids by rating how far a range of descriptions (constructs), partly
elicited and partly supplied, were true of a range of elements consisting of significant peo-
ple. In the case of the dyad grid (Ryle & Lunghi, 1970), the elements are the relationships
between the self and significant people. Analysis of such grids provided a number of meas-
ures of the individual’s way of construing self and other. Measures that reflected the issues
which had been noted clinically and described in psychodynamic terms could be identi-
fied, and the changes in these seen to be desirable in terms of the aims of therapy could be
specified. Repeating the grid after therapy showed how far such changes had occurred.
Through the use of such repertory grids, described in Ryle (1975, 1979, 1980), it became
12 The Main Features of CAT

possible to derive measures of change between pre- and post-therapy testing that indicated
how far dynamic aims had been achieved.
What started as an exercise designed to provide evidence of the effectiveness of
dynamic therapy proved to be successful. Outcome research could now be based on
identifying and measuring change in patients’ “dynamic” problems, described as pat-
terns of traps, dilemmas, and snags at the start of therapy, and on measuring change in
the associated repertory grid measures. But the main effect was incidental to this aim,
for this process, which involved explicit, joint work with the patient to identify and
describe problems, had such a powerful positive effect on the course of therapy that
conventional dynamic therapy was abandoned. The joint reformulation of the patient’s
problems became a key feature of what developed into CAT. Clear identification of and
agreement between therapist and patient about aims, goals, and objectives is now well
recognized as a common factor enabling and predicting successful therapy outcomes
(Castonguay & Beutler, 2006; Castonguay, Boswell, Zack et al., 2010; Gabbard, Beck, &
Holmes, 2005; Greenberg, 1991; Lambert, 2013; Norcross, 2011; Roth & Fonagy, 1996;
Wampold & Imel, 2015).

­The Early Development of CAT Practice

The “Psychotherapy File” was developed at this stage and was the first specific CAT tool. A
version of this is reproduced in Appendix 1. This is usually given to patients to take away at
the end of the first session. It gives explanations and examples of dilemmas, traps, and
snags and invites patients to consider which may apply to them; these will be discussed
with the therapist at the next session. The File also gives instructions in self-monitoring of
mood changes and symptoms, based on cognitive therapy practice, and contains screening
questions concerning instability of the self. Positive answers to the latter suggest “border-
line” type features. The use of the File introduces patients to active participation in the
therapy process and initiates them in the task of learning self-reflection. For many patients
it is also reassuring to realize, given that the File exists, that many others must experience
similar problems. At this point readers may find it useful to go through the File with a
patient, and perhaps with themselves, in mind.
Practice diverged from the psychodynamic model and was now based on the active,
joint creation and use of the reformulation. Thereafter, historic difficulties, daily life,
and the evolving therapy relationship were understood in terms of this reformulation
and patients were involved in homework on issues related to recognition and revision of
the identified patterns. Self-monitoring of symptoms and behaviors to identify when
they were activated contributed to the creation of a written list of target problems (TPs)
and underlying target problem procedures (TPPs), the latter in the form of dilemmas,
traps, and snags. TPPs (in therapy now often simply described as “key issues”) would
now be understood as varieties of RRPs. Changes in TPs and TPPs were rated by patients
on visual analog scales and discussed at each session. This procedure was not popular
with therapists from psychodynamic backgrounds, but for them and for many patients
it served to maintain the focus and to encourage the patient’s self-observation and assist
its accuracy.
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 CHAPTER XIX

W E travelled after the manner described by Abd er Rahman as

that of the Arabs when in difficulties in the desert. We rested,
that is, in the middle of the day, marching throughout the morning
and through most of the night.
At our last noon halt before reaching the bushes I overhauled the
caravan. With the exception of the one big camel the whole of the
beasts by this time were in a deplorable condition. My hagin was so
weak that he was unable even to carry my hurj. Another brute that
Abd er Rahman called the “rather meskin” (feeble) camel, was very
emaciated; while one that he called the meskin beast, par
excellence, was so excessively attenuated, that, in the photograph I
took of him, only the desert appeared!
It was the big camel that pulled us through. The loads of the
meskin and the “rather meskin” camels were both put on to his back,
in addition to his ordinary burden, and my hurj was added to the pile.
Moreover, whenever any of us wanted a lift we rode him—and he
seemed to like it!
