MA Psy_Sem-3_Psychotherapies_Unit-2_P-2

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M.A.Psychology COGNITIVE ANALYTICAL THERAPY Course Code MAP613 Semester: III COGNITIVE ANALYTICAL e-Lesson: 4 THERAPY SLM Unit: 2 P 608) INSTITUTE OF DISTANCE AND ONLINE LEARNING

COGNITIVE ANALYTICAL THERAPY INTRODUCTION 3 OBJECTIVES Mechanism of Cognitive analytical therapy A time–limited, integrated psychotherapy is (CAT). referred to as Cognitive analytical therapy (CAT). Significant features of CAT Diagrams are often used in CAT to illustrate sequences or recurrence of problems. P 6013) The most vital and significant features of CAT are the joint descriptive reformulation of the patient’s problem and their active participation in therapy. INSTITUTE OF DISTANCE AND ONLINE LEARNING

TOPICS TO BE COVERED CAT is implemented in a shortened format (covering only 3 to 8 sessions) as the model of client illness. Diagrams are often used in CAT to illustrate sequences or recurrence of problems The flow of events can be changed by giving proper alternative behaviour patterns or thoughts (exits) that can be incorporated into the diagram. COGNITIVE ANALYTICAL THERAPY .

COGNITIVE ANALYTIC THERAPY A BRIEF OVERVIEW

WHAT IS COGNITIVE ANALYTIC THERAPY (CAT) • Developed by Dr. Anthony Ryle + colleagues since late 1970’s • Commonly 16 sessions (can be 8-32 or more) • CAT is predominantly a relational theory • Suitable for treating neurotic and personality disordered patients • Also used for ‘case management’ and ‘consultancy’

CAT in relation to other therapies CBT Psychodynamic Psychotherapy ■ Uses self-observation ■ Unconscious factors ■ Emphasis on relationships ■ Structured ■ Therapist–client relationship CAT ■ Problem-focussed similarities ■ Collaborative CAT Greater emphasis on ■ Shorter contrasts ■ More structured ■ Relationships ■ More openly collaborative ■ Early experience ■ Emotionally driven (unconscious?) patterns of coping

CAT Basics • Main idea : through early experience we develop patterns of relating, including thinking, acting and feeling that can be adaptive at the time but later may become problematic

WHAT DOES IT INVOLVE ? • Time limited/conscious from the start • Three R’s of CAT – Reformulation; Recognition; Revision. • The therapeutic relationship is at the forefront of the therapy

KEY CONCEPTS AND TOOLS IN CAT • Target Problems (TP) • Target Problem Procedures (TPP) • Reciprocal Role (RR) • Reformulation Letter • Sequential Diagrammatic Reformulation (SDR) – the ‘map’ • Endings and ‘Goodbye letter’

Traps, Dilemmas and Snags • Essentially circular patterns of behaving and relating (“vicious circles”; “roundabouts” – from which we need to find the exits) • Traps – self-fulfilling negative prophecies • Dilemmas – forced choices and polarised actions • Snags – abandoning or sabotaging progress

Trap (self-fulfilling negative prophecies) I am bad (B) I feel guilty (F) I must not be angry (A) I sulk or get angry (R) I’ll give in, try to please (P) I comply but get used, feel out of control (A) 8

Dilemma (forced choices or polarised actions) so my needs are ignored either be strong and care for them I feel lonely, uncared for I want to be close to others but it seems as if I must so I feel out of control and break off or give in to them to get care 9

Snag (abandoning or sabotaging progress) I want to succeed and enjoy life I feel a failure, unhappy things go well up to a point… so I undo or spoil things (but then) it is as if I am not allowed, must pay 10

Reciprocal Roles - Concept [parent derived role]to [child derived role] e.g. e.g. good enough to autonomy/trust conditional to striving/performing idealised to fused dependency

Reciprocal Roles - Theory • We develop our child ‘role’, who felt & acted in certain ways to the parent figure(s) • The parent role is internalised and both roles can be enacted in subsequent relationships - e.g. abandoning to abandoned • We also learn to elicit and enact parent ‘roles’ or behaviour. • The parental and child roles [RRs] are experienced and internalised as a relationship pattern, i.e. briefly they are - a) experienced, b) internalised and c) enacted as Reciprocal Role Procedures • Interpersonal and self-care problems can develop if the repertoire of reciprocal roles is limited (and so, inflexible) or distorted



RECIPROCAL ROLE PROCEDURES • A stable pattern of interaction originating in relationships with caretakers in early life. • Procedures for dealing with relationships and self management • We learn to predict how others respond to us (so two RRs are learned – our own and the other ‘pole’) • Playing/enacting a role always implies another, or the internalised “voice” of another, whose reciprocation is sought or experienced. – i.e. we are always ‘in relation’, no person is an island ……….. – Winnicott ‘there is no such thing as a baby’



RECIPROCAL ROLE PROCEDURES cont. (Sarah Littlejohn CAT North) • We enact RRs in interaction with others AND elicit RRs from them (e.g. Encouraging/Praising – Assured/Uplifted/Confident). • Others did it to me, so I do it to others (similarly) this can feel a scary concept AND/OR to myself. • I draw others in – so they do it to me again OR it FEELS like others do it to me. • The therapist tries not to collude (or manages collusion) with unhelpful RRPs.





