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This revised edition is being offered given an evident need to update, expand, and clarify aspects of the first edition which appeared now almost two decades ago, and given a keen wish by Tony Ryle to do this. Our aim was to offer a summary but comprehensive overview of the current evolved Cognitive Analytic Therapy (CAT) model, its background and comparative context, and of its range of applications, that would be informative and helpful to those new to the model, to trainees and even established practitioners. Very sadly however, as many readers will be aware, not long after being commissioned to do this Tony, who was the senior author and progenitor of the cognitive analytic therapy model, developed a serious illness from which he ultimately succumbed in 2016. Summaries of his remarkable creative personality, his career and contributions to the field of psychotherapy and mental health more broadly have been published in various obituaries which are available on the internet and in a special issue published in 2018 of Reformulation the newsmagazine of the Association for Cognitive Analytic Therapy (ACAT) in the UK, also available on‐line.

One of the critical tests of the achievement of any remarkable, creative, and charismatic character, which Tony certainly was, is the way in which their achievement and any model they may have created survives and prospers subsequent to their death. In this I am very clear, as are many others, that the current CAT model described in some detail in this volume is doing just that and that, given its principles and underpinnings, it should continue to play a major creative and contributory role in the future to human mental health and well‐being in various ways. That this might occur was one of his principal passions and aims. Having said that, like many of us he was recurrently saddened and frustrated by the evident socio‐political direction of the world at large. I am sure his enthusiasm to update and publish this volume despite his illness also related to a hope that the model might in some small way contribute to ameliorating and improving this situation. Certainly, the evolved CAT model seemed to us also to address a global epidemic, including and especially in more “developed” countries, of so‐called mental disorders in a much more radical, thorough‐going, and humane manner than currently dominant, more individualistic and mechanistic paradigms. As such we were sure that if human sense, compassion, and evidence prevail (about which sadly neither author was very confident) CAT will ultimately be able to offer a great deal, including in ways far beyond its use as a model of individual therapy, important as that is, into more clearly systemic and socio‐political domains. These issues and these potential applications are discussed further in the book.

However, Tony’s death left the final task of articulating and presenting many of these revisions to myself. These have however all been based on our extended discussions—some quite animated!—and also on our deep, essential agreement about the core of the model and what sorts of revisions needed to be undertaken. These have been also based on initial drafts that we both did and discussed, and on consideration of various review articles and books containing both theoretical and clinical developments that had appeared in recent years and presented and/or approved of by himself (e.g. Ryle et al., 2014, Kerr et al., 2015, Kerr, Hepple and Blunden, 2016; Pickvance 2017; Ryle and Kellett, 2018).

Tony was very clear that he wished the revision to proceed on this basis with myself as more active co‐author despite his illness. I believe there is nothing in this volume that was not agreed and decided at least in principle with Tony, although of course its presentation, expansion, and articulation in many cases has fallen to myself notwithstanding our initial drafts. I am, therefore, wholly responsible for any serious deficiencies of content or style related to this. However, I hope that it may still represent an important “staging post” in the development and evolution of CAT in that it represents the last position and views of its creator. This should not of course be regarded as any kind of “final word”; and indeed Tony certainly did not wish this to be the aim. We were both very clear this volume could only represent a re‐statement, expansion, and clarification of Tony’s own views on the development of the model hitherto, aided and abetted in this case by myself. We were clear about the subsequent need to continue developing the model in a further integrative manner, in ways which may prove to be quite counter‐intuitive and unexpected. Nonetheless this re‐statement may be perhaps an important reference point in that process of the development and of the application of the model by others.

We agreed that there was a need for a revised and updated edition for various reasons. These include a proliferation of new understandings over the past couple of decades relating to mental health, treatment for mental health problems or disorders, understandings of psychotherapy, and in relation to the CAT model itself. These developments have occurred in fields as diverse as infant psychology, developmental neuroscience, social psychiatry, through to the social and political sciences, and also developments, for example, in understanding of factors, including common factors, relating to process and outcome in psychotherapy. Since the first edition appeared there has also been a proliferation of innovative and humane uses of CAT, some rather unexpected, for example in work with schools, refugees, police and forensic services, in consideration of broader socio‐political challenges (see e.g. Lloyd and Pollard 2018), as well as for a whole range of mental health problems (see especially Chapter 9).

