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Brief Overview of CAT Mark C. Ramm, NHS Lothian

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Title: Brief Overview of CAT Mark C. Ramm, NHS Lothian


1
Brief Overview of CATMark C. Ramm, NHS Lothian
  • Integrative
  • A theory based on the integration and extension
    of ideas and methods used in conventionally
    opposed approaches

  • (Anthony Ryle)
  • More than just Cognitive and Psychoanalytic
  • Cognitive
  • Behavioural
  • Psychoanalytic
  • Developmental
  • Social

2
Brief Overview of CAT
  • Distinctive individual psychotherapy
  • CAT accepted as a distinctive and Independent
    form of psychotherapy
  • - Roth Fonagy (1996)
  • An integrated theory of personality and change
  • So applicability to a wide range of situations,
    problems and settings

3
CAT Radically Relational
Almost everything we do is acted out in relation
to a real, imagined or anticipated other. Lev
Vygotsky Activity Theory. All higher mental
functions are internalised social relationships
4
How does CAT approach it ?
  • Relational
  • Understands this in terms of Reciprocal Roles
    (derived from Object Relations)
  • Most distress in human beings is relationship
    based
  • self and others
  • self and self
  • Dynamic
  • Understands how people can act very differently
    at different times and in different contexts

5
DEVELOPMENT
Babies are born attuned to interact with
others Each baby has its own genetic
predispositions The baby interacts with carers
who are massively influential - Attachment
issues The infant internalises its
experience Forms joint understandings with others
Forms concepts about self and others
Formation of Relationship templates Formation
of Reciprocal Roles
6
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7
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8
Developmental Psychology
  • The self emerges from our experiences with
    others
  • This forms our basis for our feelings about
    ourselves and for predicting how others will be
  • The core premise of CAT is that the child learns
    acquires and learns to convert interpersonal
    experiences into intrapersonal processes and
    templates

9
  • Present interpersonal difficulties are frequently
    found to be the result of these kinds of
    developmental roots
  • (Although traumas and powerful relationships
    later in life can also cause major disruption)
  • A persons attempts to cope with such issues
    often leads further problems

10

  • RECIPROCAL ROLES

Mother or Main Other (Critical demanding)




SELF (Unworthy Striving)



11

  • RECIPROCAL ROLES

Mother or Main Other (Critical demanding)



Other (Critical demanding)
SELF (Unworthy Striving)


SELF (Unworthy Striving)
12

  • RECIPROCAL ROLES

Mother or Main Other (Critical demanding)

SELF (Critical demanding)

Other (Critical demanding)
SELF (Unworthy Striving)
Other (Unworthy Striving)

SELF (Unworthy Striving)
13

  • RECIPROCAL ROLES

Mother or Main Other (Critical demanding)

SELF (Critical demanding)
SELF (Critical demanding)
Other (Critical demanding)
SELF (Unworthy Striving)
Other (Unworthy Striving)
SELF (Unworthy Striving)
SELF (Unworthy Striving)
14
  • The self emerges from our experiences with others
  • This forms the basis for our feelings about
    ourselves and for predicting how others will be.

15
Reciprocal Roles are therefore
  • The templates for all subsequent relationships
  • Interpersonal (self - other)
  • Intrapersonal (self - self )
  • Are the basis of our dialogical selves. Our
    various internal voices (Implications for
    understanding psychosis)
  • Are the origin of much Intra-personal conflict
    and associated distress

16
  • BALANCED PERSONALITY
    ORGANISATION










A Reciprocal Role is a block of procedural
knowledge about how to do a particular
relationship and what to expect from it (Denman
2001)
17
RIGID PERSONALITY ORGANISATIONRestriction and
distortion of the Reciprocal Role Repertoire









Particular Reciprocal Roles have a dominance and
extreme polarization or there are a limited in
number of Reciprocal Roles.
18
Dynamic state dependent functioning
  • How we think feel and remember is to a large
    extent state dependent
  • We move in and out of our states and prefer to be
    in some rather than others

19
Procedures and the maintenance of problems
  • The cause of problems in some shape or form is

Abusing Abused
Unmet needs Negative emotion Stress
20
Procedures and the maintenance of problems
Abusing Abused
Ignoring problem, drinking, running away (feels
better)
Unmet needs Negative emotion Stress
Avoiding
21
Procedures and the maintenance of problems
Abusing Abused
Ignoring problem, drinking, running away (feels
better)
Doesnt solve
Unmet needs Negative emotion Stress
Avoiding
22
Procedures and the maintenance of problems
Abusing Abused
Ignoring problem, drinking, running away (feels
better)
Alternative Reciprocal Role Procedure
Doesnt solve
Unmet needs Negative emotion Stress
Avoiding
23
Self States
  • Self states connected by procedures and
    relationships

Dynamic state dependent functioning. How we
think feel and remember is to a large extent
state dependent. We move in and out of these
states and prefer to be in some rather than others
24
Self State Disorders
  • Disruption of integrating procedures
  • Deficient and disrupted self reflection
  • Dissociation of self-states
    (Multiple Self States Model)

Confused, Cant think, Unstable
Dissociation normal
25
Ramm Mair 2009
  • Issues disrupting Attachment
  • Dismissive Avoidant Attachment Styles
  • Poor Coping Skills
  • Poor emotional regulation
  • Interpersonal difficulties
  • Poor mentalisation

PERSONALITY DISORDER PSYCHOSIS
26
CAT
  • Formulation use of Formulation map
  • Recognition, insight self-awareness (diaries
    etc)
  • Continued focus on Map
  • Develop insight
  • Change Methods
  • Huge flexibility and range of therapeutic
    activity possible
  • CBT techniques/behavioral experiments/IPT
  • Mentalisation
  • Occupational interventions
  • Art work
  • Psychodrama
  • Active use of the therapeutic relationship
  • Exits
  • New strategies/ways of coping/relationships
    developed
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