Reformulation Training 1

This is a practical guide to “understanding context” or “shared understanding” informed by the relational principles of Cognitive Analytic Therapy (CAT). It explains what understanding context is, why it matters, and what it involves. Like all therapeutic work, it places the human relationship at the centre as the most important part. Understanding context is like taking those loose threads and weaving them into a clear tapestry. Together, a practitioner and young person explore the patterns hiding in early experiences, uncovering the roots of current struggles, and map out a way forward.  

Learning objectives 

In this guide you will learn: 

• How to co-create a meaningful narrative that links past experiences with present struggles, while recognising the young person’s strengths and coping strategies. 

• Understand the rationale and the task of understanding context. 

• To establish goals and boundaries early, including a planned ending, to shape the direction and containment of therapy. 

• To practise active listening by staying curious. 

• To explore the bigger picture by placing the young person’s story in context, including caregiver histories, to help them locate themselves within their own narrative. 

• How to create a visual map to simplify complex patterns into a collaborative, accessible diagram that highlights cycles, relationships, and possibilities for change 

• Note: risk management needs to be openly considered throughout therapy, for example through ongoing supervision. Please refer to the module on supervision. 

 

*Video animation 1: breathing ball* 

 

What is Understanding context? 

“The creation of a meaningful story out of incoherent accounts of distress” (Ryle, A 1993). Understanding context is a collaborative process by which a practitioner and young person better understand current difficulties by placing them into a wider human context. Rather than simply listing events, this process weaves together early experiences, relationship patterns, coping strategies, struggles, and strengths to better understand what has caused and maintains current presenting problems.  

Therefore, understanding context: 

• Strengthens the bond between the young person and practitioner, guiding the focus of future sessions. This includes spotting how early relational patterns might resurface during sessions.  

• t.From the outset, the young person’s goals are clarified alongside a shared understanding of how the work will end, establishing clear boundaries around the beginning and end of contact as a key part of understanding context. This helps the practitioner to foresee and overcome any challenges 

• It allows the young person and practitioner to collaboratively synthesise their shared understanding in a written and/or diagram format.  

*Video 6: shared understanding* 

 

What understanding context is not  

Understanding context is not simply a timeline of life events or a detached, clinical retelling of a childhood biography. Most young people have already retold their stories for teachers, doctors or social workers and may feel distant from what they share.  That’s why understanding context is so powerful. It invites young people to return, this time with a curious practitioner who helps them notice and uncover reactions, feelings, sensations and coping mechanisms within their story so far.  

How understanding context guides session planning 

Understanding context acts as an important beginning, creating a deeper understanding of the root causes of difficulties, and establishing a relationship that feel safe, not blaming or shaming. It can also inform the rest of the therapeutic contact with the young person, allowing the practitioner to work together to achieve agreed goals with the young person.  This can include work such as mindfulness, emotional regulation skills, decider skill, DBT, behavioural graded exposure, social re integration, family work and creative therapies. 

Note: In many cases, taking time to understand someone’s background while acknowledging their experiences and emotions, can itself spark acceptance and change. 

Why understanding context matters 

• Based on developmental foundations: Our earliest relationships shape who we become. Childhood bonds with caregivers form the template for how we relate to others, to ourselves, and even to our own difficulties.  The focus of understanding context is on the importance of social interaction and relationships (including during sessions) rather than the individual’s diagnosis  or difficulties. Alone.  

• It allows for identifying and understanding patterns:  In understanding context, we look for patterns in the young person’s life—what showed up in their past, what shows up now, and even what shows up during sessions. This can help the young person see why their early coping strategies once made sense and why they may now get in the way. For example, behaviours like hiding, avoiding or people-pleasing may have been vital in childhood as ways of responding to an unsafe environment. But now, those same coping mechanism can lead to relational difficulties. Together a practitioner might map these patterns out together to see them more clearly. Recognising this can bring about new understanding and gratitude for previously developed coping strategies, calling for personal agency and change from a validating and non-judgemental stance.  

