Potter, S., 2002. Brilliant or Doomed: Cognitive Analytic Therapy and Relational Intelligence in Higher Education. Reformulation, Autumn, pp.8-12.
At the heart of higher education is a criticising, exposing and demanding voice. The reciprocal response can be a feeling of inadequacy, pressure and exposure. This, in turn, is coped with by contrasting procedures of perfectionist, 'never good enough' striving, the seeking of admiring or protective care or finding ways of bypassing exposure through avoidance, denial or grandiosity. Thankfully, we counter all this with balancing activities of humour, coaching, tutorial nurture and mutual aid. But still, the dominant voice is critical and exposing and whilst we might wish to soften it we would not wish to lose it completely in a society driven by excellence, performance and achievement.
In universities, Cognitive Analytic Therapy (CAT) can inform brief, structured, intense individual counselling for personal, emotional and mental health problems of varying degrees of severity. CAT can also play a more general part in improving understanding of the relational nature of academic achievement in a culture which presents itself as radically individualised and overvalues self reliance. A CAT informed relational perspective can identify the typical reciprocal role procedures of higher educational activity and provide a scaffolding for linking personal and academic development. This may be particularly important as universities become agencies of mass education, lose their interpersonal feel and rely increasingly on virtual communications (75% according to a report by Anderson Consulting) rather than face to face contact.
As I write, the annual round of A-level results are being digested by pupils parents, teachers and politicians. I have been talking to school leavers about their results and the impact on their self esteem, their own evaluation of the work they did, the results they deserve and the educational and emotional support they had. They offer a consensus view that educational activity is as much about how you feel as what you do. Success may be determined by combining natural ability with hard work but also by the containing and guiding power of relationships as in: 'I did well in biology because I had a good teacher whom I liked or because a group of us clicked in class.' Academic abilities and skills are only half the story. Relational competencies are also needed in today's schools and universities.
There is a concern for personal and academic development through what is in part a hidden psychological curriculum of project work, resilience, adaptability and self reliance. Currently this psychological curriculum is too individualised and not guided enough by a relational understanding. What is needed is a relational intelligence that can see and use the interplay of aspiration and interaction within and between self and others. Pragmatic, integrative psychotherapies such as CAT which process experience through a cognitive- procedural lens as well as a relational-enactment lens can help a great deal both as individual psychotherapy and as an educational framework for better self care and self management.
Higher educational achievement is now a central aim of society. It constitutes a huge investment of money, human effort and expectation. On its back ride our collective hopes for the enlightened, open, cosmopolitan, affluent and versatile knowledge economies of the future (50% of young adults attending university by 2010). Individually, university is experienced as the highway to career resilience and mobility, enhanced income and opportunities and greater understanding and appreciation of society . Individually it is also experienced as a great personal challenge. At the most basic level it is an expensive personal investment by young people with average debts of £12,000 by graduation day. Thoughts of misspending such a sum has helped create an earnest, anxious and pressured student population. Today's mass higher education is a great psychological experiment in the making and we need to understand and better harness and resource the relational efforts and costs. We need this not least to avoid unnecessary suffering, wastage, drop out or increased vulnerability to mental health problems. Less visibly we need it to help counter the personal lessons about achievement potential that may be laid down in university years ( I am lazy, I am not a high flyer, I have to really work to get results, I am easily bored) and lead to lifelong patterns of under achievement or misapplication of efforts.
One student sees himself as nowhere near as bright as some of his peers but he worked hard for A-levels, scoring A-grades in all subjects and doing much better than his apparently cleverer peers. One of his naturally brightest peers took on an identity of such cool superiority and disdain that he left work to the last minute and under achieved dramatically. These two contrasting examples of the interaction between personal abilities and the relational and procedural assumptions which encase them could be repeated with many variations.
Consider a few such patterns that can be in play in adolescence and early adulthood.
" (All I did in my teens was practice the violin) Perfectionist striving in one area of talent over rides/delays other developmental needs.
" (I am doing it for you) achievement carries the burden of family expectations and debt.
" (head down) hard work masks or bypasses disturbance or difficulty.
" (one day I will do what I want) there will be a window of opportunity for me to do what I want at graduation, after the next degree or at retirement but for now I must soldier on with something I dislike.
" (the scholar's asylum, the ivory tower or monastic retreat) I can only risk losing myself in my work if I have a secure base, a web of safety around me without which sustained concentration can feel disturbing.
" (not a true test) the procrastinator who submits half hearted efforts which can then be dismissed by him as not a true test of his ability.
