Title: Brief Overview of CAT Mark C. Ramm, NHS Lothian
1Brief 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
2Brief 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
3CAT 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
4How 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
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8Developmental 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 Mother or Main Other (Critical demanding)
SELF (Unworthy Striving)
11 Mother or Main Other (Critical demanding)
Other (Critical demanding)
SELF (Unworthy Striving)
SELF (Unworthy Striving)
12 Mother or Main Other (Critical demanding)
SELF (Critical demanding)
Other (Critical demanding)
SELF (Unworthy Striving)
Other (Unworthy Striving)
SELF (Unworthy Striving)
13 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.
15Reciprocal 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)
17RIGID 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.
18Dynamic 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
19Procedures and the maintenance of problems
- The cause of problems in some shape or form is
Abusing Abused
Unmet needs Negative emotion Stress
20Procedures and the maintenance of problems
Abusing Abused
Ignoring problem, drinking, running away (feels
better)
Unmet needs Negative emotion Stress
Avoiding
21Procedures and the maintenance of problems
Abusing Abused
Ignoring problem, drinking, running away (feels
better)
Doesnt solve
Unmet needs Negative emotion Stress
Avoiding
22Procedures 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
23Self 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
24Self 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
26CAT
- 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 -