Ibrahim was two days overdue, and, as nothing had been seen of
him, I was beginning to feel rather anxious and to fear he had
passed us in the dark without our seeing him. During one noon halt,
however, Abdulla, who was still rather jumpy, raised the alarm of
haramin (robbers). We immediately collected our ironmongery and
turned out to receive them. But to our great relief we found it was
only Ibrahim approaching with three camels and another man.
Dahab and one of my camels, we found, had knocked up on the
journey to Mut and had had to be left behind. It had taken Ibrahim
two days to get more beasts and someone to fill Dahab’s place. The
new-comer was an elderly Sudani, who had been at Qasr Dakhl with
two camels on Ibrahim’s arrival at Mut. He went by the name of Abeh
Abdulla.
I was considerably prejudiced in his favour by hearing him invoke
the aid of a certain “Sidi Mahmed,” or Mahmed ben Abd er Rahman
Bu Zian, to give him his full name, the founder of the Ziania
dervishes, a branch of the great Shadhlia order, that plays the rôle of
protector of travellers. It is, I believe, better known in north-west
Africa than on the Egyptian side. In the Western Sahara “Sidi Bu
Zian,” as he is sometimes called, may almost be termed the patron
saint of wayfarers in the desert.
Abdulla, when he got into difficulties, used to invoke a certain “Sidi
Abd el Jaud,” whose identity I was never able to discover.
Ibrahim had done his job splendidly. During the two days in Mut,
he had had the leaking tanks repaired and had borrowed some
others from the native officials. He had brought them all out filled to
the brim. We watered all the camels, and, when we had given them
time to absorb their drink, made a fresh start for the bushes.
When we reached Mut it was evening, and I walked to my
lodgings through the quaint old town, stumbling over the uneven
surface of the tunnelled street, whose darkness in the gathering dusk
was only broken here and there by a gleam of firelight, through some
half-opened door. The familiar smell of wood fires, whose smoke
hung heavily in the streets, the scraping drone of the small hand-
mills that the women were using to grind their flour, and the
monotonous thudding as they pounded their rice inside their houses,
had a wonderful effect in making me feel at home.
Soon after my arrival the usual boring deputation of the
Government officials turned up to felicitate me in conventional terms
on my safe return. After thanking them for the loan of the tanks, I
asked the mamur whether anything had been heard of Qway. He
professed to a total ignorance on the subject and wanted to have full
details of what he had been doing. I gave him an account of Qway’s
conduct as shown by his tracks and the empty tanks and asked, as
he had nearly done for Abdulla, that he should be immediately
arrested.
 The mamur hesitated for a moment, then burst out with a
passionate “Never! Qway is a gada” (sportsman). I pointed out the
gada had, at any rate, walked off with a rifle and telescope of mine,
and that I felt certain he had come into the oasis and was hiding. The
mamur did not think he was hiding, but that he would turn up as soon
as he heard I had got back—and anyway he declined to send out
men to look for him or to have him arrested. I insisted that it was his
duty both to find and arrest him, and, after a considerable amount of
pressing, he at length gave way to the extent of promising, if Qway
did not turn up, to send a man to look for him “the day after to-
morrow.”
This must have constituted a record in energy for an oasis official,
and seemed to exhaust his powers altogether. He refused to send a
message round to the ’omdas to have him detained if he appeared,
and shortly after said something about supper and departed.
I was left to reflections that were not over-pleasant. There was no
doubt that I had made a great mistake in asking to have Qway
arrested, for, even if I could get him tried for the offence, I should
have to find some motive for his actions, and I could not see how
that could be done without raising the Senussi question in an oasis
where, though their numbers were few, they possessed enormous
influence. I decided it would be best to confine my accusation
against him to that of stealing the rifle and telescope.
The possibility of my being able to secure him seemed extremely
remote. The attitude towards me of the natives of the oasis left no
doubt in my mind that they would all shield him. The Government
officials were obviously of the same frame of mind, and though they
might make some show of attempting to arrest him, I felt certain that
they would be surreptitiously endeavouring to aid him in his escape.
In the background I knew would be the Senussi, using all the great
influence they possessed in the oasis, in order to shield their puppet,
Qway, and to prevent his capture.
With only three Sudanese and an old Berberine cook at my back,
it was difficult to see what I could do. Still, as I had foolishly insisted
on his being brought to justice, I had to see it done. The task was not
altogether hopeless, for in cases of this description one Sudani is
worth a thousand fellahin. But for the time being the only thing to be
done in the circumstances was to lie low and await developments.
