Healthy Islands in CAT

This blog features a conversation about the idea of the Healthy Island in CAT.  This is a concept developed particularly by Elizabeth Wilde McCormick, author of the CAT self-help book “Change For The Better“. 

In the conversation below, Emma, who has made use of CAT in the past as a therapy for eating difficulties (with a different CAT therapist) discusses the concept with Elizabeth.  Their conversation touches on the process of change and recovery in therapy.  It also refers to helpful relationships and resources which can help this process.


The idea of a healthy self is implicit in CAT theory. Therapy helps support the person to create a healthy island of spacious, kind, self-observation. This can help the person make changes to those attitudes and habits that get in the way of healthy relating and self-expression. The focus of CAT is to find accurate descriptions of ways of relating, learned in early life.  These can restrict our sense of ourselves as unique valuable human beings.  Hence understanding them better can aid this healthy island to expand.


To me this is really interesting. I often speak about my difficulties with food as something that developed out of necessity to survive. But they ultimately obscured my sense of my self, including, ironically, my sense of agency, control, and choice. Everything becomes simplified to this most restrictive measure of worth .  Other aspects of ‘you’ become obscured or depleted. Those get lost inside but also within relationship to others and the world around you. ‘Getting better’ seems to involve unhooking from these restrictive behaviours.   It seems mportant too, to learn to notice the pull into a critical or self-attacking place.

It seems to me though that there’s an even bigger task of re-discovering or rebuilding the ‘you’ uncovered from beneath those restricted patterns. I wonder whether this would be part of fostering the ‘healthy island’? I sometimes liken it to an experience of posttraumatic growth.  There’s a very real challenge of developing and trying new things, beginning to take up and occupy space in a different way. I suppose restrictive, punishing survival strategies do not allow for any kind of self observation or noticing.


This is very well observed and expressed Emma. Yes, restrictive, punishing survival strategies tend to push out simply observing.  They also work against kindness to oneself.

As an example, if we have learned to survive a chaotic or demanding early life by having to find basic methods of control, then this way of relating, to ourselves and to others, becomes dominant. Control over food is one of the prime ways we have available to us naturally. Free, spontaneous self expression can feel dangerous, messy and ‘out of control’. But through self monitoring and also sharing with another within therapy, we can learn to observe our patterns. This helps us to take small steps towards allowing more space.

There is also another factor here. There are many different approaches to understanding human development and behaviour. Having a psychological understanding that all of us have an inherent sense of self, something uniquely ours, works to both respect and clear away the hold of adaptations we’ve made that work against us. We sometimes develop survival strategies that can get in the way of growing fully into ourselves. We are more than the sum of the parts and adaptations! This is why it is so important to have friends and companions along the path who can mirror back to us that we are more than the sum of our symptoms.

We can think of newborn humans being like seeds planted into the garden of life. We can imagine that each seed has to develop a ‘survival self’ in order to manage what might be the less-than-ideal conditions. Few seeds are given the ideal soil. Some find themselves on stony ground. Developing a survival self, together with coping tactics for adapting to a difficult, hostile or strange environment, is then necessary. Indeed, it’s a mark of the human capacity for adaptation. Human beings are extremely creative!

But when our way of thinking and relating to ourselves and others has been restricted by problematic relationships, this can result in emotional struggle.  We develop and carry inside reciprocal roles which cause us problems and pain. For example, if someone has acted towards us in a way that is belittling and crushing, we can end up feeling crushed and worthless in response. Or if a significant fugure has been critical or judging, then we can end up feeling very put down. Either of these can leave little room to experience ourselves as free to choose our response or attitude.  It may feel hard or impossible to take in goodness.

We might survive these early learned restrictions by either going onto automatic, or developing a harsh survival attitude to all life, neglecting or dismissing the life that lies within us.


In my experience the kind of survival strategies you describe are sometimes so habitual that to consider doing things in any other way can initially feel very ‘wrong’. For example if you’re accustomed to others dismissing you, you can end up feeling dismissed or undeserving. To step out of this, instead noticing and validating your own needs and experiences, can feel risky and scary.

I think for me, this is where the therapeutic relationship becomes really important. Or differently but equally powerful, a good, solid friendship can provide what’s needed. It’s about being with another, being seen, allowing space. These things matter a lot. And maybe we can get something helpful and healing too from earlier experiences that have given us brief or rare glimpses of that. I’m thinking of extended family members who showed care or interest.  Or teachers who offered something different from the more usual narrative around us. I wonder whether those experiences can then be drawn and built upon inside to strengthen this idea of a healthy island or self?