" (always trying to please the teacher) the obliging approval seeker who does what seems wanted and never develops confidence in taking his or her own position.
" (cannot say no) or they will think I don't care or am not up to it so end up overloaded and having to say no.
" (my way) The way I am used to doing things is the only way I can trust so I keep plodding on.
" (if only snag) If only I had not studied this here or now or then.
" (brilliant or doomed) the polarised thinking of the striver-perfectionist for whom success can only be brilliant and admired and anything less will feel like doom and rejection.
" (now or not now) If doing it now is too much, not now is too late so flip moment by moment between approaching and avoiding work.
" (every fault is acutely shameful) If I predict criticism will be humiliating I become hyper vigilante about my faults and examine myself so much more harshly than any examiner that I become paralysed.
These are intermediate procedures which can be spelt out as snags, traps and dilemmas. They are clearly influenced by but somewhat less general than those detailed in the CAT Psychotherapy file (Ryle 1995, Ryle and Kerr 2002) but still of a sufficient level of generality to apply to both academic and other achievement goals.
In recent years at the University of Manchester and UMIST Counselling Service we have been running workshops for staff in which these and other procedures are mapped out and exits identified through peer discussion and support. These workshops, titled 'Coping Better with Academic Pressures', are popular and offer a way of developing better self care and more effective work without the stigma of seeking counselling. They normalise thinking about the relational and emotional aspects of academic achievement.
A typical combination of patterns as in the diagram below (which strikes a chord with many academics) shows a critical and contemptuous internal voice which, in CAT terms, produces a reciprocal role of feeling inadequate and hurt. The child's procedure for coping with this, which survives to the present, is a defiant one of "I will show them; I will get approval by showing them". But following the left hand side of the diagram it is never enough and attempt after attempt must be made to make it perfect or else the feared alternative of rejection, despair and doom is nigh. The dilemma is that "I will be brilliant and loved if perfect or a total failure and therefore unlovable". However the longed for feeling of brilliance and an admiring other is short lived because then some fault is found which provokes fear and self criticism. An alternative way of coping with critical pressure is shown on the bottom right hand side of the diagram; retreating into feeling doomed and giving up until the breeding of a fresh start or new project and again setting off on the path of "I will show them". Avoidance is always unsatisfactory because it brings with it a continuous fear of exposure and criticism about being in avoidance. Thinking procedurally in this and other ways offers many points of change and a greater sense of self recognition. As in good CAT practice, it lays out the routine for better spotting when interactions along these lines are enacted. It reduces self blame and cuts through some of the ways that we can draw other people into our problems. Benign versions of each of these procedures can easily be identified: striving can be rewarding and creative; exposure can be timely, considerate and constructive; avoidance can be restful and regenerative. Obtaining a perspective on one's self at work in this joined up relational way can help promote a more diplomatic, attuned and democratic executive self which can oversee striving, caring, resting and exposing in appropriate ways.
The enactment of these typical procedures constitutes the relational bedrock of the interpersonal culture of the university. There is no shortage of reciprocation and many patterns have that teasing quality of being both highly functional whilst being emotionally and relationally limiting. For example the left hand side of the above diagram of 'never good enough striving' can fuel a lifetime of academic achievement as many a professor has ruefully confirmed. Not all of these patterns are directly imposed or learnt from parents but can arise in adolescence where they solve a particular developmental need or crisis in relation to peers. They then can be compounded by the indirect collusion of significant others and endure and dominate more than they should. They are ways of managing powerful self referential emotions such as anxiety, shame, pride, blame and guilt.
The use of CAT in student counselling can be very brief and allow an intensity of engagement and openness of exploration that is empowering and fast acting. A student seeks help in his or her late teens, often for the first time, in acute distress, because ways of coping have failed. The combination of heightened emotion and motivation to change calls for a rapid, containing and educational response. At Manchester we see 92% within two days of help seeking and 53% straight away. Often, first time help seekers can quickly benefit from such an approach and reformulation, plus one or more follow up sessions, becomes the entire intervention. Such work seeks to solve a particular problem whilst highlighting a general lesson. However funding limitations mean that hard pressed university counselling services don't want to convey the impression that surely every student would benefit by a brief series of CAT informed counselling sessions in order to develop a more competent executive self to cope with the rough and tumble of personal and academic development during university years.
A CAT informed student counselling service is also well placed to cope with more severe and enduring problems including promoting self care during serious episodes of mental ill health and working in a more sustained way with elements of personality difficulty and disorder. A student interrupted one course following a serious psychotic episode, the onset and early management of which may have been masked by the over valuation of self reliance, heavy drinking, drug use and over striving to do well and keep up with studies whilst his health was deteriorating. Careful planning of a new start two years later at a different university was helped by a combined approach; working with a CPN and keeping in mind the risks inherent in the academic and life style pressures of student life.