• The power of narrative: When we share our narratives with someone who is curious and willing to understand, we feel validated, truly seen, and emotionally connected—without anyone judging or taking sides. By exploring early life stories, we gain clearer insight into how our sense of self dallowing for a understanding of ourselves today. 

• Supporting the practitioner:  Understanding context increases empathy from the clinician for challenging behaviours, lowers the risk of overwhelm or burnout, and prevents the practitioner’s unconscious bias ** with the patterns the young person brings. For example: If a young person learnt to please adults, notice how you respond to people-pleasing moments. If they cope by rebelling or shutting down, check your own reactions if these behaviours appear within your work together. 

**Definition: Unconscious bias happens when people make quick judgments or decisions about others without realizing it, based on hidden stereotypes or assumptions. These automatic reactions can be influenced by things like someone’s ethnicity, gender, age, social background, or sexual orientation, even if the person doesn’t intend to be unfair or prejudiced. 

What is the process for understanding context? 

1. Practitioner’s stance and self-regulation 

• It starts with noticing and caring for your own emotional state. If you’re overwhelmed, fearful, fraught, then we can become caught in our own defences. This may include reacting rather than responding, over responding or under responding to the young person. Unintentionally, overwhelmed services or practitioners may mirror the behaviours of over orunder controlled care givers. 

*Video 7: Awareness of stance* 

 

1. Confidentiality 

• Review your service’s confidentiality policy. Make sure the young person knows what stays private, any limits to confidentiality(e.g., risk disclosures), and how or when you might share information with other professionals.  

3. Introducing understanding context

• Try to frame the process clearly and compassionately, you might say: 

“We are trying to understand how you have learned to be you so far- how you have been related to by others and learned to cope and relate also to yourself. We will link this in with current strengths and struggles, to help make sense of things. 

So, we are going briefly backwards to try to make sense of things which will hopefully help moving forwards.  

This is not a court of law or a confessional. We will not be fact checking or judging your experiences. There is not a single truth in life, but many perspectives. We will be interested in your experiences and viewpoint, and we hope to find you and the themes and patterns within your story.  

We will talk about childhood memories. You can say as much or as little as feels alright.  It may feel vulnerable to do this. We will check in together on this and work towards you understanding and not being too overwhelmed by feelings as we go.” 

Key points to share:  

• You’re not there to judge or fact-check  

• there’s no single “truth”—only different perspectives.  

• the young person decides how much to share; you should check in about any discomfort. You might say: 

“I want to make sure this feels okay for you, would you like to pause here, or keep going?” 

This kind of gentle check-in helps the young person feel safe and respected while sharing.   

4. Emotional safety and regulatiion

Revisiting past experiences can trigger strong emotions in a young person.  Introduce simple emotion-regulation techniques and manage any risks as they arise. Explain that part of understanding context is creating a space to voice the unsayable and bear the unbearable together, always moving at the young person’s own pace.  

5. A non-blaming approach

 Our goal is to understand the complexities of the young person’s early experiences,not to label anyone as simply “good” or “bad.”  

•  Sessions are not about judging caregivers or families but they are about exploring how patterns of relating have unfolded across generations. This exploration can include the cultural, social, and environmental landscape iwhich the young person grew up around, helping them connect their story to a broader context. Although abusive or neglectful caregiving may be understood in a wider context, it cannot be justified and the impact on the young person needs to be validated. Sometimes, taking a pause, with a steady gaze and saying to the young person that you are  sorry this happened to them, and they did not deserve it, is powerful and reparative. 

NOTE: Your validation must come from genuine feeling before you express it. Young people can be  highly attuned to any hint of insincerity. 

6. Active, open-minded listening

When working with a young person, it can be helpful to take a open‑minded listening stance, blending seriousness with playfulness, inviting creativity, and fostering moments of connection by moving between deep questions and lighter exchanges. It can also be helpful if a practitioner takes a balanced position of being emotionally present while not becoming overwhelmed. Active listening is important throughout interactions with young people and it involves using both verbal and non-verbal cues, reflecting meaning, and responding with intention. Finally, pausing to notice both your own feelings and the young person’s needs before acting is important, so that your response is thoughtful, measured, and supportive rather than driven by immediate emotion. 

