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Carol Gregory, 2025. Book review: Creativity and Mental Health edited by Yvonne Steens. Reformulation, Spring
Book Review By Carol Gregory
What a rich year 2024 was for the publication of books about CAT. In addition to ‘The Oxford Handbook of Cognitive Analytic Therapy, which was published in June, three other books, Conversations in Later Life, Innovative Practice in Forensic Settings, and Working Relationally with Young People, all published by Pavillion Publishing under the series heading ‘Innovations in CAT’ reached the shelves. The fourth book from this series Creativity and Mental Health, A Cognitive Analytic Approach to Integrating Play and Imagination in Psychotherapy, Supervision and Training, is the subject of this review, and what a delight it is.
Ryle’s CAT model, integrative in its theoretical development and pragmatic in its ‘push where it moves’ stance encourages the inclusion of interventions from other models. Ryle, as quoted by James Turner in his chapter ‘Enabling Change through Metaphor and Imagery’, said ‘CAT is what works… and if pictures work then we use them’. And so, as a consequence, mindfulness techniques, body-somatic based interventions, therapeutic writing, empty chair work and compassion focused work, and more, have all found a place in the working phase of CAT, held and contained within the over-arching relational framework of the CAT model.
In this book Yvonne Stevens has brought together 17 authors across 16 chapters to share, describe, discuss and reflect on theoretical and clinical aspects of creativity within their therapeutic and supervisory work. Allowing authors to write in their own style as they describe their clinical work, or more theoretical contributions, makes their work come alive.
The book is divided into three sections; ‘Mental Health and the Capacity to Play’, ‘Creative Practice in Psychotherapy’ and ‘Bringing our Creative Selves to Therapy’
The first section contains a simple and brief overview of neuroscience as it is currently understood in relation to novelty, safety and creativity within the therapeutic space. It is followed by an interesting theoretical chapter by Paul Sullivan on the Zone of Proximal Development, explored and extended into the Zone of Playful Proximal Development and, via a ‘Bakhtinian lens’, considered through its application in private and public arenas.
In the second section, Creative Practice in Psychotherapy, clinicians describe their individual ways of working creatively, supported by case material, providing a window into the heart of the relational encounter, the ‘work in action’. In this section you can read about working with objects in complex trauma, the use of drama therapy interventions, exploration of dreams, the use of metaphor and imagery, and work with the ‘inner child’. How the work is integrated into the CAT model is made clear and many chapters provide details of the theory underpinning the creative work described and comments from clients. I particularly enjoyed the chapter on CAT and dreamwork by Coulter and Rushbrook, as despite a training in psychodynamic psychotherapy, I have not found space for working with dreams in my CAT practice. Something for me to think about and explore.
Other chapters are focused on a particular client group e.g. Sarah Nicholas’ and her client Col’s chapter on ‘Innovative ways of working within a learning disability service’ and James Randall’s chapter on ‘Neurodivergence and the Multiple States Model’. There is little written to date on CAT and neurodiversity and so these contributions are a welcome addition. Chapters are well written and rich in clinical material with many having clear, step-by-step guidance, on how to begin to work with the particular creative endeavour, so that it becomes fully integrated into the CAT work contributing to, and expanding, the relational heart of CAT work rather than being a bolt on technique. Louise Yorke’s chapter on ‘Relational dialogues with the inner child’ offers a detailed description of a way of working that Louise developed over many years, and her considerable experience and skill with it is clear. Feedback from clinicians exploring this method under her supervision report on its challenges. Anyone interested in work with the inner (traumatized) child might wish to also read work by Richard Schwartz and other clinicians on Internal Family Systems, which has some differences in approach in order to prevent overwhelm.
The final section, Bringing our Creative Selves to Therapy, ’ is a ‘smorgasbord’, to run with Vicky Petratou’s cooking metaphors, and includes descriptions and feedback on the use of her ‘House of Self States’ in supervision. A comprehensive and interesting description of the use of Cognitive Analytic Music Therapy (CAMT) by Compton-Dickinson in a forensic setting , which many of us may not have read about before is also included.
It goes without saying that all the ways of working described require a strong therapeutic relationship, robust scaffolding by the CAT model and nuanced attunement on behalf of the therapist, to assist the creation of a safe-enough space to allow for curiosity, playfulness and exploration of more creative ways of working. Many chapters are likely to extend aspects of the ways you are already working, offering ways of further developing the observing eye, and often creating a with a multi-modal component. But we need to be mindful that we do not impose ways of working (imposing to imposed).
So who is this book for? I would say any one of us. In training we mostly consider the ZPD in terms of the client, but our own ZPD as the therapist, is equally, if not more, important and its development is helped by flexibility and opportunity. The overlap of the two ZPDs, the client’s and our own, creates the ZPD of the therapeutic work. And so, by expanding our own ZPD, we create the possibility of enhancing what is possible in therapy.
As we seek to help our clients move towards their aims and goals, questions abound. How can I, the therapist, help the process of loosening tightly held unhelpful cognitions, help unstable emotions become more stable, assist in making difficult feelings more easily tolerated, widen a client’s access to their entire, disavowed selves, connect to emotions previously not connected to in a manageable way without overwhelm and with the ability to keep thinking, and find sense-making where there has been only overwhelming feeling? This book offers many different ways of working and can help us with these questions. Some chapters may resonate with you and support a way of working that you are already exploring. For those who think of themselves as ‘not creative’ ideas within this book may reveal the fact that, although perhaps nervous to bring a more playful aspect yourself to the therapeutic encounter, there are ways in which you can expand your own ZPD. And if you are a therapist of many years standing fresh ideas and perspectives are available to invigorate your work.
So pick it up! Be curious! How, and in what way, might a more imaginative, playful way of working allow you and your client to explore and be curious together.
‘Working Relationally with Young People: A Cognitive Analytic Approach to Connecting One to One, with Families and Across Communities’, was followed by ‘Reflective Practice in Forensic Settings: A Cognitive Analytic Approach to Developing Shared Thinking’
Dr Carol Gregory is a retired Consultant Psychiatrist now working in independent practice as a CAT practitioner, supervisor and tutor and can be reached at carol.gregory78@gmail.com