They soon came. As is often the case when dealing with natives
they were rather of the comic opera type. I first located Qway as
staying in the Senussi zawia in Smint. But the clerk to the qadi in
Mut, Sheykh Senussi, whom Qway had told me was “like a brother to
him,” finding that I was hot on his trail, and fearing that the Senussia
might become involved, moved him on to Rashida, and then, like the
mean sneak that he was, came round, and, to curry favour with me,
told me where he was.
I went off at once and saw the mamur; told him I had heard that
Qway was in Rashida, reminded him that this was “the day after to-
morrow,” on which he had promised to send “a man” to look for him,
and called on him to carry out his promise.
The mamur endeavoured to avoid doing so; but after some
trouble, I at length managed to get him to send a man at once.
I was in the merkaz the next day when he returned. He rode
pattering up on a donkey, dismounted, shuffled into the room,
saluted clumsily and made his report. According to instructions he
had gone to Rashida and seen Qway, and given him the mamur’s
message that he was to come into Mut. But Qway had said that he
did not want to come. The man had argued with him, and had done
his best to persuade him to come; but Qway had stuck to it that he
really did not want to, so he had climbed again on to his donkey and
ridden back to Mut to report progress.
The mamur was greatly relieved. He had done everything I had
asked him to do. He had sent a man on a Government donkey to
fetch Qway; but Qway did not want to come. What more could he
do? It was of no use asking Qway to come if he did not wish to. He
was very sorry, but he had done the most he could.
I suggested that perhaps he might send a policeman—a real
policeman in uniform with a rifle, not a ghaffir—and give him
instructions that, if Qway again refused to come, he was to BRING
him. But the mamur did not see his way to doing this. Why should he
arrest Qway? What had he done? Stolen a rifle had he? Had he any
cartridges? He still had twenty cartridges and a rifle had he? No, he
could not possibly arrest him. Qway might be old, but the Arabs were
very wild fellows, and he had no troops—only a few armed police.
A long discussion followed, and at last a solution of the difficulty
occurred to the mamur. He said he could not arrest Qway, but he
would send a policeman to bring back the rifle and cartridges. Did
that satisfy me? It didn’t. I said I must have Qway as well. After a
long discussion he at last agreed to send to fetch him, if I would send
a message by the policeman to tell Qway that he was not to shoot
him!
The next day the mamur came round to see me, looking
immensely relieved. He said that the policeman had gone to Rashida
to fetch Qway, but found that he had left the village, so now there
was nothing more to be done. He evidently felt that he was now clear
of all responsibility in the matter.
I had thus lost track of Qway, and began to despair of ever being
able to get hold of him. But the next day Abd er Rahman, who all
along had been indefatigable in trying to pick up information of his
whereabouts, told me that Qway had been seen near Tenida
dressed up as a fellah[4]—a fact that caused the little Sudani the
keenest amusement.
So I sent Abdulla to go off on his hagin to Tenida, under pretence
of buying barley, and to try and find Qway, and, if he succeeded, to
tell him from me to come at once to Mut.
The next day I went down to the merkaz to enquire whether there
was any news. I saw the police officer, who told me that he had just
had certain news that Qway had left the oasis and taken the road to
the Nile Valley. So, as he was now out of his jurisdiction—which
seemed to greatly relieve him—he was in a position to draw up the
proces verbal about the telescope and gun that he had stolen, a
piece of information that was distinctly depressing. I began to
wonder what was the best thing to do next.
 This problem, however, solved itself. I had just finished lunch
when a timid knock came at the door, and in walked Qway!
The old brute had evidently had a terrible time of it. He had
allowed himself to become the tool of the Senussi, but his plans
having miscarried, he had got lost and nearly died of thirst in the
desert, for, as I afterwards discovered, he had been nearly two days
without any water—and two very hot days they had been—and it had
only been the excellence of his camel that had pulled him through.
He looked ten years older. His eyes were bleary and bloodshot,
his cheeks sunken, his lips parched and cracked, his beard
untrimmed, and he had an unkempt, almost dirty, appearance.
He laid the rifle and telescope on my bed, fumbled in his
voluminous clothing and produced a handful of cartridges, took some
more out of his pocket, from which he also produced a rosary—the
Senussi mostly carry their beads in this way and not round their neck
as in the case of most Moslems. He then unknotted a corner of his
handkerchief and took out two or three more cartridges and laid
them all on the table.
“Count them, Your Excellency,” he said. “They are all there.” I
found that the tale of them was complete.