Feedback from and reflection on the first edition made it clear also that some clarification of fundamental theoretical concepts was needed, as well as perhaps a clearer and in places a more helpfully didactic presentation of them. Some confusion and ambiguity have occurred, in retrospect probably largely due to the history and “archaeology” of CAT and its development over many years. This has resulted in certain key concepts like procedures, reciprocal roles, reciprocal role procedures, and even repertory grids, being more predominantly focused on and stressed at different stages in the evolution of the model, and accordingly subtly changing, with these concepts sometimes being used in ambiguous or overlapping ways for these reasons. This evolution and history has undoubtedly caused some perplexity, for example to trainees over the years, and has also undoubtedly affected the way in which practitioners and supervisors, who would have trained at different times, have understood and used these concepts and how they work with the model. Although we are clear that the underpinning, relational, core concepts in CAT have remained consistent for many years, we have therefore revisited these and, we hope, helpfully clarified, amplified, and restated these in the early chapters of this revision.

As regards the enduring fundamental core of the established CAT model, Tony clearly felt increasingly that this was still essentially embodied in the “Procedural–Sequence Object–Relations Model” (PSORM) notwithstanding various later refinements and enrichments, for example by Vygotskian activity theory and Bakhtinian concepts of a dialogical self, and by diverse, for example more “here and now,” clinical and other applications. The PSORM of course implies a clear presentation and understanding of early developmental internalization of (formative) reciprocal relationships (reciprocal roles, akin to although differing significantly from internal objects), and an understanding of and stress on how, on this basis, we subsequently develop and enact patterns of coping and responding (reciprocal role procedures). We were both rather concerned that the important interest in more recent years in systemic or “contextual” role enactments in the here and now (including also therefore more “situational” RRs) can potentially lead to loss of focus on deeper, historic internalized RRs and their consequences for the patient or client, given that these are of fundamental importance in clinical presentations and in therapy. Indeed, at times in therapy they may be the sole focus of activity. These issues are again addressed in the early and then later chapters.

I have felt rather freer to expand as I saw fit concepts or sections for which I was originally largely responsible, for example consideration of psychotic disorders, “contextual” and systemic approaches, and the clarification and presentation of “Self” as an “organizing construct” within CAT. These have appeared to be of some importance and were developments that Tony also contributed to and fully supported, both in discussion and having read and approved various publications up to 2016—where some of these various changes and clarifications were first mooted. We also both felt the section on sex and gender‐related issues (Chapter 9) needed to be expanded considerably given important developments over recent years in this challenging and complex area, and we have attempted to do this with the assistance of others who are acknowledged in the text.

We were both keen to expound clearly the importance of the socio‐cultural and political dimensions of mental health, which is implicit in the model and its applications, notwithstanding Tony’s, and my own, frustration and sadness at many socio‐political developments in the world at large. As therapists we can all too often only bear witness to these and it can feel very hard to influence them helpfully. However, we both felt that a model such as CAT can and should helpfully offer humane and compassionate, while scientifically valid, understandings of mental health and well‐being much more broadly. We have been very clear, therefore, and unapologetic about a need to locate the model in a broader context, both scientifically and clinically but also socio‐politically. We also felt it important to attempt to locate CAT broadly within the extensive field of “brand name” therapies, the distinctions between which, as discussed, are frequently spurious and appear to relate sadly more to professional narcissism, parochialism, and campanilismo. These considerations and views will be evident yet again in this edition, as they were in the first. Hence the book is, and aims to be, more than simply a summary of key features of CAT as a model of therapy and of its applications.

Having said this, Chapter 9 in this edition, which aims to overview clinical uses and applications of CAT, is considerably expanded given a considerable increase in these, and also given the continuing and often quite acrimonious debate with regard to classification and nosology in the field of mental health. Challenging currently dominant but flawed paradigms (notably those of a largely more individualistic biomedical and/or cognitivist persuasion) and reconceptualizing disorders and how we might help treat them is an important part of what any good and evolving model should offer. However, it is still avowedly not an explicitly “how to” kind of chapter giving detailed descriptions of treatments by various specialist authors. Such a volume or volumes are undoubtedly needed but this was certainly beyond the remit or feasibility of a one‐ or two‐author volume.

