It is again with great pleasure that we offer this second issue of the International Journal of Cognitive Analytic Therapy and Relational Mental Health. This issue includes a wide range of contributions, covering both day-to- day clinical work using the CAT model, but also challenging, in-depth review articles by leading experts on the topic, broadly, of relational and psychological trauma and its consequences for mental health and treatment.

 

As we noted in the first issue ‘a common thread again in all these pieces is a relational conceptualisation of individual and systemic mental health problems’. This is firstly evident in the more purely CAT-based contributions, which range from drawing out the themes supporting a CAT-informed approach to group therapy (Siddell and Wells), working with challenging and ‘difficult’ clinical presentations (eg with ‘medically unexplained symptoms’, Jenaway et al.), through to staff and patient experiences of thinking and working in a more fundamentally relational manner (Clinkscales et al., Russell-Carroll & Gordon, Taplin et al.). Taplin et al. look at the experience of diagrammatic reformulation as a key component of the relational process in therapy. For the most part these various

 

small-scale research projects would not be typical of the more individualistic ‘illness model’ approaches of Western mental health services currently and would stand in many ways as a challenge to them. These contributions well illustrate the trend within CAT of ‘using it’ as a means of thinking about and addressing the wider context of mental health problems, in addition to using it as an effective clinical means of offering psychotherapy day-to-day. We note that this trend was a source of great interest and pleasure to the late Tony Ryle, whose considerable achievement and illuminating presence we feel still permeates all these pieces.

 

Notwithstanding these developments within CAT itself, Ryle also strongly felt and stressed the need for the model to continue to develop and integrate other important clinical and scientific findings and understandings. This issue includes also two very challenging contributions on the importance of psychological and relational trauma in mental health. ‘Trauma’ is arguably becoming a dominant paradigm through which to view the origins of mental health (and other) problems, and to frame the treatment needs of patients and clients. The concept of ‘complex trauma’, for example, will be included in the forthcoming WHO ICD11 classification, as noted by Shea (see below).

 

Oliver James, an internationally- renowned figure in the broader field of mental health, provides a masterful overview of the broader developmental literature and its important implications, and makes a heartfelt, but evidence- based, call on this basis to critically re- evaluate much of what is currently offered as psychological treatment. We are also very pleased to include a contribution from Frank Corrigan and Alastair Hull, world experts in the field of trauma. This article, in our view, represents a considerable challenge to us with regard to keeping up, at least in broad principle if not in every neuro- biological detail, with recent scientific and therapeutic developments, but also perhaps the current limitations of traditional talking therapies. Again however, this review is based broadly within a humanitarian and relational frame.

 

All of these contributions leave us, both as clinicians and as citizens, with some challenging thoughts for the future, including in relation to service provision as both James and Corrigan and Hull also stress. The final article in this issue (by Corrigan and Hull) is followed by a detailed and thoughtful review by Catherine Shea of the textbook at the core of the clinical approaches described by them. This will also stand, we hope, as a dialogic response to it from a colleague who is a practitioner both in CAT and other relational approaches, as well as being an experienced trauma therapist. However, significantly, these reviews were written ‘blind’ to each other. This issue also includes detailed and thoughtful book reviews by Caroline Dower (on a partly CAT- based volume on music therapy by Compton-Dickinson and Hakvoort), by Frank Margison (on a book by Meares emanating from the ‘conversational model’), and by Steve Potter (on a controversial book by Hari on the causes and nature of depression).

 

We hope and anticipate that these various contributions may raise some serious questions and concerns amongst our readership, and for the future we would very much welcome any correspondence that might ensue. This we feel would be an important and healthy aspect of the future development of the journal. We also urge our readership to consider whether the work they are doing or thoughts they may be having could, potentially, be material for novel contributions to the journal. We are aware that this second volume has a largely UK voice and call upon our colleagues internationally to nurture and seek out potential contributions from far and wide. For the future, we plan to include the ‘dialogical turn’ in mental health as one theme for the next issue.

 

Finally, we hope these contributions will prove to be not only provocative and interesting to our readership but perhaps also a source of some nourishment and support in the difficult circumstances in which many colleagues work and often struggle to find support for humane and effective treatments.