Yes, they can and this is really important. As the space within our healthy observing island grows, we bring into it those connections that most reflect our basic ‘seed’. It feels all very new, and often we have to check things out with people. “Did you really say x?” And we can then begin to have those conversations self to self within ourselves.  ‘I can; I will, I care; I am allowed’

As we begin to clear the ground of unhelpful patterns we open the healthy island within us.  We can become aware of the possibility of this healthy self inside who has been there all along. We feel more ‘real’. This is because, for the first time, we have more space and energy. Our responses to others (and to ourselves) are less conditional. We become aware of moments when we have received kindness, and we allow earlier more positive memories to surface. We allow them to nourish us.


I have to say that the idea of a ‘healthy’ (adaptive, compassionate?) self existing, but hidden under layers of other unhelpful ‘stuff’, is quite a new one to me. Particularly because those things often at one time feel helpful and necessary, if also limiting. I sometimes think of anorexia and the restrictive patterns driving it as being like ivy attached to a wall or building. Once the ivy is removed the building remains and it can be seen clearly. But perhaps it also needs care and attention to reach its full potential?


You are right. Our adaptations are vitally important for our survival and human beings are very creative! Once we realise they are overly dominant, and more and more redundant, we can start to have conversations with them. ‘I know and understand why I’ve needed you, so I could survive. Thank you very much, but now I must let you go…’ Then, like the ivy out of the way, things can feel naked, exposed and sore. We need ways and practices to be with our vulnerability.

To introduce another metaphor, I often use the analogy that part of oneself has been in the dark for a very long time.  As this part begins to emerge, the space can feel overwhelming and the new light can feel blinding. We need a period of ‘thawing out’ and then rebuilding in order to claim a more robust sense of self.


I wonder whether that tiny bit of time in therapy before the session starts, but after the two of you sit down together, is a glimpse of that healthy island too? Maybe it serves as a foundation upon which to build that more robust sense of self. For me in that moment there is a feeling of being with, attending to.  There’s a spaciousness that is often missing at other times. Perhaps this is either because I crowd it out with activity or it because becomes crowded out by the demands of life and a mind that works too fast. In any case that little bit of time feels like something new and warm, if uncomfortable.

For me, finding the people who understand this process and are able to be alongside me through it feels really important at the moment. It’s funny how when ‘symptoms’ remit there is an expectation that you are ‘fine’ and ‘better’. But actually that rawness can feel like the most challenging thing to navigate.

I wonder whether it is also about giving attention to the parts of oneself, or to experiences, that have been silenced or lost in some way. Finding a way to make space for those things.

It seems to me at the moment as though that takes a lot of courage, not least because it is such an individual process. It’s easy to dismiss that in ourselves or others. But to me, it takes a huge amount of bravery to actually begin to notice what you might think or feel about something, or make a decision to hope for something. Or to notice what you think you need and to take steps towards trying to establish that in a consistent way. Maybe all this is part of it?


I feel moved by what you write Emma. This is such a vitally important point. Therapy can be in too much of a hurry to encourage a patient to ‘get well’ by some external goal or chart standard, in order to be ticked off a list! One of the values of CAT is that the work is collaborative and directed toward what the person can manage. The initial ‘goals’ can be very small. It might be just sitting down and taking a breath for five minutes twice a day.

I was trained to value the opportunity of therapy and the therapeutic relationship to help people restore a sense of the healthy self, and to also build gradually upon a continuity of being. Once we step away, however slightly, from our survival patterns, we can feel so vulnerable and are exposed. After all they have been the vehicle through which we navigated the outside world.  Using your metaphor, the ivy that has kept an unsteady wall standing up. We have not yet established a template for ‘going on being’. We are in a completely new place and new state.

To be expected to move seamlessly from our presenting difficulties and symptoms directly into wellness contradicts what is hopefully on offer from a good therapeutic relationship.  Wellness, for me, is built from within, from the flexible strengths, observations and trust that we can develop inside ourselves.

In my own experience of emerging from emotional breakdown, I noticed an initial process of ‘thawing out’ from the crisis of the event, taking time to be present with shock and begin the slow process of healing. A second process came later, that of ‘rebuilding’. For me this was a gradual rebuilding of a sense of myself.  When the time came for a ‘return’ to the everyday, my inner resources were more finely tuned and available.

I remember at a particularly vulnerable time of change noticing in such detail the clouds in the sky, the leaves on trees and all the insects. After I had ‘allowed’ myself to give this time without feeling guilty, I realised that the animate world carried on, whatever I did or didn’t do! And this noticing, or being invited into noticing, felt like a gift. That I was part of something so much bigger than before and could feel connected to this.

Healthy Islands in CAT by Elizabeth Wilde McCormick and ‘Emma’ CC BY-NC-ND 4.0