Introducing Cognitive Analytic Therapy. Anthony Ryle

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СКАЧАТЬ at an agreed conclusion. This is clearly the preferred therapeutic mode, although Cheyne and Tarulli, in a significant aside, point out that some psychotherapies, while supposedly “Socratic,” in reality impose a disguised form of the “Magistral” approach in which clients are taught to ask the right questions. Such an approach would clearly militate against beneficial change. Psychotherapists should aim to provide a reparative scaffolding, explicitly “Socratic,” respecting and caring, creating descriptions of current roles and procedures in words and diagrams that open for reflection the patterns that have operated automatically since their early formation.

      It is of interest that whole cultures may be characterized by certain dominant modes and voices in this fashion. Protestant cultures, for example, would be partly characterized by harshly (self) critical (or “Magistral”) voices and the task of therapy may be at times to work explicitly with a patient to question internalized culturally derived voices.

      In Bakhtin's words: “Just as the body is formed initially in the mother's womb (body), a person's consciousness awakens wrapped in another's consciousness” (Bakhtin, 1986, p. 138). In a related understanding, Winnicott's “there is no such thing as an infant” emphasized the need to make the unit of observation in understanding development this infant–caretaker dyadic system rather than the infant alone. In essence, the dialogic approach replaces the “I think, therefore I am” of Descartes with “We interact and communicate, therefore I become.” This dialogic model presents an unproblematic way of understanding the acquisition of a theory of mind.

      In a more overtly “political” contribution, the Bakhtin‐inspired philosopher Terzakis explicates further the enmeshment of the socio‐political with the intrapsychic, as illustrated by the following quote: “We should then talk of official consciousness and unofficial consciousness, official language and unofficial language: this reformulation does not only re introduce the dialogic principle deep into what we tended to consider as strictly the intrapsychic but also reincorporates the artificially isolated island of the self in a great field of social and ideological currents. Behind every individual symptom hides the conflict between opposing significations of the world. The problem of so‐called psychopathology is always in the last analysis a political problem: managing relations between the individual and the group, choosing a moral or political stance” (Fotos Terzakis unpublished, personal communication).

Contrasts with Other Concepts of Self

The CAT model of Self and its formation shares much with the different conceptions of self formulated historically by various clinical writers. These would include notably Jung (see Samuels, 1985), although Jungians have tended to neglect the social dimensions of the self, Sullivan (1953) within the North American “interpersonal” tradition, and Kohut (1977). CAT shares with Kohut an emphasis on the damage which can be done to the developing self by empathic failure or overt neglect but places more emphasis on active abuse and trauma. CAT also shares a central interest in social conceptions of the self with group analysts. Foulkes, for example, saw individuals in a social fashion as being nodes in a “social matrix” (Foulkes & Anthony, 1957). Later group analytic writers (e.g., Brown & Zinkin, 1994; Pines, 1996) have also developed an interest in the (Bakhtinian) dialogic aspects of the self.

      Although object‐relations theorists were a major influence on the development of CAT, they were on the whole little interested in the concept of self. However, the current CAT model is close to some later authors in the object relations tradition, such as Sutherland (1980), Ogden (1990), and Sandler and Sandler (1998). It is also close to Bowlby's attachment theory (1988) and to subsequent work influenced by this (Fonagy & Target, 1997; and see Bateman, Brown, & Pedder, 2000) in their descriptions of the important role of internalization, and there are some similarities with more recent developments in cognitive psychology stressing the importance early interpersonal experience and of attachment patterns (see Gumley & Schwannauer, 2006; Guidano, 1987, 1991; Liotti, Cortina, & Farina, 2008; Neisser, 1993; Perris, 2000; Young, Klosko, & Weishaar, 2003). However, these authors do not take the further, and, in our view, important, conceptual leap of seeing the self as being essentially constituted by early, socially meaningful, sign‐mediated interpersonal experiences, as opposed to “representing” them mentally.

      Nonetheless, object‐relations theories made a considerable contribution by indicating the importance of early development in determining personality, by offering an account of how parental figures were “internalized” to form a part of the personality, and by recognizing the parallel, linked features of intrapsychic and interpersonal processes and their emergence in transference relationships (see also discussion in Ryle, 1996, 1997c). However, the attribution of these phenomena by some psychoanalytic object‐relations theorists to “splitting” and “projective identification,” and the location of “psychopathology” in the posited internal system of object relations and to “ego weakness,” innate destructive instinctual forces, and unconscious fantasy is seen as unhelpful and untenable from a CAT perspective. The phenomenon of projective identification, whereby others are powerfully induced to experience feelings or play roles which the person cannot tolerate, is not regarded as a defense in CAT; it is seen to represent an exaggerated example of the normal empathic processes of RR relating. CAT understands Self states (dissociated RRs) to be precarious and to leading the person to induce powerful identifying responses in, or to forcefully seek reciprocations from, others even where these are harmful. While usually discussed in relation to destructive procedures, CAT would understand that the same intense pressures can characterize the seeking for “good enough” or ideal care.

      Cognitive Psychology and Cognitive Therapy

One important early influence in the development of CAT was personal construct theory (Kelly, 1955), an approach which challenged both psychoanalytic and behavioral assumptions and which, especially if linked with social constructivism, goes some way toward acknowledging the specifically human, cultural influences on personality. The dominant cognitive theory of the last decades, however, influenced by artificial intelligence research and computer metaphors, has been concerned with information processing and storage. In our view this is still largely the case, although some authors began to show an increasing interest and awareness of the effects of early interpersonal experience and of the importance of (social) meaning in development and in therapy (see Brewin, 1988; Salkovskis, 1996; Safran & McMain, 1992; Stiles, 1997; Perris, 2000). An important contribution of these cognitive and behavioral theories to the CAT model was their demonstration of the value of analyzing and describing sequences (for example, linking behaviors to outcomes, cognitions to emotions) and their demonstration that many problems can be understood without postulating unconscious forces. The cognitive component of CAT theory was derived initially from the work with repertory grids and, to a degree, from personal construct theory. Miller, Galanter, and Pribram (1960) and Neisser (1967) were also significant influences. In Ryle (1982), the Procedural Sequence Model (PSM) was compared in some detail to Beck's model of cognitive therapy (Beck, 1976), to Roth's model of learned helplessness (Roth, 1980), to Rehm's model of depression (Rehm, 1977), to Rotter's model of generalized expectancies (Rotter, 1978), to Forstelling's attribution theory (Forstelling, 1980), and to Bandura's model of self‐efficacy (Bandura, 1977). In terms of practice, the use of patient self‐monitoring was derived from Beck and became one important aspect of the reformulation process, but in CAT the focus of attention was shifted as soon as possible from symptoms to procedures.

      Later developments in cognitive‐behavior therapy (CBT), for example the work of Guidano (1987) or Neisser (1993) focusing on a concept of self, and those stressing the importance of early interpersonal experience and of attachment patterns, including in relation to dissociation (see Gumley & Schwannauer, 2006; Liotti et al., 2008; Perris, 2000), or interpersonally‐derived “schemas” (Young et al., 2003), or even those seeing the self as a set of information processing systems (Prescott, 2015), show some convergences with CAT. This would include clinical work noting and addressing ways in which so‐called “therapy interfering behaviors” or “resistance” СКАЧАТЬ