He looked sadly down to the ground and sighed profoundly. “I
have been working very badly,” he said, “very badly indeed. I am a
broken thing. I am the flesh and you are the knife.” It certainly looked
remarkably like it.
I asked him what excuse he had to make for his conduct. He
looked at me for a moment to see what line he had better take, and
the one that he took was not particularly complimentary to my
intelligence.
“It was very hot, Your Excellency—very hot indeed. And I was
alone and an afrit climbed up on to my camel.”
At this point I thought it might be advisable to have a witness, so I
sang out for Dahab.
 “No, Effendim, not Dahab. Don’t call Dahab,” said Qway in a
much perturbed voice. Presumably he thought Dahab would be less
likely to be convinced by his story than I would. Dahab entered the
room with surprising promptness—the doors in the oasis are not
sound-proof.
I told Qway to get on with his story of the afrit, which promised to
be a good one.
“There was an afrit, Your Excellency, that got up behind me on my
camel and kept on telling me to go there and to do this, and I had to
do it. It was not my fault the water was upset. It was the afrit. I had to
do what he told me.” Then, hearing a snort from Dahab, he added
that there was not only one afrit, but many, and that that part of the
desert was full of them.
I thought it time to stop him. I told him I had heard quite enough,
and that he had to come round with me to the merkaz. This upset
him terribly.
“No, not the merkaz, Your Excellency. Not the merkaz. In the
name of Allah do not take me to the merkaz. Take everything I have
got, but do not take me to the merkaz.”
But to the merkaz he had to go. We called in at the camel yard to
pick up the other men, as they might be wanted as witnesses, and
then proceeded in a body to the Government office, Qway all the
way attempting to bribe me to let him off by offering me his
belongings, among which, with an obvious pang, he expressly
offered me his camel.
We met the mamur at the door of the merkaz, and Qway
immediately rushed forward to try and kiss his hand. The mamur,
however, would have nothing to do with him. Like nearly all the
fellahin he backed the winner, and I for the moment had come out on
top.
“This man is a traitor, a regular traitor,” said the judge, who had
not yet tried him and who had previously told me he was a
sportsman; but I had got the best of the deal, and, moreover, was
shortly returning to Egypt and might report on him to one of the
inspectors; so he determined to show me how an Egyptian official
can do justice when he takes off his coat for the job. He bustled in to
the office and began arranging the papers fussily on his table. The
police officer also came in and prepared to take down the
depositions.
Having got things to his satisfaction, the mamur ordered the
prisoner to be brought in. He arrived between two wooden-looking
policemen.
“Well, traitor, what have you got to say for yourself?” Then, as it
occurred to him that he had overlooked one of the formalities, he
asked Qway his name.
“Qway, Effendim.”
“Qway what?” asked the mamur irritably.
“Qway Hassan Qway, Your Presence. My grandfather was a Bey.”
“A Bey?” snorted the mamur.
“Yes, Your Excellency.”
“Where did he live?”
“Near Assiut, Your Excellency. Perhaps he wasn’t a Bey. I don’t
know. Perhaps he was a mamur or a police officer. I don’t quite know
what he was, but he worked for the Government.”
“Bey!” repeated the mamur contemptuously. “Mr. Harden Keen
says you upset some water. What do you say to it?”
“Yes, I upset the water. But I could not help it. It was a very hot
day . . .”
“Liar!” said the mamur.
“Na’am?” said Qway, rather taken aback.
“I said liar,” shouted the mamur, thumping the table. Qway, who
was a high-spirited old fellow, found this more than he could stand,
and began to get nettled. It was entirely characteristic of our position
in Egypt at that time that at this juncture, Qway, the accused, should
turn to me, the accuser, for protection from the judge.
 “It was a hot day, Effendim, wasn’t it?”
Badly as he had behaved, I was getting to be very sorry for him,
and I had taken a strong dislike to that mamur. So I replied that it
was one of the hottest days that I ever remembered.
The mamur could not contradict me, but looked distinctly
uncomfortable and shifted uneasily in his chair. He told Qway to go
on. Qway, who was beginning to recover his composure, proceeded
to make the most of the victory he had gained over him.
“As I said, Effendim, it was a hot day—very hot, and I am an old
man and perhaps it was the sun. I don’t know what it was, but an
afrit—”
“Allah!” said the mamur, spreading out his hands, “an afrit?” Qway
began to get a bit flurried.
“Yes, Effendim, an afrit.”
“Liar,” repeated the mamur. “I said you were a liar.”
