Introducing Cognitive Analytic Therapy. Anthony Ryle
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In CAT a mature “phenotypic” Self is understood to be the result of a process of development through which an original “genotypic” Self interacts and communicates with caregivers and others. This process occurs on the basis of an inherent human capacity and need for intersubjectivity and relationality, in the context of likely genetic and temperamental variation. Importantly, the Self also “internalizes” the social meanings and cultural values implicit in these interactions. From a Vygotskian perspective, “internalization” is seen to involve meaning‐making and sign‐mediation and, as it proceeds, to result in transformation of the psychological structures involved. This results in a considerable cross‐cultural diversity of the Self. Such development takes place optimally, through benign, collaborative “activity,” in the infant's “zone of proximal development.” The CAT model also developed from a consideration of Kellyian personal construct theory, cognitive therapy, and psychoanalytic object‐relations theory, but has diverged increasingly from these in its emphasis on the social formation of mind and Self, based on consideration of recent developmental psychology, Vygotskian activity theory, and Bakhtinian concepts of the dialogic self. The Self is understood in CAT as having developmentally internalized, and as being fundamentally constituted by, a repertoire of reciprocal roles (RRs) and emergent adaptive, coping reciprocal role procedures (RRPs), and as characterized by a varying emergent capacity for agency, self‐reflection, empathic imagination, relationality, executive function, creativity, and, for some, a sense of spirituality. A more complete although tentative definition of the Self from a CAT perspective is offered.
The theory and practice of CAT is based on a clearly defined and radically relational and social concept of the Self. As noted previously, we have deliberately capitalized the concept of “Self” to imply a substantive “organizing construct” while recognizing that this remains a problematic concept requiring careful definition that must remain at present provisional and tentative (see also discussion in Chapter 2). Indeed, its multidimensional nature (extending “from the epigenetic to the existential”) represents a currently insoluble challenge for any model of mental disorder and treatment. Despite lip service paid by mental health professionals of various backgrounds, ranging from the biomedical to the socio‐cultural, to some form of “bio‐psycho‐social” approach, in practice most workers focus, perhaps inevitably, on their own area of interest, to the exclusion of a sustained consideration or attempt at integration of other factors. In this chapter we shall offer an outline of the process by which the Self is understood in CAT to be formed, and outline and consider some of the background factors that play a role in determining and influencing the outcome of that process. The more detailed therapeutic implications of abnormal or damaging development of the Self are considered further in Chapter 4. Some of this background may, again, reasonably be skimmed or read selectively by those more immediately interested in the clinical use of the model.
The CAT Concept of Self
The mature, individual, “phenotypic” Self is understood in CAT to be formed through a process of development during which an original, infant (possibly foetal) “genotypic” Self, with a set of inherited characteristics, including an evolutionary predisposition to and need for inter‐subjectivity and relationality, interacts reciprocally with care‐giver(s) and others in a given culture. In time, the developing Self psychologically internalizes and is shaped by this experience and their “voices.” These patterns of relationship and “voices” (RRs), when established, convey the values of the immediate family and the wider culture and contribute to the subsequent formation of a repertoire of responsive “coping patterns” (RRPs) embodying feeling, thinking, memory, meaning, and action. In CAT the social meanings and cultural values intrinsic to such interactions are seen as contributing fundamentally to the dynamic structure and processes of the Self.
The processes of internalization as described by Vygotsky will be considered more fully later in this chapter. Combined with the ideas of Bakhtin, they offer a transformation of object‐relations theories by embodying social, cultural, and semiotic understandings and a fundamentally different perspective on the role of collaborative relationality and meaning‐making in development and, by implication, in therapy. These ideas were principally introduced into CAT by Leiman (1992, 1994a, 1994b, 1995, 1997, 2002, 2012) and subsequently further elaborated by others (Affleck, 2014; Hepple & Sutton, 2004; Pollard, 2008; Ryle & Kerr, 2002). These Vygotskian and “dialogic” Bakhtinian views have been an important influence on the CAT model of development and mental activity (see also Holquist, 1990). Leiman has also, through his clinical work and by means of his technique of “dialogical sequence analysis” (Leiman, 1997, 2004, 2012), demonstrated that it is possible and productive to work explicitly with such “voices” in psychotherapy. This would, to some extent, now be a routine part of CAT practice. However, it should be noted that in our view, the notion of a purely dialogical self does not in itself represent a fully adequate account of the Self, as some authors appear to suggest (e.g., Hermans and di Maggio, 2004), although it offers an important contribution to it.
The process of development of the Self as understood in CAT is depicted in the drawings in Figure 3.1. This stresses the interaction between caregivers and a young child predisposed to intersubjectivity, relationality, and therefore “reciprocal role” enactments. The ideal outcome of this process of development is a mature, phenotypic Self characterized by a repertoire of more or less healthy formative RRs and adaptive RRPs, living in a supportive and healthy social setting. These RRs (shown as completed internalized circles in Figure 3.1b) operate internally (“Self–Self”) as well as in interpersonal, “Self–other” relationships. In the healthy Self, these RRs and RRPs co‐exist and complement each other in a seamless and integrated fashion. This also results in the unique, subjective sense of continuous and integrated existence and of agency (Knox, 2010) that most of us take for granted, but which is so strikingly and distressingly disrupted in individuals suffering from severe personality‐type disorders and, more radically, in acute psychotic disorders. This subjective sense of Self is accompanied by a life‐long need to experience and enjoy a sense of individual and collective “pride” and purpose (Apter and Williams, 2018; Bruner, 1990; Reddy, 2008; Stern, 2000, 2010; Trevarthen, 1993, 2001 2017) and of personal and social meaning embodied in narrative. This view of the importance of the narrative self, which we share with others (Bruner, 2003; Crits‐Christoph, 1998; Holmes, 1998; Meares, 1998, 2005; Schafer, 1992; Spence, 1982; White & Epston, 1990), is explicitly addressed and acknowledged in CAT through reformulation and the relational work of therapy. Ultimately, the process of development of Self in relation to others results in an emergent capacity for higher level processes such as self‐reflection, empathic imagination, relationality, creativity, and executive function, and, importantly for some, a sense of spirituality (Kerr et al., 2015; Samuels, 1985; Symington, 1999). A further exploration of the relation of CAT theory and therapy to more overtly spiritual approaches, such as mindfulness and Buddhism, including consideration of states such as “no‐self” (anatman), are offered by Low (2000) and McCormick (2017).
Figure 3.1a CAT‐based sketch of normal development of the Self through healthy early infant‐caregiver interactions (RRs) shown here in a ‘nuclear’ family type setting and in a particular sociocultural context.
Figure 3.1b Their subsequent internalisation