quality education for a healthier scotland psychology sofmh school of forensic mental health brief...

Quality Education for a Healthier Scotland

Psychology

SoFMHSchool of Forensic Mental Health

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

CognitiveBehavioural Psychoanalytic Developmental Social


Psychology


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


Psychology

SoFMHSchool of Forensic Mental Health 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’


Psychology


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 othersself and self

Dynamic: Understands how people can act very differently at different times and in different contexts


Psychology


DEVELOPMENT

Babies are born attuned to interact with othersEach baby has its own genetic predispositions

The baby interacts with carers who are massively influential - Attachment issues

The infant internalises its experienceForms joint understandings with others Forms concepts about self and others

Formation of Relationship templatesFormation of Reciprocal Roles


Psychology



Psychology

SoFMHSchool of Forensic Mental Health 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


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RECIPROCAL ROLES

Mother or Main Other(Critical & demanding)

SELF (Unworthy & Striving)


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RECIPROCAL ROLES



Other(Critical & demanding)

SELF(Unworthy & Striving)


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RECIPROCAL ROLES



SELF(Critical & demanding)

Other (Unworthy & Striving)




Psychology


RECIPROCAL ROLES




Other (Unworthy & Striving)






Psychology


The self emerges from our experiences with others

This forms the basis for our feelings about ourselves and for predicting how others will be.


Psychology


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


Psychology


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)


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“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.


Psychology


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


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Procedures and the maintenance of problems

The cause of problems in some shape or form is:

The person develops strategies or procedures to cope

Abusing

Abused

Unmet needsNegative emotion

Stress


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Abusing

Abused


StressAvoiding

Ignoring problem,drinking, runningaway (feels better)


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Abusing

Abused


StressAvoiding


Doesn’t solve


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Abusing

Abused


StressAvoiding


Doesn’t solve Alternative ReciprocalRoleProcedure


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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


Psychology


Self State Disorders

Disruption of integrating proceduresDeficient and disrupted self reflectionDissociation of self-states (Multiple Self States Model)

Confused, Can’t think, Unstable

Dissociation normal


Psychology


Ramm & Mair 2009

Issues disrupting Attachment

Dismissive Avoidant Attachment Styles

Poor Coping Skills

• Poor emotional regulation

• Interpersonal difficulties

• Poor mentalisation

PERSONALITY DISORDER PSYCHOSIS


Psychology


CAT

•Formulation & use of Formulation map Recognition, insight & self-awareness (diaries etc)Continued focus on MapDevelop insight

•Change MethodsHuge flexibility and range of therapeutic activity possibleCBT techniques/behavioral experiments/IPTMentalisationOccupational interventions Art workPsychodramaActive use of the therapeutic relationship

•ExitsNew strategies/ways of coping/relationships developed

quality education for a healthier scotland psychology sofmh school of forensic mental health brief...

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