Qway looked round again for help, but I was not going to bolster
up that statement. The mamur began to examine him as to the exact
nature of that afrit. Qway broke down, stammered and generally got
into a terrible mess. At the last the mamur, having elicited from him
in turn the fact that there was one afrit, that there were two, that
there had been a crowd of them, and finally that there were none at
all, went on to the next stage and asked what had happened
afterwards.
Qway explained that after leaving the depot he had ridden for two
days to the south-west, and then had turned back and circled round
Jebel el Bayed and finally ridden off to the east.
“The east?” said the mamur. “I thought Dakhla lay to the north.”
“The north-east, Effendim,” corrected Qway. “Rather north of
north-east.”
“Then why did you go to the east? Were you lost?”
Qway stammered worse than ever. The mamur repeated his
question. Two tears began to roll down Qway’s cheeks and his great
gnarled hand went up to hide his twitching lips.
“Yes,” he said, with a great effort. “I was lost.” Being an Arab he
did not lie—at least not often.
“But you are a guide. And you got lost!”
“Yes,” stammered Qway. To have to own to a mere fellah that he,
the great desert guide, had lost his way, must have been most
intensely humiliating; for the favourite gibe of the bedawin to the
fellahin is that they are “like women,” and get lost directly they go in
the desert.
No Egyptian could have resisted such a chance. The mamur
began to question Qway minutely as to where, how and when he
had got lost, and to the exact degree of lostness at each stage of the
proceedings; and Qway, to his credit be it said, answered quite
truthfully.
When he could rub it in no further, the mamur began to question
him as to the remainder of his journey. Qway described how he had
had to go two days without water and had almost ridden his camel to
death in order to get back to our tracks, and how he and his camel
had eventually managed to get back to Dakhla more dead than alive.
“You were hiding when you got back. Where did you hide?”
Qway hesitated a moment, then asked him in a low voice if he
need answer. The mamur did not press that question. It was a
distinctly ill-advised one. Qway had been in the Senussi zawia at
Smint. He put a few more questions to him, then told him again that
he was a traitor and that his work had been “like pitch,” and asked
me what I wanted done next. I suggested that he might perhaps call
a few witnesses, so Abdulla was brought in.
Abdulla had entirely recovered from the scare he had had in the
desert, and, though Qway had tried to let him down, the mamur’s
treatment of him seemed to have softened his views towards him.
There is a bond of union between those who “know the nijem” and
Qway, too, was in difficulties, and Mohammedans are usually
sympathetic towards each other in those circumstances, so Abdulla
tried to get Qway off.
 The mamur asked him what he knew about the case.
“Effendim,” he said, “I think Qway went mad.”
The mamur flung himself back in his chair and spread out his
hands.
“Allah!” he exclaimed. “Are you a doctor?”
This little pantomime was completely thrown away on the stolid
Abdulla. He looked at the mamur with the amused curiosity that he
would have shown to a performing monkey.
“No,” he said, in his slow stupid way. “I am not a doctor, of course
—but I know a fool when I see one!”
The mamur concluded that he had heard enough of Abdulla’s
evidence. I began to wonder if the Sudani was quite so “feeble in the
head” as he had been represented!
“I find that Qway is a traitor. His work has been like pitch. What do
you want me to do with him?” asked the judge.
I suggested, as delicately as I could, that that was a question to
be decided by the court, and not by the accuser. After a whispered
conversation with the police officer across the table, the mamur
announced that he intended to put him in prison and send him, when
the camel-postman went, in about a week’s time, to Assiut to be
tried.
The attitude of the men towards Qway changed completely after
his trial. There was no longer any need to be afraid of him. Their
resentment at his conduct in the desert had had time to cool down.
He had been bullied by a fellah mamur, been forced to confess in
public that he had disgraced himself by getting lost in the desert, had
been arrested by a Sudani and publicly paraded through the oasis
dressed as a fellah. His humiliation was complete and could scarcely
have been more thorough. The bedawin instinct for revenge had
been amply satisfied. Hatred is generally largely composed of fear,
or jealousy, and there was certainly no room for either where Qway
was concerned. Moreover, the men had the usual feeling of
compassion for those in adversity that forms one of the finest traits in
the Mohammedan character.
So far as I was concerned, I was feeling rather sorry for my erring
guide, to whom I had taken a strong liking from the start, for he had
only been made a tool by the Senussi, who were the real culprits. So
having once got him convicted, I told the mamur I did not want him to
be severely punished, provided that “the quality of mercy was not
strained.”
