Introducing Cognitive Analytic Therapy. Anthony Ryle

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СКАЧАТЬ of a response or action plan or role on the basis of predictions of its efficacy and outcome.

      3 Action, including playing a role in a relationship.

      4 Mental processes: (a) evaluating the consequences of the role or action; (b) confirming or revising the aim and/or the means used.

      This model (described in Ryle, 1982) was compatible with current cognitive models but offered a more comprehensive and apparently more helpful description of the ways in which problem procedures remained unrevised. Affect, cognition, meaning, and action were seen to be intimately linked and were not studied in isolation from each other and the individual was understood in relation to past and present relationships with others. Many psychoanalytic concepts, including the relation of development to structure, could be restated in these terms. But it differed from both cognitive and psychoanalytic theories in its emphasis on the way in which the individual's interactions with others constantly reflect and largely maintain their self processes.

This basic theory needed further development in order to explain the formation of the self in early life and to clarify the problems in self‐management and relationships which are a principal concern of psychotherapy. This initially involved bringing ideas derived from object relations theories into the model. All procedures involve, frequently unconsciously, predicting, or seeking to achieve, certain outcomes. In seeking relationships with another, one plays a role based on the expectation of, wish for, or the attempt to elicit, one particular outcome, namely their acknowledgment and reciprocation (see Ryle, 1985). These procedures were therefore named “reciprocal role procedures” (RRPs) and were ultimately understood to emerge from early reciprocal roles (RRs) experienced with caregivers, siblings, and peers. These RRPs are seen, non‐judgmentally, as representing a person's “best efforts” at coping with frequently challenging or traumatic interpersonal experience. These concepts became of key importance in the revised model—the Procedural Sequence Object Relations Model (PSORM), and this remains the foundation of the CAT model. It should be emphasized that “role procedure,” as used here, implies action linked to memory, meaning, affect, and expectation. The common lay meaning of the subjective experience of playing a role can be understood as a state of mind or state of being. In contrast, the terms RRs and RRPs (see definitions below) describe somewhat more complex theoretical constructs.

The Development of a Vygotskian and Bakhtinian Object Relations Theory

      By the mid‐1980s, the CAT model of self processes therefore incorporated ideas concerning procedural sequences linking internal (mental) and external events, but the origins of these in early development were not clearly described. Current theories appeared unsatisfactory. On the one hand, the dominant object‐relations school, largely derived from theory‐based speculative hypotheses regarding psychological development based on the psychoanalysis of adults, emphasized innate conflicting, frequently destructive, drives, largely neglected the role of experience, and paid little attention to the expanding body of observational studies of real life, early infant development. On the other hand, simple cognitive descriptions, such as were included in the original PSM, while useful as guides to identifying negative or maladaptive patterns, did not offer an adequate understanding of structure or of their relational developmental origins.

The introduction into CAT, initially by Mikael Leiman (1992, 1994a, 1997, 2000), of Vygotsky's understandings of the social and historical context and formation of higher mental processes and of the key importance in human learning of meaning‐making and sign mediation, linked with Bakhtin's illuminating understandings of the role of interpersonal and internal dialog, allowed a radical restatement of object relations ideas. The theoretical language now referred to RR relationships and accompanying dialog acquired in interaction and meaning‐making with caretakers and others, mediated by signs that are used first in outer and then in inner dialog. The theory supported the use of the concrete mediating signs and meaning‐making created (partly through the “psychological tools” of diagrams and letters) through the reformulation process in CAT. This relational “mediation” was understood as being the medium of the internalization through which change of the patient's internal psychological structures and processes could be achieved. These theoretical developments have also been informed and supported by the extensive body of observational and experimental research into infant–caregiver interactions over the past few decades (see Hobson, 2002; Lyons‐Ruth, 2008; Reddy, 2008; Stern, 2000; Trevarthen, 2001, 2017; Tronick, 2007; and see also Chapter 3). CAT was now able to move on from the traditional psychoanalytic model (or one dominant version of it) of an internal world populated by frequently conflicting “objects” or “part objects” derived from ego and others, frequently driven by endogenous destructive forces, and operating like little “ghosts in the machine.” The emerging CAT model described instead internalized relationships and associated “voices” located within a Self, the structure of which is actually constituted by (as opposed to simply “representing”) these internalized relationships. These have been acquired in activity, interaction, and conversation with others, but are now equally involved in external and internal communication, activity, and control. (A more detailed account of the CAT concept of the Self and its formation is given in Chapter 3.) By this point, the key CAT concepts of “reciprocal roles” and “reciprocal role procedures” reached their current point of evolution and therapeutic application. These are currently best understood as follows (and see Glossary):

      A Reciprocal Role (RR) is a relational position between Self and other. An internalized (formative) reciprocal role, originating largely in relationships with caregivers in early life, comprises implicit, therefore often unconscious, relational memory, possibly traumatic, and also the emotions, cognitions (including cultural values and beliefs), expectations, and bodily states associated with it. A RR may be associated with a clear specific or general dialogical “voice.” An internalized reciprocal role is understood to comprise the experience of the whole relationship, that is both poles of that subjective experience, both childhood‐derived and parent/culture‐derived. RRs may be enacted in both “external” interpersonal situations and in “internal” self‐management. Being in or enacting a reciprocal role always implies another, or the internalized “voice” of another, whose reciprocation is anticipated, sought, or experienced.

      A Reciprocal Role Procedure (RRP) is an aim‐directed “coping” or “responsive” stable pattern of interaction, with associated emotions, cognitions, and memories, arising out of the experience of formative reciprocal role(s). RRPs are usually long‐standing, often unconscious, and highly resistant to change. They determine current patterns of relationships with others and self‐management, and may be highly maladaptive, symptomatic, and self‐reinforcing. RRPs may be enacted in both “external” interpersonal situations and also in “internal” self‐management. RRPs may be described as “traps,” “snags,” or “dilemmas” depending on their configuration. Playing or enacting a role procedure always implies another, or the internalized “voice” of another, whose reciprocation is anticipated, sought, or experienced.

Formative RRs are understood to determine and underlie our sense of Self, of Self in relation to others, and also the repertoire of “responsive” (as initially described by Leiman) or “coping” patterns we subsequent develop (“reciprocal role procedures”). Common RRs range from, for example, “properly caring for/loving—properly cared for/loved” at one extreme, through to “emotionally neglecting—emotionally neglected,” or, “abusing—abused” at the other. The actual verbal description of a RR in therapy, however, would be always be negotiated with a patient to whom it must make personal sense. Importantly, the experience or enactment of a RR or RRP always unconsciously anticipates, or attempts to elicit, an expected reciprocal reaction from a historic or current other. In CAT, all mental “activity,” whether conscious or unconscious, is understood (following Vygotsky) to be rooted in and highly determined by our repertoire of RRs, as is, correspondingly, virtually all human psychological СКАЧАТЬ