A Brief Introductory Handout About CAT

Blunden, J., 1993. A Brief Introductory Handout About CAT. Reformulation, ACAT News Winter, p.x.


The Procedural Sequence Model

The Procedural Sequence Model represents the theoretical basis of C.A.T. It gives a general account of the sequence of mental and behavioural processes involved in the canying out of aim-directed activity.

  1. Define aim (maybe in response to external event)
  2. Check aim for congruence with other aims and values i.e. for personal meaning.
  3. Evaluate situation, and predict one’s capacity to affect it, and the likely consequence of achieving the aim.
  4. Consider the range of means or roles (sub-procedures) available and select the best.
  5. Act.
  6. Evaluate (a) the effectiveness of the action and (b) the consequences of the action.
  7. Confirm or revise (a) the procedure and (b) the aim.

In terms of this model, neurosis is understood as the persistent use of, and failure to modify, procedures that are ineffective or harmful.

Tony Ryle identified three major types of faulty procedures: traps, dilemmas, and snags.

Traps represent the reinforcement of negative beliefs and assumptions (stages 2 and 3) by acting (stage 5) in ways that evoke consequences which are, or are seen to be, confirmatory of negative assumptions (stages 6 and 7). In other words, a vicious circle of thoughts, feelings, and actions.

Dilemmas represent undue narrowing (false dichotomization) of the possible sub-procedures (stages 4 and 5). In other words, acting as if there are only two alternatives (each of which has adverse consequences).

Snags represent, for example, the inappropriate abandonment of aims (stage 7) due to a true or false perception or prediction of negative outcomes. The person acts as ~/ in accordance with an internal rule.

Common examples of traps, dilemmas, and snags are collected together in the psychotherapy file. A copy of this is given to each patient at the beginning of therapy.

Important Elements of Therapy

The usual length of a C.A.T. is sixteen once weekly sessions with a single follow-up session three months later. C. A.T. has been used over one, four, twelve, or twenty-four sessions.

The intention is for it to be a collaborative therapy in which both therapist and patient work veiy hard. Homework is usually set for the patient between sessions.

The task of the therapist is to identify target problems on which the patient wishes to work, and then to identify the target problem procedures (the traps, dilemmas, or snags) which lead to the target problems. The therapist spends the first three sessions gathering infonnation. In the fourth session he gives the patient a letter, the reformulation, in which he has written the patient’s stow and linked the patient’s past experiences to his present problems; the reformulation ends with a formal list of the target problems (T.Ps) and target problem procedures (T.P.Ps). The reformulation is discussed with the patient, and changed if necessaiy; by the end of the fifth session there should be a mutually agreed fonnulation of the problems and their cause. In the sixth session the therapist gives the patient another piece of paper, the sequential diagrammatic reformulation (SDR). This is basically the T.P.Ps ~witten in the form of a flow diagram and related to the patient’s core state (the patient’s internalised parentlchild roles from childhood). Aims deriving from the core state are not adequately met because, %ia the T.P.P, they lead back to a reinforcement of the core state.

The rest of the sessions are spent on helping the patient to recognise when his T.P.Ps are occuning, to plan alternative responses, to implement them, and see what happens. By doing this, the patient becomes more flexible in his emotional or actual responses.

The transference is an important consideration in C.A.T, as it is in other psychodynamic therapies; it is a valuable source of infonnation for the therapist and can be turned into a useflul learning experience for the patient.

The ending is an important event in the therapy and should be considered and prepared for from the beginning. During the final session, the therapist and patient exchange goodbye letters; these contain a summing-up of the therapy, and areas which still need to be worked on. The letters which are exchanged during C.A.T. (the reformulation and the goodbye letters) are often very moving.

Reference

Cognitive-analytic therapy: active participation in change. (1990) Anthony Ryle. Pub: Wiley.

Full Reference

Blunden, J., 1993. A Brief Introductory Handout About CAT. Reformulation, ACAT News Winter, p.x.

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