Dahab told me Qway was confined in irons and being fed only on
bread and water. So I sent him some tea and sugar, with a message
to the police that they might take the irons off and that I would “see
them” before I left the oasis. Dahab asked for money to buy a quite
unnecessary number of eggs for my consumption. I never enquired
what became of them all; but the same evening he asked for leave to
go to the doctor’s house, and started off with bulging pockets in the
direction of the merkaz. He came back again with them empty
shortly afterwards, saying that he had been told that Qway was
resigned and very prayerful. The Sudanese, as I afterwards heard,
sent him some cheese and lentils, to which Abdulla added a handful
of onions, so altogether Qway must have rather enjoyed himself in
prison.
 CHAPTER XX

H AVING disposed of the question of Qway, I went off to Rashida

for the fête of Shem en Nessim (the smelling of the breeze). The
officials of the oasis were also there, and we celebrated the day in
the usual manner. In the morning we put on clean clothes and took
our breakfast out of doors to “smell the breeze.” Then we went up
among the palm plantations to a primitive swimming bath the ’omda
had made by damming up a stream from one of his wells. The
natives stripped and disported themselves in the water, swimming
about, splashing each other and enjoying themselves immensely.
After the bath they dressed again and we lay about under the
palms till lunch was brought out to us. We lounged about on the
ground, sleeping and talking till late in the afternoon, when a woman
from the village appeared, who had been engaged by the ’omda to
dance. A carpet was spread for her to perform on, and we lay round
and watched her. She looked quite a respectable woman, and it was
certainly a quite respectable dance that would have been an addition
to “Chu-Chin-Chow,” but the mamur took occasion to be shocked at
it. He sat with his back half turned to the woman, watching her out of
the corner of his eye, however, and apparently enjoying the
performance. Though I was unable to detect anything in the slightest
degree wrong in the dance, the delicate susceptibilities of the mamur
were so outraged that—as he was not on good terms with the ’omda
of Rashida—he felt it his duty to report him to the Inspector in Assiut
for having an immoral performance in his private grounds.
Government under the Egyptian mamurs is a wonderful institution!
The next day I returned to Mut to pack up. A number of callers
came round to see me during the short remaining time I stayed in the
town. For since I had come out on top, the whole oasis had become
wonderfully friendly.
 Among them was the Sheykh el Afrit from Smint. He was
extremely oily in his manner and kept on addressing me as “Your
Presence the Bey!” He gave me a lot of information about afrits. He
spoke in the tone of a man who had had a lifelong experience in the
matter. It was most important, he said, to use the right kind of
incense when invoking them, as if the wrong sort were used the afrit
always became very angry and killed the magician—it seemed to be
a dangerous trade.
He told me a lot of information of the same nature and gave me a
number of instances of encounters with afrits to illustrate his
remarks. Among them he mentioned—quite casually—that it had
been an afrit that had led Qway astray. The object of his visit had
apparently been to put this opinion, as an experienced magician,
before me, for he left almost immediately afterwards.
Among my other visitors was the ’omda of Rashida, who said he
had come into Mut as he had a case to bring before the mamur
against his cousin Haggi Smain. He, too, stood up for Qway. He was
the only native of the oasis who had the backbone to openly
champion his cause.
Some time after he had gone, I had to go round to the merkaz. I
could hear a tremendous row going on inside as I approached.
Someone kept thumping a table and two or three men were shouting
and bawling at each other and, judging from the sounds that
proceeded from the court, all Bedlam might have been let loose
there.
But I found that it was only the mamur “making the peace” among
the Rashida people. The ’omda of Rashida and two of his brothers
were bringing an action against their cousin, Haggi Smain, who
owned part of the same village. The row stopped for a while as I
came in, and the proceedings were conducted for a few minutes in
an orderly manner. Then they went at it again, hammer and tongs,
bawling and shouting at each other, and at the mamur, who was
endeavouring to effect a reconciliation, at the top of their voices. The
mamur at first spoke in a quiet persuasive tone, but soon he lost his
temper and was as bad as they were. He banged with his fist on the
table and yelled to them to be silent and listen to what he had to say.
The ’omda shouted back that it was not he, but Haggi Smain that
was interrupting the proceedings, while Haggi Smain himself
foaming at the mouth and at times almost inarticulate with rage,
screamed back that it was the ’omda who was making all the noise.
