An Introduction to Cognitive Analytic Therapy. PSW Conference Aileen Garrihy 30/11/12

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1 An Introduction to Cognitive Analytic Therapy PSW Conference Aileen Garrihy 30/11/12

2 Early Origins of the Model Research (during the 70 s and 80 s) into the effectiveness of psychodynamic therapy including Kelly s Repertory Grids Repertory Grids the subject rates a number of elements on a number of constructs or descriptions Computer analysis of the grids yields interesting descriptions of the individual and how he/she relates to the world

3 Early Origins of the Model Contd. These descriptions were summarised on paper, they were later elaborated upon to create an important tool of CAT the CAT diagram or map. Ryle began the process of re-stating psychoanalytic ideas in a more accessible cognitive language Joint description of problematic patterns and mapping of these was emphasised from the start Early reformulation of the patients difficulties also originated from the grids

4 Procedural Sequence Model The PSM represents the early cognitive emphasis of the model It attempts to aid recognition of problematic behavioural patterns by linking external reality, internal mental processes and action 3 examples of procedural descriptions are: Traps, Snags and Dilemmas

5 Procedural Sequence Object Relations Model The inclusion of object relations theory at this point, helped explain the aim of problematic behavioural patterns namely the elicitation of a response from the other Reciprocal Role Patterns are internalised in very early life and largely shape relationships with self and others in later life As they are stored in procedural memory (preverbal), RRPs are often not reflected upon and therefore not immediately accessible to us In relationships, we chose relationships where the response of the other is familiar even if unpleasant

6 Internalisation of Early Other Other Self Self Self Other Self

7 Implications for Therapeutic Relationship Early identification of problematic RRPs in therapy allow therapist and client anticipate potential difficulties in the therapeutic relationship Such anticipation can help repair ruptures in the therapeutic relationship when they happen Anticipation of potential difficulties in the relationship helps the therapist to resist being drawn into collusive RRPs

8 The Development of the Model Although CAT draws on both cognitive and psychoanalytic theories, it has become increasingly differentiated from both During the 1990 s, the work of Vygotsky and his description of early development added new understandings which were incorporated into the model Likewise, the incorporation of Bahktin s concept of the dialogical fits with the concept of reciprocity in relationships and therefore added a richness to the model

9 Vygotsky s Contributions Vygotsky emphasised the innately socially oriented self Innate predispositions and inherited temperament interacts with the real environment from which self processes are learnt Often there is a conflict or clash between innate needs and messages and values learnt through the early internalisation of others Such conflict is not always available for reflection One of the aims of therapy is to draw attention to such conflicts and their early origins

10 Vygotsky s Understanding of Social Formation 1. What the child does with an adult today, he/she will do by her/himself tomorrow 2. The role of the parent and teacher (therapist) is to provide a supportive scaffolding so that learning is internalised and can subsequently be managed by the child/adult 3. Learning needs to take place in the Zone of proximal Development which is the gap between where the child (client) is now and where they have the potential to be 4. Internalisation involves sign mediation the creation and joint understanding of signs begins in early life between mother and child and is elaborated upon throughout life. Examples of signs are gestures, words and rituals all of which carry meaning that have specific relevance to us

11 Implications for Therapy CAT draws parallels between the early learning experiences in childhood and learning experiences in therapy The model is designed to mirror those early learning experiences NB Learning in therapy needs to be in the client s ZPD

12 Bahktin s Contributions Concept of a dialogical self Multiple addressees Theory of Utterance Every utterance has an addressee (Bahktin)

13 Implications for Therapy His concept of internal dialogue and multiple addressees fits with the concept of reciprocity as described by Ryle early internalised voices Every utterance has an addressee to whom is the person speaking? useful to consider this in therapy with the client to whom is the client speaking? Internal dialogue is easily understood by most clients

14 Conclusions To emphasise the radically social model of self that CAT encapsulates, Ryle replaced I think, therefore I am with We interact and communicate, therefore I become (Ryle 2003, p 59) Bahktin expresses this poetically when he says Just as the body is formed initially in the mother s womb (body), a person s consciousness awakens wrapped in another s consciousness. (Bahktin 1986, p. 138)

INTRODUCING COGNITIVE ANALYTIC THERAPY Principles and Practice Anthony Ryle DM, FRCPsych Honorary Consultant Psychotherapist and Senior Research Fello

INTRODUCING COGNITIVE ANALYTIC THERAPY Principles and Practice Anthony Ryle DM, FRCPsych Honorary Consultant Psychotherapist and Senior Research Fellow, South London and Maudsley NHS Trust and Guy s, King