Very simple CAT diagrams highlighting one or two procedures can be the centre-piece of counselling lasting no more than four sessions. Mapping things out begins very quickly in session one. Here, in diagram 2, Rosa, an international student from South America and first year medic, came for the first of four sessions spread over the whole of her first year. It was just after Christmas and she was resolved to quit and go home. She was disappointed in university and felt very controlled by her mother who wanted her youngest child and only daughter to be at home. We put 'controlling to controlled' in a circle on a blank piece of paper and within minutes had linked in the 'bottling up' and 'getting an upset stomach' procedure which had prompted her visit to her GP who had referred her for counselling. She was very distraught and embattled with herself. Whilst in mental health terms her problems weren't severe the impact of dropping out of university and the loss of esteem would be considerable for her. The CAT diagram helped her overview the crisis. The diagram was an eye opener for her. Towards the end of session one a homework assignment was to see what happened if she spoke up for herself or was more assertive letting her feelings out rather than keeping them in. Two weeks later she reported she had got very cross with a boyfriend and we tentatively explored the parallel patterns of feeling controlled by others such as her mum and being controlling of others. Just over the horizon, but not yet easy to address, were patterns of eliciting control from others (her flat mates, her studies, or me, and/or her mother) and controlling and attacking herself. Rosa was ready to take an executive view of herself and monitor how she reacted to and interacted with others. The CAT diagram helped shaped her journey and offered a corrective tilt to the emotional compass giving her more room to tolerate her strong feelings. On CORE scores she was much improved and such improvement wouldn't have been achieved without the perspective taking and containing power of the CAT diagram and its higher level description. More significantly, eight months later she began her second year at university and at a brief follow up meeting reported a more 'give and take' relationship with her mother where she could see how she also could push her mother around.
Diagram 2. Rosa's diagram completed in sessions one and two of four session CAT
The mental health of students and staff in higher education is not just a welfare issue but one that goes to the heart of the academic experience. We all need good mental health, and we all have times of vulnerability whether through crises, stress, over-tiredness, disappointment or the pressure of our own and others' expectations. The process of sustaining motivation, focus and concentration is a challenge that may at times disturb us all. In this context psychological and relational competencies are essential to contemporary academic achievement. The University of Manchester and UMIST Counselling Service has sought to change existing perceptions of its work as peripheral to the purpose of higher education and embed its work at the heart. We have sought to reduce the stigma of help-seeking and give a positive and normal image both to having difficulties and learning better ways of coping. With the help of CAT's cognitive-relational model, we have learnt more about the interplay of mental health and academic achievement and want to enlarge the ways we deliver psychological help. Wherever possible the use of psychological education to develop relational understanding will be as important as individual counselling or psychotherapeutic work. The group will be as important as the individual.
For all parties to higher education an approach is needed which picks up on the relational and interactive nature of learning and which doesn't collude with an idealised version of the lone learner battling with him or herself. This is particularly useful for young adults exposed to a challenging mix of achievement pressures, social freedoms, self reliance and communal living for the first time.
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Cognitive Analytic Therapy (CAT) and (Open) Groups with Adolescents within an Inpatient Psychiatric Setting: Initial Thoughts and Experiences
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What's it like to have Cognitive Analytic Therapy?
Sloper, J., 2002. What's it like to have Cognitive Analytic Therapy?. Reformulation, ACAT News Spring, p.x.
Book Review - INTRODUCING COGNITIVE ANALYTIC THERAPY PRINCIPLES AND PRACTICE: Anthony Ryle and Ian B Kerr
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Brilliant or Doomed: Cognitive Analytic Therapy and Relational Intelligence in Higher Education
Potter, S., 2002. Brilliant or Doomed: Cognitive Analytic Therapy and Relational Intelligence in Higher Education. Reformulation, Autumn, pp.8-12.
CAT and Cognition. A Personal View and Conference Report
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Developing New Systems for ACAT Administration and Communication
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Differences Between Borderline and Narcissistic Personality Disorders
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In Celebration of Integration and Diversity. CAT in the West Country and Beyond
Fawkes, L., 2002. In Celebration of Integration and Diversity. CAT in the West Country and Beyond. Reformulation, Autumn, p.5.
Time Limited Therapy: A Necessary Evil in the Managed Care Era?
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Update on The Melbourne Project - Prevention and Early Intervention for Borderline Personality Disorder
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