A Pair of Reciprocal Roles in Diagrammatic Form Caring Holding Supportive Cared for Confident Secure



A Pair of Reciprocal Roles in Diagrammatic Form Critical Attacking Angry or Aggressive Withdrawn Unsure Doubting

We relate……therefore I am



The Development Of Reciprocal Roles PAIR OF RRs – SELFSTATE M/other self self self other self INTERPERSONAL RECIPROCAL ROLES & INTRA-PERSONAL PROCEDURES RECIPROCAL ROLES & PROCEDURES

Exercise: A Fairytale Wedding? • Read the ‘Reformulation Letter’ to Cinderella • What ‘reciprocal roles’ describe Cinderella’s experiences in relationships? • Write down your immediate responses in ‘RR’ pairs 26

Cinderella - RRs and procedures (Map) Exploiting Desperate Tries to cater for for love all sisters needs Exploited Used Striving Perfectly Caring Perfectly Cared For

Cinderella - RRs and procedures (Map) Exploiting Desperate for love Exploited Used Striving

Cinderella - RRs and procedures (Map) Exploiting Desperate for love Exploited Used Striving Perfectly Caring Perfectly Cared For

Cinderella - RRs and procedures (Map) Exploiting Desperate Tries to cater for for love all sisters needs Exploited Used Striving Perfectly Caring Perfectly Cared For

Cinderella - RRs and procedures (Map) Exploiting Desperate Tries to cater for for love all sisters needs Exploited Used Fails Striving Perfectly Caring Feels inadequate Perfectly Cared For Strives even harder To be….

Cinderella - RRs and procedures (Map) Exploiting Exploited Desperate Tries to cater for Used for love all sisters needs Striving Fails Fantasy Perfectly Caring Feels inadequate Perfectly Cared For Strives even harder To be….

Cinderella - RRs and procedures (Map) Exploiting Desperate Tries to cater for for love all sisters needs Exploited Used Fails Fantasy Striving Perfectly Caring Feels inadequate Perfectly Cared For Strives even harder To be…. But….

….Avoiding the “dance” • Personality shaped by the genetic ‘hard wiring’ and the repertoire of RRPs • Patient will unwittingly try to elicit RRs from you which they are used to (e.g. controlled to controlling) • Ryle: “The first rule is not to collude” • Recognise what’s going on between you, describe it (don’t interpret) • Then you can explore other ways of relating • This is CAT’s way of naming and managing the transference and countertransference

Endings and Goodbyes • CAT, as a time-limited therapy, always holds in mind the ending from the beginning. The approaching ending is considered in relation to the predicted impact it might have on therapy and the th. rel’ship. • Child Time • Adult Time • Disappointment • The Goodbye Letter

CONCLUSION ❖ The most vital and significant features of CAT are the joint descriptive reformulation of the patient’s problem and their active participation in therapy. ❖ Therapy is normally 16 weekly session that is introduced initially with clarification of the patient’s persistent problems and case history. ❖ The psychotherapy treatment that is initiated after the first session acts as a self–completion aid to help the patient understand themselves better by recognising problem patterns. ❖ It establishes the terms of CAT and describes how to keep track of unwanted symptoms and behaviours.

MULTIPLE CHOICE QUESTIONS • 1. How many sessions are conducted in CAT to client ________? • a. Two –five sessions • b. Three – eight sessions • c. Four – seven sessions • d. Five - nine sessions • Answer-B 40

MULTIPLE CHOICE QUESTIONS 2. Which one of the following is regarded as the pivotal school of psychoanalytic theory? a. Freudian b.Ego-Psychology c.Self-Psychology d. All of these Answer-A

REFERENCES Gabbard, Glen O. (2009). Textbook of Psychotherapeutic Treatments. U.S.A: American Psychiatric Publishing, Inc. Gabbard, Glen O., Beck, Judith S. and Holmes, Jeremy. (2005). Oxford Textbook of Psychotherapy, 1st Edition. Oxford: Oxford University Press. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

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