The story of your life is a very important part of cognitive analytic therapy. A CAT therapist will be interested in how your own particular life history has shaped you. Your story is not the same as anybody else’s. Your therapist will tailor the therapy to you in your own world. It is from your life story that your therapist will try to understand relationship roles and patterns that you carry with you. In CAT these are seen as important elements in your map and in the focus of therapy.
Your closest early relationships
Many things will have influenced how you developed, how you see yourself, and the relationship roles (reciprocal roles) that shape your way of relating to yourself and others. The CAT approach includes the idea that we take inside messages from others in our own individual worlds. These can be conveyed in a great number of ways, including:
- spoken and written words
- non verbal communication (such as tone of voice or gestures)
- actions and behaviour towards you
- ways of relating to you
- images and media
Messages given by people very close to you may have much influence. These are commonly from parents or people looking after you from a very early age. You might have taken on board messages from other close family members such as brothers and sisters. Grandparents and others in your extended family may have been important too.
Your CAT therapist may draw out a family tree with you, or use other ways to take note of the different people in your family, and what relationships with each of them was like. From this, you can explore together the messages and understandings about yourself that you may have picked up from them since your early years.
You may have had different care arrangements in your early years, such as being in care, rather than with your birth family. People involved may have included kinship carers, foster carers or staff in children’s homes. If you have had several different care arrangements, the number of different people involved may add to the number of messages you absorbed.
The wider world
Influences on you don’t stop at your closest family or care relationships. We, and our families, are all embedded in many more systems and communities. We have relationships in the context of these.
There may have been powerful figures in these places who also conveyed messages about you that you took on board. These too will have influenced your relationship roles. An example is the people who were around you in your school years, such as teachers, other children and their families.
For example, you may have had teachers who encouraged you, helped you succeed and showed you kindness. Or a teacher might have been more harsh and focussed more on what you were struggling with. You might have felt put down, criticised or shamed. Similarly, other children at school might have been accepting and included you in play and other activities. You might have felt secure in your friendships. Or some of them might have been unkind, teased or bullied you, or made you feel like you weren’t welcome.
The society around us
As individuals we are also born into a world of hierarchies. Many of the relationships we encounter will mirror the way our families and communities are positioned in wider society. Our families will be marked by their culture, their ethnicity or race, their class and the resources they have available to them.
Communities and culture
The communities around you and the culture you were born into may also have given you strong messages about how to behave, values to hold and how to express yourself. You may also pick up messages about how best to survive and thrive if your world presents you with challenges.
You and your family’s culture might sit within a mix of different communities. Or you may have migrated from one setting to another. This can be very enriching and can help you be flexible and accepting of all the differing parts of yourself. However at times it might lead to conflicting messages that cause you stress or confusion. Different parts of your social world might expect very different things from you.
If the environments you developed in were transient, with many changes (such as foster care or children’s homes) this may lead you to feel less secure in your identity and sense of belonging.
Prejudice and discrimination
There may be all sorts of things that lead to people being harsh, unkind, rejecting or damaging towards you. This can happen for no good reason. It can be related to being considered different in some way, or having characteristics that are not tolerated or accepted by the community or society you are in. People may hold prejudices which are expressed towards you in direct or indirect ways. This could be any sort of oppression, be it racism, sexism, homophobia or other forms. It may extend to mistreatment, aggression and violence towards you.
It might not just be individuals who communicate these messages or carry out harmful acts. Things may not be not equal for you in the systems that you’re part of. For example if you have a disability, the environment you live or work in may or may not build in adaptations that make it possible for you to be included or participate alongside others. This can give a message that you’re not welcome, or that what you need is less important than what others need.
Hostility of some form might be around you in day-to-day interactions and practices around you, including those expressed through politics, newspapers, the media and the way history is explained.
Your CAT therapist will be interested in a whole range of messages that you may have absorbed about yourself, both in the past and the present.
The effects of inequality
Inequalities are all around us. Some of us have more power and privileges than others. The treatment you have from others, and the messages that you pick up about yourself in an unequal world, can have a strong impact on your emotional health and wellbeing.
Harmful events may happen which cause acute upset and trauma to you, others you are close to, or people like you. More subtle effects can go on over time, becoming chronic stresses and causing ongoing, trauma. The effects of such trauma can be passed from one generation to another.
Hostile messages and actions from others can lead to you feeling anxious, wary, and angry. You might feel isolated, alone and low. Your self-esteem may suffer and you may feel weary and hopeless.
People cope with difficult relationships, including those related to forms of oppression and prejudice, by developing ways to help them survive. A CAT approach will respect how your survival strategies were needed, but may help you make changes if they are now unhelpful in other ways.
Some areas of focus for discrimination
Common characteristics that can be the focus of inequalities and discrimination include:
- biological sex (eg male, female, intersex)
- cultural expression
- disability (including intellectual and physical disabilities
- health status and health conditions, both physical and mental
- employment status
- gender, gender identity and gender reassignment
- income and poverty
- language and the way you express yourself
- marital status, including forced marriage
- physical appearance, including your size and weight
- pregnancy and parenthood
- race, including your skin colour
- religion and belief
- sexuality & sexual expression
- socioeconomic status or social class
When and how do I raise these kinds of issues?
Your therapist will be curious with you about these broader influences. Some CAT tools help to highlight them in your early sessions, if you want to include them in your therapy. As CAT is a very collaborative approach, the focus will be guided by your aims and agenda.
Many people feel aware of an imbalance of power in the relationship between a person in, therapy and the therapist. This can be the case even when you and your therapist are from very similar backgrounds. If there are more differences between you along these lines, or in your life experiences, any power imbalance may feel more marked. Relationship roles that arise from the outside world may feel important in the therapy relationship too.
Exploring these together, and adding them to your map, can help us name and address them within the safe environment of therapy. It’s not always easy to talk about them. It can take time to build up trust so that it’s comfortable to do so.
Remember that your therapist will be open to making sense of how any inequalities that have contributed to the relationship roles and patterns that cause you difficulty. They will be willing to reflect on how patterns might play out in the relationship between the two of you. They will also have their own support, in the form of clinical supervision, to help support their work with you. So if at any stage you want to raise something about these broader influences, it is fine to do so.
A place for celebration too
As well as a space to openly discuss the impact of discrimination on your relationship templates and roles, therapy can also be a space to celebrate differences. Even in the face of isolation and discrimination, many communities have connected and worked together to counter and challenge damaging experiences. In the last decade or so, movements like Black Lives Matter, and Me Too, have helped people support change in wider society.
Therapy aims to be a place to consider positive ways to counter negative messages you have absorbed along these lines. It can help build and strengthen positive relationship roles. Cultural shifts and changes in our wider worlds can help us transform messages we carry inside or take new ones in. This can offer hope for positive changes for all.
Steps you can take before therapy
Some people prefer to discuss these kinds of concerns with a therapist from a particular background themselves, or particular experience. If this is important to you, you can ask to see a therapist with that type of background or experience. This is not always possible in NHS services where your choices may be more limited. However most services will try to take your preferences into account.
In any case, completing the form at this link might help you think about what you want from therapy, and can help you prepare for a first conversation with a service or therapist.
We are grateful to many ACAT members who made helpful contributions to this page. These include members of ACAT’s Inequality and Diversity Special Interest Group and the Equality and Diversity Committee. Particular thanks go to Dupe Adu White, Nick Barnes, Hilary Brown, Jessie Emilion, Vanessa Fay and Karel Wildschut.