But even in the writing of this more summary book we have depended greatly on the work and input of others. Tony would have been the first to acknowledge and celebrate the fact that we all stand “on the shoulders of giants” and of many others, and depend on their very various contributions. In a very real, and dialogical, sense there is no such thing as completely original or independent work. Many others who are cited in the text have contributed to the model, its underpinning theory, and its range of applications over the years. By way of example the articulation and presentation of the very first specifically CAT volume was apparently greatly aided and abetted by Professor Glenys Parry, who has continued to be an active champion of the model in different ways over the years since then.

At a personal level it has been an honor and privilege to undertake the final work of this revision, although this has also felt to be, perhaps unsurprisingly, a challenging and quite arduous undertaking. In many ways it has felt a weighty responsibility to re‐state and update what was essentially Tony's life’s work, although the development of the model was assisted increasingly by various others who are cited in the text. It has also inevitably felt a rather poignant and solitary undertaking at times, despite helpful discussion with various current colleagues, in the absence of Tony’s “larger than life,” innovative, critical, and at times impatient presence and input. It would have been good at various moments to have been able to “chew things over” with him as I and many others would have done in the past.

This revised edition has unfortunately been delayed by the inevitable distractions and intrusions of life, both personal and professional. This has included, sadly, a protracted but morally unavoidable involvement in campaigning in support of “whistle blowers” in the face of some serious incompetence, victimization, and cronyism within and around the NHS in the UK. But I have also been guilty of some procrastination, a tendency to unhelpful over‐inclusiveness, and aspiring to imagined perfect outcomes; all of this Tony with his talents was much better able to transcend, to “see the wood for trees” quickly, and to express his views articulately—if sometimes very forthrightly!

As regards terminology, we have in this revision on the whole, as noted in the previous edition, referred to “patients” rather than “clients,” although we use the term interchangeably. We recognise an increasing tendency and preference among many colleagues, especially non‐clinical, to use the word “client” possibly given some of the arguably paternalistic and disempowering associations of the word “patient.” Possibly in part due to our own medical trainings and background we continue to take a view that the word patient has also an honorable history and associations implying notably a vocational and not essentially commercial responsibility to those who are in distress and are suffering. Indeed, the roots of the word lie in the Latin verb patior (I suffer). In our experience, too, people seeking help from clinicians and other health professionals are not always comfortable with the word client. However, times change and with them connotations and usages of terminology, including of diagnostic “labels” (see Chapter 9), and we recognize it is inevitably hard to know where consensus will lead.

We have also in this edition deliberately drawn back from use of the term “intervention” which we felt has become increasingly and excessively used as a synonym for “treatment” or “therapy.” While the word may make some sense as a high‐level, collective descriptive of treatment approaches, it still to our mind carries unfortunate mechanistic and militaristic echoes at best applicable in health care in, for example a “doing to” public health context, but not we suggest as a description of any collaborative, humane, relationally based treatment, far less psychotherapy. Unfortunately, in an era of increasing “commodification” of health care and of staff it also carries for us a quasi‐commercial and mechanical resonance invoked by phrases such as “delivering interventions” which we felt sat uneasily with our therapeutic position and aims. Again, however, we recognize that word usage changes and it may be our views are effectively already superceded and redundant, and that the word already means something different, perhaps regrettably, to a present generation of health care professionals.

We both sincerely hoped that this reworked and revised edition would be welcome and helpful to a range of people, both fellow mental health professionals and others, and I hope, despite its delayed and rather complicated coming into being, that this will prove to be the case. I very much hope that it may also contribute in some way to a more meaningfully relational and compassionate moving forward for us all much more broadly. This was, I am sure, another deeply felt aspiration and hope on Tony’s part.

Ian B. Kerr—Whangarei, New Zealand–Aotearoa (2020)