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A summary of the main literature on cognitive analytic therapy (CAT) is given. Ryle first developed CAT over 20 years ago, and use of the model is increasingly widespread in diverse settings and with various conditions. CAT stands as an example of modern dialogical approaches to therapy, and the underlying theory is consistent with that stance. The developments within training stress self reflexive practice and the maintenance of a collaborative approach. In contrast, however, to the rapid development in training and practice the research summarised here is primarily descriptive with a small number of open trials and one randomized controlled study in a physical disorder (Type I diabetes). The urgent need for randomized controlled research in this treatment is highlighted.
Introduction
The special section of the Journal which follows deals with four different applications of cognitive analytic therapy (CAT). These papers concern deliberate self harm, male survivors of childhood sexual abuse, asthma and borderline personality disorder. This breadth of applications suggests that CAT is establishing itself in the psychological treatments repertoire at the dissemination phase of treatment development. This means that there are diverse applications of the basic method described originally by Ryle (1979, see also 1980, 1982, 1985, 1990). A summary of the main achievements to date in CAT is given below. CAT training is now well established, but there has not been a parallel growth in the publication of outcome results, although there are several small case series and many descriptive accounts which make the work accessible to a wider audience. The relative lack of outcomes oriented research is discussed in terms of a general treatment development paradigm described by Salkovskis (1995) as the `hourglass model'.
The treatment development paradigm
Treatment development is usually conceptualised as having three phases. The initial phase is characterized by single case studies and small uncontrolled or quasi-randomized trials alongside the development of treatment descriptions, manuals and measures of adherence. CAT therapy trials of this type were published 20 years ago (Ryle, 1979, 1980, 1981).The second phase forms the `neck' of the `hourglass' model (Salkovskis, 1995) characterized by a relatively small number of studies optimized for internal validity (by use of treatment allocation concealment, randomization and prior power analysis to determine appropriate sample size), typically in...