The States Description Procedure

Ryle, T., 2003. The States Description Procedure. Reformulation, Autumn, pp.13-16.


The States Description Procedure

Tony Ryle

Introduction
CAT has always emphasised the need to involve patients in accurate self reflection and has provided tools, notably the Psychotherapy File, to assist them. The joint work involved in reformulation with people with Borderline personality structures is difficult, but both the process and the resulting diagram are essential if therapy is to be effective. In order to support this process and to derive more accurate reformulations Philip Pollock, Dawn Bennett and I have developed the States Description Procedure (SDP). This has gone through a number of revisions, with help from a number of patients and therapists, and is now in a final form. You can photocopy this for your own use (remember Part 2 is completed separately for each state, so several copies will be needed). We hope you will try it out with suitable patients, introducing it as part of the early reformulation process.

Which Patients May Benefit?
Any with a clinical diagnosis of BPD. Those with scores of 28+ on the Personality Structure Questionnaire or ++s in the last section of the Psychotherapy File. The PSQ and File replies also provide the first step in exploring alternating states.

The Completion of the SDP
The form is accompanied by explanations and instructions but the task is unfamiliar and patients may need help, in particular in completing Part 2 for each state, but time spent on this will not be wasted.

Interpreting the SDP
The completed form yields descriptions of states, each of which will be subjectively experienced by the patient; in some cases it may be appropriate for therapists to merge two states where their descriptions overlap. By also eliciting an account of the sense of self and other accompanying each state the SDP makes it relatively easy for therapists to deduce the underlying reciprocal role patterns. The additional data about frequency, duration, mode of onset and ending and awareness of other states is seldom obtained from clinical interviewing.

The Phenomenology of Borderline States
In addition to its clinical use, data from a series of patients will provide a clearer picture of the characteristics of the states found in these patients. As you will see, a consent form to this use of (anonymised) data is included. If you obtain consent, please send me the details requested and copies of the replies, as indicated on the form. And any comments or suggestions.

Thanks. Tony Ryle

A Method Of Guided Self-Description

Explanation for Therapists
This procedure is designed to assist in the reformulation of borderline patients. It provides a form of guided introspection which mobilises patients’ capacity for self reflection and yields details not always recorded.

It should be used with patients scoring 28 or more on the Personality Structure Questionnaire (PSQ) or otherwise reliably diagnosed as BPD.

By ‘state’ we mean distinct, contrasted ways of being, feeling and acting. States can be reliably identified as being present or absent at a given time. They are more distinct and often less obviously responses to events that are ordinary mood changes.

Once the idea of contrasting states has been discussed and accepted, patients are usually able and willing to use the SDP to work at describing their states. Some will need help with the task.

There are 3 Pages:
Page 1
describes the purposes of the tests for patients:
It includes a consent form allowing their replies to be passed on for comparison with others provided anonymity is guaranteed. No pressure should be applied. If consent is given please send photocopies of part 1 and of part 2 for each state, with the patient’s age and sex and PSQ score, but no other details, to Tony Ryle, CPTS, Munro Centre, Guys Hospital, London SE1. The research aim is to describe the extent to which the descriptions of the states are similar in different patients or patient groups and to clarify the phenomenology of BPD.

Page 2 is Part 1 of the SDP:
It offers titles and brief descriptions of common states. Patients identify those they recognise and may add more of their own. From this (and possibly other information you may have gathered) a complete list of this patient states is obtained.

Pages 3 and 4 are Part 2 of the SDP:
It should be completed for each identified state:
It provides:

  • A summary of the subjective experience of each state
  • and descriptions of:
  • Self to other and
  • Other to self attitudes and behaviours

 

The last section describes the duration, frequency, mode of starting and stopping and awareness of other states.

The completion and discussion of the SDP can contribute to accurate and detailed reformulation of borderline patients. Each state will be associated with one pole of a reciprocal role pattern; in many cases the other pole will also be described as a state (for example, patients may identify both bully and victim states) but in any case replies to 3b and 3c allow you a quick access to the apparent reciprocal role patterns through which self states (partially dissociated rrps) can be identified.

For a PDF of the SDP follow this link:

State Description Procedure PDF

Full Reference

Ryle, T., 2003. The States Description Procedure. Reformulation, Autumn, pp.13-16.

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