Ryle, T., 2010. The Political Sources of Reciprocal Role Procedures. Reformulation, Summer, pp.6-7.
I recently re-visited an old church in Sussex which I had last been inside about 60 years ago, shortly after the end of the war. At that time I had been enraged by a seventeenth century pre-civil war fresco of the lion and the unicorn, with a quotation from Hebrews advising the congregation to ‘Obey them that have the rule over you’, a sentiment which did not accord with the spirit of the times or with my egalitarian convictions. It is still there and in addition I noticed another fresco in the arch of a window. At first sight it looked like a flower with two legs sticking out of it, but a closer inspection showed the flower to be the skirt of an upside down woman whose red hair was leading her plunge down, I presumed, to Hell. The message seemed clear: Do what you are told and look at the consequences if you don’t. But here my bias had led me to an incorrect interpretation; a brochure informed me that the figure was of an uncertainly identified female saint—possibly St Wilgefortis—tied upside down on a St Andrews cross, a habit that had apparently enjoyed a brief vogue. It still seemed to refer to human oppression and cruelty, but did offer victims the possibility of becoming saints.
As it has developed, CAT has moved steadily away from the individual, ‘in the head focus’ of most historical and contemporary understandings of human psychology; few other therapy models have concerned themselves with the social formation of individual personality. The frescos of St Wilgefortis and the words on the wall are conventional signs from a particular era which were clearly designed to persuade the parishioners to know their place. What I want to suggest is that, in our understanding of the social formation of individual personality and in identifying the sources of our patients’ RRPs, we may fail to identify equally powerful but less obvious contemporary influences.
The blatant directness with which authoritarian power was exercised made it clear that you had to know your place. With the evolution of increasingly complex societies, the interests of the powerful were less overtly imposed, being enshrined in institutions, justified by religions, embodied in laws, and only brutally enforced when seriously threatened. The powerful still needed to gain acceptance of their underlying values, but this depended less on direct control and more on the shaping of their citizens’ personalities. In place of obedience the human qualities needed in a mercantile society, such as a positive evaluation of individual ambition and aggressive competitiveness, were-and are- encouraged. To question one’s place in this brave new world requires one to understand how, and in whose interests, one’s personality has been shaped. One has to know oneself.
CAT theory has drawn on Mead’s suggestion that social relationships are replicated within the structure of the self and on Vygotsky’s understanding of the social formation and maintenance of the individual self. Assumptions passed on within the family are rarely reflected on and many are examples of Blake’s ‘mind-forged manacles’, which impose the qualities required by the society and determine the agendas and limits of personal life. These social forces do, of course, provoke some opposition and may be challenged by the ideas of the articulate few, but they also engender the distresses which bring people to psychotherapy.
Psychotherapists, however, seldom spell out how damaging individual values and assumptions may be derived from the past and present interests of the powerful, in part because they too are shaped by the same forces. And all too often psychotherapy theories reflect the ideologies and interests of the powerful. The Freudian superego, for example, is not a human universal, it is an internalized representative of the nineteenth century European ruling class. The internalized forces of rebellion and protest are dismissed as the id, a disruptive remnant of our animal nature, dangerous and forbidden and needing to be repressed. What was seen to be universal and innate is the result of the internalization of the reciprocal class roles of ruler and ruled and as such both reflected and served to support the ideology of the capitalist culture of 19th and 20th Europe.
Our culture, although predominantly hierarchical, has many voices. We can replace a passive acceptance of the ideas of the socially dominant with an exploration of an infinitely rich and complex critical and oppositional dialogue. But do we? In CAT practice, despite our awareness of the social formation of individual personality, we reformulate our patients’ difficulties largely by identifying the reciprocal role patterns evident in their parents and families and fail to explore adequately the historical antecedents of these or the influence of their current social realities in determining the agenda of their lives.
In the political sphere dominant social forces determine what is said and what may not be said. For example, the world economic crisis is discussed as if it were a natural catastrophe such as a Tsunami or the result of an outbreak of moral weakness among a few bankers, rather than noting that greed is a necessary aspect of finance capitalism. We commit a similar distortion if, in therapy, we restrict our attention to the immediate family and leave wider forces off the agenda. Social and historical influences form aspects of the self which feel innate or ‘given’ and which, in most cases, have never been articulated, let alone questioned. In our work as psychotherapists we should recognise and name them.
What is true in individual clinical work is also true of our role in society as a profession. Psychotherapists are well placed to recognize the harmful effects on individuals of both current and of internalised historical and social factors. But the track record of the profession is not good. For a long time psychoanalysis was content to be a commodity purchasable by the rich, rather than a critical witness and all too often psychotherapists, psychiatrists and psychologists have followed where they might have led. For example, in recent decades public attitudes to gender inequality and to racism have become more civilized. But professional organizations took little part in encouraging these changes and in some cases even offered spurious ‘scientific’ support for the now discarded prejudices.
