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The “Psychotherapy File” was developed at this stage and was the first specific CAT tool. A version of this is reproduced in Appendix 1. This is usually given to patients to take away at the end of the first session. It gives explanations and examples of dilemmas, traps, and snags and invites patients to consider which may apply to them; these will be discussed with the therapist at the next session. The File also gives instructions in self‐monitoring of mood changes and symptoms, based on cognitive therapy practice, and contains screening questions concerning instability of the self. Positive answers to the latter suggest “borderline” type features. The use of the File introduces patients to active participation in the therapy process and initiates them in the task of learning self‐reflection. For many patients it is also reassuring to realize, given that the File exists, that many others must experience similar problems. At this point readers may find it useful to go through the File with a patient, and perhaps with themselves, in mind.

Practice diverged from the psychodynamic model and was now based on the active, joint creation and use of the reformulation. Thereafter, historic difficulties, daily life, and the evolving therapy relationship were understood in terms of this reformulation and patients were involved in homework on issues related to recognition and revision of the identified patterns. Self‐monitoring of symptoms and behaviors to identify when they were activated contributed to the creation of a written list of target problems (TPs) and underlying target problem procedures (TPPs), the latter in the form of dilemmas, traps, and snags. TPPs (in therapy now often simply described as “key issues”) would now be understood as varieties of RRPs. Changes in TPs and TPPs were rated by patients on visual analog scales and discussed at each session. This procedure was not popular with therapists from psychodynamic backgrounds, but for them and for many patients it served to maintain the focus and to encourage the patient's self‐observation and assist its accuracy.

Despite the introduction of these “cognitive” practices, the main form of early sessions was exploratory and unstructured and particular attention was paid to “transference–counter‐transference” enactments and feelings, and to their relation to the identified patterns. Change in therapy was seen to be the result of the patient's heightened, conscious, focused ability to recognize and, in due course, attempt to revise the unhelpful patterns, and of the therapist's ability to avoid colluding with and reinforcing them. In addition, within the framework defined by the descriptive reformulation, a wide range of different techniques might be employed toward the revision of problem procedures and their integration. Several accounts of this early brief CAT work have been given (see, e.g., Ryle, Spencer, & Yawetz 1992). All of these activities would be understood to occur within a benign, collaborative relationship that was implicitly healing in itself.