The cause of all this hullabaloo was as follows: Haggi Smain had
an orange tree growing on his property, one branch of which
projected beyond his boundary and overhung some land belonging
to the ’omda. Three oranges had fallen off this branch on to the
’omda’s territory and the case had been brought to decide to whom
these three oranges belonged. Their total value was a farthing at the
outside.
I left next day for Egypt. As I got on my camel to start, the mamur
and Co. announced that they intended to walk with me for part of the
way. As this was calculated to increase my prestige with the other
natives, I decided to keep them with me for some time.
I rode—and the mamur walked—which was quite as it should
have been, for these little distinctions carry great weight among
these simple natives. The mamur, I was glad to see, was wearing a
pair of new brown boots fastened with a metal clasp over the instep,
and having soles about as thin as dancing pumps. The road was
rough and baked very hard by the sun in those places where it was
not boggy. The mamur, I fancy, was not used to much pedestrian
exercise and soon became very obviously footsore.
I saw him look longingly at an unloaded camel, so told Dahab to
get up on it and ride. Several times he hinted that he had come far
enough, but I merely had to look surprised and displeased to keep
him trotting along beside me for another mile. He had not shown up
well while I had been in the oasis, and he realised that in a very few
days I should be seeing one of the Inspectors about Qway, so was
desperately anxious not to do anything to displease me.
At last I decided to take a short cut. We left the road, such as it
was, and went straight across country over a very rough stretch of
desert. I called out to Abdulla to hurry up the camels, as they were
going too slowly, with the result that the limping mamur and the fat
old qadi began to fall behind. The farce was becoming so obvious
that all my men were grinning at them and Abd er Rahman
sarcastically whispered to me that he thought the mamur must be
getting tired.
When I had got them well away from the road, and two or three
miles from any habitation, I looked back and suddenly discovered
the mamur was limping, and asked him why on earth he had not told
me before that his feet were all covered with blisters. I insisted that
he should go back at once to Mut.
On the way to Assiut, in the train, I saw old Sheykh Mawhub, the
Senussi, going, as he said, to Cairo. But I was not in the least
surprised to find that he broke his journey at Assiut, where he lay
doggo in the native town, pulling strings in the mudiria to get his
catspaw, Qway, out of his difficulties—unfortunately with
considerable success.
I went round to the mudiria as soon as I got to the town, only to
find that the English Inspector was away, so I asked to see the mudir
(native governor of the province). The mudir did not think Qway had
been tried, but would I go up into the town and ask at the mamur’s
office? There I was requested to wait while they made enquiries.
They made them for about three-quarters of an hour, and then a man
came in with an ill-concealed grin and announced that Qway had just
that moment been tried and had been acquitted!
I went round to interview the mudir again—rather indignantly this
time. He was bland and courteous—but firm. He had been acquitted,
he said because I had said that I did not want him to be severely
punished, and because I had given him a good character the year
before. The course of true law never did run smooth in Egypt!
I tried to get this decision reversed by applying to a very exalted
personage. He told me, however, that the Government did not want
to raise the Senussi question and were anxious to avoid an incident
on the frontier, and he was afraid that he could not take the matter
up.
 I had to get the best of Qway somehow and, as the regulation
methods of dealing with him had failed me, I took the law into my
own hands—which is quite the best place to keep it in Egypt—and
fined him the balance of his pay, which amounted to about twenty
pounds. I afterwards heard that the Senussi, in order to prevent
Qway from having a grievance against them, had bakhshished him
£42 worth of cotton; so I got at the real culprits in the end; but it was
a roundabout way of doing it.
Thanks to Qway and the Senussi, the results of my second year
did not come up to my expectations, for the main work I had planned
for the season was, of course, the fifteen days’ journey to the south-
west of Dakhla, which I hoped would take me to Owanat. Instead of
this we had not been able to get farther than the centre of the desert,
so far as we could estimate where the middle lay.
 CHAPTER XXI

D URING my first two seasons I had managed to get out to the

middle of the desert and had succeeded in mapping a large
area of it; but the main object to which these two years had been
devoted—the crossing of the desert from north-east to south-west
had not been attained—there seemed no prospect of my being able
to accomplish it, for Owanat, the first stage on the journey, was
evidently so far out that it could only be reached by adopting some
elaborate system of depots or relays, that Qway’s escapade had
shown to be too dangerous. The Senussi had certainly won the first
trick in the game; but I did not feel at all inclined to let them have
things all their own way.
