Anthony Ryle - Introducing Cognitive Analytic Therapy

11 4 The CAT Model of Abnormal Development of the Self and Its Implications for PsychotherapySummary Abnormal Development of Self and Its Consequences Common Therapeutic Factors Damaged or Abnormal Development of the Self and the CAT Model of Therapeutic Change Understandings of “Transference” and “Counter‐Transference” and Avoiding Collusion Use of Personal and Elicited Counter‐transference Identifying and Reciprocating Counter‐transference Self‐Esteem The “False Self” Who Does the Therapist Speak for? Implications of Our Evolutionary Past for Psychotherapy Concluding Remarks

12 5 The Practice of CATSummary Referral Assessment Information The Conduct of the Assessment Interview Other Considerations Assessing Motivation Combining CAT with Other Treatment Modes Assessing the Risk of Self‐Harm and Suicide Assessing the Potential for Violence “Paper and Pencil” Devices and Questionnaires Treatment “Contracts” Concluding Remarks

13 6 The Practice of CATSummary Case Formulation and CAT Reformulation The Process of Reformulation The Reformulation Letter Diagrammatic Reformulation or Mapping The Order and Process of Reformulation Formal Evaluation of the Impact of Reformulation

14 7 The Practice of CATSummary Later Sessions—General Considerations Change and the Working Alliance in the “ZPPD” Making Use of Transference and Counter‐transference in Enabling Change Transference, Counter‐transference, and the Working Relationship of Therapy Dialogic Sequence Analysis Technical Procedures Rating Progress Recognizing Enactments and Procedures as they Occur Recapitulating and Reviewing Sessions Homework Accessing Painful, Possibly Traumatic, Memories and Feelings Not Recognizing Enactments and Procedures as they Occur The CAT Model of Resistance and of the “Negative Therapeutic Reaction” Dropping out of Therapy Recognizing Enactments and Procedures at Termination and Ending Well Concluding Remarks

15 8 The CAT Model of Therapist Activity and of SupervisionSummary The Competence in CAT (CCAT) Measure Therapist Activities in CAT Supervision of Therapists in CAT Audio‐tape Supervision Dialogical Sequence Analysis “Parallel Process” Group Supervision Reflective Practice Distance Supervision

16 9 CAT in Various Conditions and ContextsSummary The Problem of Diagnosis CAT in Some Specific Conditions and Settings Concluding Remarks

17 10 The Treatment of “Severe and Complex”Personality‐Type DisordersSummary The Concept of Personality Disorder Borderline Personality Disorder (BPD) Aids to Reformulation The Course of Therapy Narcissistic Personality Disorder (NPD) The Treatment of “Severe and Complex,” Personality‐Type Disorders: CAT and the Research Evidence

18 11 The “Difficult” Patient, Contextual Reformulation, Systemic Applications, and Reflective PracticeSummary The “Difficult” Patient Causes of “Difficult” Behavior General Approaches to the “Difficult” Patient Contextual Reformulation Constructing a Contextual Reformulation Examples of Contextual Reformulations Broader Uses and Applications of Contextual and Systemic Approaches Reflective Practice

19 Afterword Distinctive Features of CAT The Continuing Expansion of CAT The Evidence Base and Research The Implicit Values of CAT

20 Glossary

21 Appendix 1: The Psychotherapy FileThe Psychotherapy File Keeping a Diary of Moods and Behavior Patterns that Do Not Work, but Are Hard to Break Different States

22 Appendix 2: Cognitive Analytic Therapy (CAT) Competences for Individuals with Personality DisorderCognitive Analytic Therapy (CAT) Competences for Individuals with Personality Disorder Knowledge of CAT Theory Knowledge of Key Features of CAT The Psychotherapy File Reformulation Knowledge of the CAT Theory of BPD Key Skills of CAT Reformulation Constructing the Sequential Diagrammatic Reformulation (SDR) (or “Map”) Constructing Target Problem Procedures (TPPs or “key issues”) Formulating Aims or Exits Moving Between Task and Process CAT Methods of Intervention Ability to use CAT Skills to Manage the Ending of Therapy Ability to use CAT‐Specific Measures to Guide the Intervention CAT Skills of Particular Relevance for Work with Borderline Personality Disorder Engagement Developing the Reformulation Sustaining and Consolidating Positive Change Using CAT to Facilitate Work with Wider Systems (Contextual Reformulation)

23 Appendix 3: Personality Structure Questionnaire (PSQ)Personality Structure Questionnaire (PSQ)

24 Appendix 4: Repertory Grid Basics and the Use of Grid Techniques in CATRepertory Grid Basics and the Use of Grid Techniques in CAT

25 References

26 Index

27 End User License Agreement

1 Chapter 4 Table 4.1 List of Some Typical (Formative) Reciprocal Role Patterns and Some ...

1 Chapter 2 Figure 2.1a Key formative RR for Bobby. Figure 2.1b Key RRP enactments. Figure 2.2 Rating sheet for target problem procedure 1 for Bobby.

2 Chapter 3 Figure 3.1a CAT‐based sketch of normal development of the Self through healt... Figure 3.1b Their subsequent internalisation as formative RRs within the gro...

3 Chapter 4 Figure 4.1 CAT‐based diagrammatic sketch of damaging and abnormal developmen...

4 Chapter 6Figure 6.1 Part diagrams: sequences illustrating traps, dilemmas, and snags....Figure 6.2 Types of cores in sequential diagrams.Figure 6.3 (a–c) Beatrice—Self states sequential diagram. (a) Initial depict...Figure 6.4 (a) Depicts formative reciprocal roles; (b) mapping of most commo...

5 Chapter 7Figure 7.1 Self states sequential diagram for Rita showing reciprocal roles....

6 Chapter 8Figure 8.1 Sequential diagram for Grace.

7 Chapter 9Figure 9.1 Simplified SDR/map for Susan showing key formative RR and key RRP...Figure 9.2 SDR or “map” for Tamara.Figure 9.3 SDR/map for Alan.Figure 9.4 (a) Key formative RRs for Sarah. (b) SDR/map for Sarah.Figure 9.5 The client in the sessions.Figure 9.6 The therapist in the sessions.Figure 9.7 A problematic sequence (RRP) of thoughts, emotions, and behaviors...

8 Chapter 10Figure 10.1 (a–d) Stages in construction of a stereotypical BPD‐type diagram...Figure 10.2a Deborah—grid of self‐descriptions.Figure 10.2b Deborah—grid of self–other relationships.Figure 10.3 Narcissistic personality disorder: the two common Self states.Figure 10.4 (a–c) Stages in constructing a stereotypic NPD‐type diagram show...Figure 10.5 Olivia—sequential diagram (revised and simplified).Figure 10.6 Sam—final Self state sequential diagram (revised and simplified)...

9 Chapter 11Figure 11.1a Schematic patient SDR or map showing (formative) RRs and conseq...Figure 11.1b Schematic rudimentary contextual reformulation showing patient ...Figure 11.1c Schematic extended contextual reformulation showing added layer...Figure 11.2a Initial description of patient's formative RRs.Figure 11.2b Simple contextual reformulation showing patient RRPs and staff ...Figure 11.3a Initial SDR or map for Paula showing her formative RRs.Figure 11.3b Initial SDR or map showing subsequent RRPs and consequences.Figure 11.3c Initial SDR or map showing additional tendencies to dissociate ...Figure 11.3d Contextual reformulation showing (situational) reciprocal role ...

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