Because, as therapists, our work is private, some would argue that we do not have the right to speak up. I would ask if we have the right to remain silent? We live in a dangerous and unhappy world and are well placed to know some of the human costs, even though we have no claim to know the solutions. Our care for those damaged by it is humanly valuable but could be likened by a cynic to the provision of buckets to those affected by rising sea levels! In our clinical work we should ensure that, in reformulating our patients’ distresses, we attend to the ultimate as well as intimate causes. And we should speak up as a profession, not claiming more authority than we have, but adding our professional witness to the public dialogue. We should not join the sleepwalkers.
Tony Ryle is the Oldest (still working-a bit) Inhabitant of the CAT village and is President of ACAT. He qualified in medicine in 1949 and worked successively in general practice, a University Health Service and as Consultant Psychotherapist until retirement from the NHS in 1992. CAT emerged from his clinical and research activities from the 1960s on and involved increasing numbers of colleagues since the 1980s.
The ethical implications of social class in the practice of CAT
Lucy Howe, 2013. The ethical implications of social class in the practice of CAT. Reformulation, Summer, p.36,37,38,39.
Thoughts on the Inner Dialogue Between a CAT Therapist and Karl - I am not a marxist - Marx
Welch, L., 2004. Thoughts on the Inner Dialogue Between a CAT Therapist and Karl - I am not a marxist - Marx. Reformulation, Autumn, pp.24-26.
Research and Cognitive Analytic Therapy: What do we need to know?
Pollard, R., 2001. Research and Cognitive Analytic Therapy: What do we need to know?. Reformulation, ACAT News Autumn, p.x.
Australia and New Zealand Unites Again; This Time to Consolidate the Promotion & Practice of CAT in the Region
McCutcheon, L., 2010. Australia and New Zealand Unites Again; This Time to Consolidate the Promotion & Practice of CAT in the Region. Reformulation, Summer, p.50.
Book Review: Self-Harm Assessment in Young People â€“ A Therapeutic Assessment manual By Dennis Ougrin, Tobias Zundel and Audrey V. Ng Published by Hodder Arnold, 2010
Jenaway, Dr A., 2010. Book Review: Self-Harm Assessment in Young People â€“ A Therapeutic Assessment manual By Dennis Ougrin, Tobias Zundel and Audrey V. Ng Published by Hodder Arnold, 2010. Reformulation, Summer, p.49.
Cognitive Analytic Therapy and the Role of Brief Assessment and Contextual Reformulation: The Jigsaw Puzzle of Offending
Mitzman, S. F., 2010. Cognitive Analytic Therapy and the Role of Brief Assessment and Contextual Reformulation: The Jigsaw Puzzle of Offending. Reformulation, Summer, pp.26-30.
Confidentiality and Good Record Keeping in CAT Therapy - A Discussion Paper
Brown, H., 2010. Confidentiality and Good Record Keeping in CAT Therapy - A Discussion Paper. Reformulation, Summer, pp.10-12.
Reflections on ACAT Relational Skills in CAT Supervision Course â€“ December 2009
Coombes, J., Dunn, M., 2010. Reflections on ACAT Relational Skills in CAT Supervision Course â€“ December 2009. Reformulation, Summer, pp.46-47.
The Development of a 12-Session CAT Therapy for Use in a Workplace Setting
Collins, J., 2010. The Development of a 12-Session CAT Therapy for Use in a Workplace Setting. Reformulation, Summer, pp.13-16.
The Development of a Cognitive Analytic Therapy (CAT) Relational Framework for Bipolar Disorder (BD)
Shannon, K. and Swarbrick, R., 2010. The Development of a Cognitive Analytic Therapy (CAT) Relational Framework for Bipolar Disorder (BD). Reformulation, Summer, pp.17-25.
The Political Sources of Reciprocal Role Procedures
Ryle, T., 2010. The Political Sources of Reciprocal Role Procedures. Reformulation, Summer, pp.6-7.
Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship â€“ A Case Example
Bristow, J. and Reason, A., 2010. Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship â€“ A Case Example. Reformulation, Summer, pp.31-33.
Thoughts and Experiences of the Application of Cognitive Analytic Therapy to Clinical Work with Adolescents
Mulhall, J., 2010. Thoughts and Experiences of the Application of Cognitive Analytic Therapy to Clinical Work with Adolescents. Reformulation, Summer, pp.34-36.
Will ACAT Join Other Professional Bodies in Calling for an End to the Detention of Families with Children?
Toye, J., 2010. Will ACAT Join Other Professional Bodies in Calling for an End to the Detention of Families with Children?. Reformulation, Summer, pp.47-48.
Words With Arrows The Benefits of Mapping Whilst Talking
Potter, S., 2010. Words With Arrows The Benefits of Mapping Whilst Talking. Reformulation, Summer, pp.37-45.
This site has recently been updated to be Mobile Friendly. We are working through the pages to check everything is working properly. If you spot a problem please email email@example.com and we'll look into it. Thank you.