It was, however, pointed out to me that the omens to any further
journeys were by no means propitious just then, as the natives were
much excited over the Italian invasion of Tripoli, and, moreover, the
Senussi were clearly prepared to take an active hand in the game
and, even at that time, were evidently contemplating an invasion of
Egypt, should a suitable opportunity occur.
The latter fact, however, seemed to me to cut both ways, for the
Senussi were quite wide-awake enough to realise that, if an
European got scuppered by them, some form of punitive expedition
was extremely likely to follow, which might force them into hostilities
at an inconvenient time—so I concluded that they would just as
unwillingly start scrapping as I would myself—and that was saying a
good deal.
As crossing the desert seemed an impracticable scheme just
then, I abandoned that part of my programme, and as there were
plenty of other large areas waiting to be explored, decided to try a
different district, and set out to explore as much as possible of the
unknown parts of the eastern and western sides of the huge
depression in which lies the oasis of Farafra.
I intended, too, to visit the little oasis of Iddaila, that lies not far to
the west of Farafra, and I hoped to score a trick off the Senussia by
making a dash into the dunes to the south-west of Farafra and
locating the oasis of Dendura, that was used sometimes by them as
a half-way house when travelling from Egypt to Kufara.
Unfortunately—though I did not learn this till afterwards—before
my start some rag of a native paper in Cairo announced that I had
come out again to Egypt and intended to go in disguise to Kufara,
and a copy of the paper had been sent out to that oasis itself. This
was a piece of pure invention on the part of that journal that led to
rather unpleasant consequences.
I was advised to take as my guide some man who was admittedly
a member of the Senussia and camel drivers of the same
persuasion. The advice did not commend itself very strongly to me;
but in deference to the views of those whom I expected to know a
good deal more of the country than I did, I so far accepted it as to
decide on taking a Senussi guide and one or two of his camel men,
while adding Abd er Rahman, Ibrahim and Dahab as well to the
caravan—Abdulla unfortunately was not available.
I eventually engaged a man called Qwaytin, who was stated to be
reliable. Haggi Qwaytin Mohammed Said—to give him his full name
—though a native of Surk in Kufara Oasis, at that time was living in
the Nile Valley, in the Manfalut district, near Assiut. For some time he
had acted as a tax-collector among the Bedayat for ’Ali Dinar, the
Sultan of Darfur, and when he was inclined to be communicative
could impart a considerable amount of information about unknown
parts of the desert. He seemed to have led a fairly wandering
existence and to be at home in most parts of North and Central
Africa; at any rate he had a Bedayat wife in Darfur, a Tawarek one
somewhere near Timbuktu and one—if not two—others near
Manfalut.
He was a queer fellow, and I did not altogether take a fancy to
him. When I told him that I already had two camel drivers and did not
want more, he was very much put out and declared that he could not
trust his camels to strangers. Eventually we compromised the
question by arranging that he should take three men and that I, in
addition, should bring Abd er Rahman, Ibrahim and Dahab.
I asked to see the men he was going to bring with him. The three
he produced—Mohanny, Mansur and ’Abd el Atif—were even less
prepossessing than Qwaytin himself. They were typical specimens of
the low-class bedawin camel drivers that the camel owners engage
on nominal wages, to take charge of their beasts when they hire
them out. They proved to be most indifferent drivers. But Qwaytin
and his men were such an obviously feeble lot that, with my three
men to back me up, I had no doubt of being able to deal with them, if
they gave any trouble.
I intended to pump Qwaytin as dry as I could of the information he
could give me of the unknown parts of the desert and, with the
assistance of my own men, to compel him, by force if necessary, to
take me within sight of Dendura, after we had left Farafra.
These preliminaries having been gone through, I sent for Abd er
Rahman and Ibrahim to come up and join me in Assiut—Dahab was
already with me. While waiting in the little Greek pub, where I stayed
for the arrival of my men, I made the acquaintance of an educated
Egyptian, who was engaged in some sort of literary work, the exact
nature of which I was unable to discover. His English was excellent,
and he was evidently anxious to practise it, for he stuck to me like a
leech.
He was never tired of dilating on the beauties of Arabic as a
literary language. In Arabic literature, he said, the great thing was to
use as many metaphors as possible, and the best metaphors were
those that were the most obscure or, as he expressed it, that made
the reader “work his brain” the most. Certainly some of the examples
he gave left nothing whatever to be desired in that direction.
He insisted in coming to see me off at the station, where he
explained that he had lain awake for a considerable part of the night,
in order to be able to think of a really good metaphor for me at
parting.