Boa, C., 1998. SDR's for Beginners. Reformulation, ACAT News Autumn, p.x.
Annie’s excellent contribution to the August 1997 Newsletter, her article “Beyond State Shifts - Metashifts” -moves me to put pen to paper in an appeal for us not to lose sight of the original, simple SDR - her fig.2 - as a useful introduction to CAT for raw beginners.
In our necessary, and exciting, search for ever more relevance and accuracy in theoretical explanation - especially in understanding and treatment planning for unpopular and difficult to deal with patients, it seems important we should not abandon a simpler explanatory model that is perhaps the carrot to attract future trainees. I am talking about a graphic representation of the written reformulation, a clear and coherent Sequential Diagrammatic Representation which, while over-simplistic in current CAT thinking, is nevertheless the acorn from which we grew, and which I believe is still more than good enough for a starter.
A major part of my work is involved with introducing ‘naïve’ subjects to basic theory and practice methods of CAT. CAT-naïve trainees come with a hodgepodge of mostly poorly digested theories, ranging anywhere from Rogerian person-centred to classical psychoanalysis. Few that I have met have really thought through their “theory of person” and what sort of consequent change the person may be helped to initiate. Yet CAT-initiates tend to hold fiercely to their first learned theory and in the new learning experience, to be reluctant to have these ideas challenged.
Rarely have I encountered resistance to the idea of reciprocal roles. Whatever the trainee’s theoretical preference, the intention to hear and to help the “hurt inner child” is acceptable. That the hurt child has experienced a similarly “hurtful adult” is also readily understandable, and it is a short step from there to recognise that these roles have been internalised and are acted out in specific situations. The conflict set up between these roles - the admitted and the denied, which masks unmanageable feelings, may seem more complex at first but when clearly explained is generally accepted as the focal point of most therapies.
So in earlier CAT times we had the “central issue” or “core pain”, including the unknown but to-be-discovered unmanageable feelings, as what could be described as the driving engine. The energy generated by this central conflict motivates the procedures, that is, the behaviours devised to escape the central conflicted state. These behaviours, more often than not, proceed to loop back in self-defeating patterns, to the original limited choice of roles.
A very simple graphic model can demonstrate the above. Once we have found the reciprocal roles I encourage trainees to think about how the person trying to escape their particular conflict would act in and on the outside world -for example what sort of career has been chosen, how well was school life managed - perfectionist striving perhaps? An alternative route out of the central issue is the search for a particular kind of relationship; the therapeutic work is then to see how, given the reciprocal role repertoire, such a relationship gets into difficulties, falters and fails.
The conflicted core state plus these two directional escape routes I find adequate to put across, in what is generally very limited time, the basic ideas incorporated in the PSORM. The model does not appear to assault any major theoretical standpoint and its explanatory power is usually accepted, often with a degree of “aha”, by a wide range of trainees of different “persuasions”.
I appreciate this model has been superseded, both for what Annie calls the RWIP’s (relatively well integrated personalities) and especially for more complex patients, (PIP’s - poorly integrated or borderline personalities) who have several ‘state shifts’, and the object of further training is to develop deeper understanding and greater descriptive accuracy. However, I feel it to be an important aid to puffing over the essential circularity of the PSORM that we retain the central core states. As supervisor, I have seen some SDR’s, which, while excellently depicting reciprocal roles, have emanating procedures which trail off without coherence or logical progression.
It would seem such SDR’s get caught in a dilemma similar to that found in neuroscience, where it is observed that several neuronal firings are going on at once but there is no clear indication why one particular stimulated firing takes precedence, in terms of behaviour, recognition or consciousness, over the others. Is the signal stronger, more insistent, reinforced by similar firings, more relevant to the specific situation? In CAT terms why does one reciprocal role activate or dominate in which specific situation? But to get back to our CAT “naïve” population. They may have heard something of the value of CAT as therapy, and of its research possibilities in an increasingly dose-related, evidence-based profession. I am asking that we continue to respond to this interest with something immediately accessible and “de-mystified” - a graphic representation illustrating the continuous interaction of cognitions, emotions and behaviour.
The Development of the Sequential Diagrammatic Reformulation
Parkinson, R., 2008. The Development of the Sequential Diagrammatic Reformulation. Reformulation, Summer, pp.33-37.
CAT and its Relationships to Non-CAT - Preliminary Thoughts About Annalee's Diagram
Nehmad, A., 1993. CAT and its Relationships to Non-CAT - Preliminary Thoughts About Annalee's Diagram. Reformulation, ACAT News Winter, p.x.
The Special Needs Project (CAT For Borderline Patients)
Ryle, A., 1995. The Special Needs Project (CAT For Borderline Patients). Reformulation, ACAT News Winter, p.x.
Sequential Diagrams, Reflections and Suggested Revisions
Ryle, A., 1998. Sequential Diagrams, Reflections and Suggested Revisions. Reformulation, ACAT News Autumn, p.x.
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