The Impact of Reformulation in Cognitive-Analytic Therapy with Difficult-to-Help Clients

Cognitive analytic therapy (CAT) uses written reformulations of clients' problems. It is argued that the reformulation, usually presented in the fourth session, enhances the therapeutic alliance, provides an explicit focus for subsequent therapeutic work and gives an understanding which stimulates change in the client. This focused, explicitly collaborative approach, is seen as one reason why CAT may be effective with clients for whom other psychotherapeutic interventions are ineffective, including clients described as having borderline personality disorders. In the present study a multiple baseline design was used to evaluate the short-term impact of reformulation on the therapies of four clients who had previously been difficult to help. Results showed that reformulation did not have a systematic short-term impact upon measures of the client's perceived helpfulness of the sessions, the therapeutic alliance or individual problems. However, in semi-structured interviews clients reported that the reformulation had considerable impact upon them.