*Video 8: holding balance* 

7. Exploring the bigger picture

Begin by exploring the broader story that surrounds the young person’s experiences. Ask about their caregivers’ own childhoods, how those early years shaped their beliefs and behaviours before they became parents. This can help the young person find themselves in their story. Childhood narratives often centre on what was done to the young person, rather than what they actively did in response. Find together what the young person learned to do, think and feel in their childhood. For instance, how was a recalled episode experienced by the young person, how did it land in the body, where was it felt, what sense did they make of it, what did they do to cope, and what happened next.   Hence, the practitioner is gently exploring and adding to the story the young person already holds about themselves. 

8. Timeline and note taking

• This phase usually takes 4–8 weeks and practitioners should take notes throughout sessions. It is important to recall and gather details from week to week. For example, on: 

                      – Names of pets or favourite toys  

                      –   Key phrases or themes they use, repeated words/ metaphors  

                      –   Gaps or changes in the story 

Note: Try to use the young person’s wording during sessions and explain that notes are for your reference only and will be securely destroyed when the work ends. 

9. Reviewing each session:

It could be helpful to begin each session by reviewing the last session from both the young person and your own perspective   Additionally, it can also be helpful tplink up themes and shared feelings from week to week, both from within sessions and from the  young person’s daily life experiences. 

10. Creating a visual map

*Video animation 2: Mind Map* 

A visual map is a collaborative tool that turns complex experiences into a clear, shared picture, making it easier to understand patterns and context. The map acts as a visual and simplified version of the shared understanding context, and it is done jointly within 2–4 sessions. 

It can use colours, shapes, pictures, arrows, and metaphors, drawing on the language of the young person. The map can simplify complex patterns and clarify origins and maintaining factors of presenting difficulties, and it can also act as a visual aid to seeing repeated cycles of behaviour. It can help show that whilst we are strongly impacted by others, particularly in childhood, our learned ways of coping and relating also impact ourselves and others now. Mapping further highlights that relationships are reciprocal.  

The young person is given a copy of the map to take home, which they might choose to share with family or use privately as a reminder of what has been explored together. The map is used to anchor future sessions, to create a spirit of understanding difficulties and symptoms. The young person may choose to highlight one aspect of the map, with the aim of recognising the patterns currently in their life and consider alternative coping mechanisms. By tracing these origins and mapping out new possibilities, the young person can see that they were never the original problem and with support, they can become their own solution. Understanding where difficulties began fosters compassion, reduces shame, and makes room for different, healthier ways of coping. In this way, the visual map highlights past experiences and guides new possibilities. 

*Video 12: mapping* 

11. Practising small changes

It’s important to remind the young person and ourselves that: 

•  Even one small tweak to the way we respond in a situation, a pause, an added step, or a minor adjustment, can slow down or interrupt our usual rapid, automatic patterns.We can’t change every deeply ingrained habit all at once, and the harder we fight against them, the more they tend to stick. Observing ourselves with greater awareness, acceptance and compassionate boundaries is also a form of change. A more realistic aim for change reduces idealised expectations and allows the young person to adapt in a way that will work for them in the longer term.  

*Video 9: change* 

Summary  

In this module, you have learnt:  

• Understanding context is the shared creation of a meaningful story that connects past experiences with present struggles, while also recognising the strengths and coping strategies a young person has developed. 

• It places the therapeutic relationship at the center, with trust, warmth, curiosity, and clear boundaries forming the foundation of the work. 

• From the very beginning, understanding context sets goals and boundaries, shaping the direction of therapy and introducing the idea of a planned ending as part of the process 

• Active, open‑minded listening means staying curious, blending seriousness with playfulness, and being emotionally present without becoming overwhelmed. 

• Exploring the bigger picture places the young person’s story in context, including their caregivers’ histories, and helps them find themselves in their own narrative. 

• Creating a visual map simplifies complex patterns into a collaborative, accessible diagram that highlights cycles, relationships, and possibilities for change, reinforcing that the young person is not the problem but part of the solution.