Sequential Diagrams, Reflections and Suggested Revisions

Ryle, A., 1998. Sequential Diagrams, Reflections and Suggested Revisions. Reformulation, ACAT News Autumn, p.x.

Sequential Diagrams, Reflections and Suggested Revisions

Tony Ryle

Evolving theory and practice are characteristic of CAT and reflect a healthy refusal to establish immutable doctrines, but it is difficult for trainees (and supervisors) to keep up with, comment on, challenge or propose changes. The newsletter is increasingly the obvious place for this to happen, so I hope this brief paper on revising priorities in the construction of sequential diagrams will elicit discussion as well as groans.

I have come to feel that the requirement to produce sequential diagrams in the early sessions can lead to the production of misleading, inaccurate or inadequate versions, and that these may sometimes reflect the early impact of transference - countertransference collusions which effectively leave out or obscure the issues which need to be addressed in the therapy. I would propose the following as a more effective procedural sequence:

I) From the first session, think reciprocally. Every story and interchange will reflect a dialogue between the individual and an actual or fantasy other, or between aspects of the self Both poles of every reciprocal role relationship (in Leiman’s terms, both participants in the dialogue) need to be identified. Traps, dilemmas and snags, which serve to identify recurrent unrevised problems, are all capable of expression in reciprocal terms.

2) From the history, psychotherapy file and your developing relationship, assemble, in consultation with the patient, the repertoire of reciprocal roles.

3) Discuss how both poles of all of these roles have been, or may be, enacted by the patient and elicited from others, including you. Where, as often happens, direct role enactments are replaced by symptomatic or avoidant alternatives, the avoided role must be identified or hypothesised and less damaging alternatives explored. In the case of dangerous or therapy -threatening procedures, this needs to be done early. It is only by knowing a patient’s repertoire that therapists can stay out of it.

4) Only when role patterns are clearly described and reliably recognised can transitions between them be monitored and their provocations and consequences are identified. In time, this allows an SDR to be made.

5) Core pain, unmanageable feelings and unmet needs. The danger of the term “core pain” is that it feeds the therapist’s need to be a nice rescuer and can ignore the accompanying core rage or the patient’s reciprocal abusive potential. Writing “unmanageable feelings” invites exploration of them, and serves to indicate the source of defensive procedures. The term “unmet needs” both acknowledges past experience and shows how it is the consequence of the patient’s current procedures. If a number of role enactments (direct or symptomatic) fail to meet needs, the different enacted procedures may be traced to a common intersection or “crossroads”. This is often the point at which unmanageable feelings erupt or threaten to erupt, leading to enacted violence or self- medication (substance abuse).

6) Identifying and mapping borderlines. Look for evidence of sudden, inappropriate or inexplicable jumps from one pattern to another and explore this (using the “difficult and unstable states of mind” section of the file or other questions). If patients can identify separate self-states and if they describe confusing transitions between them, make a Self States Sequential diagram (SSSD). The common role patterns of these dissociated states are abuser - crushed victim, abuser - revengeful victim, Ideal care giver - ideally cared for, admiring - admired, Blanked off- threatening or absent, controlling - compliant.

7) A “complete” diagram constructed in this way should accommodate all the patients reported and enacted behaviours. If a diagram does not offer a satisfactory place to locate a significant reported event, change it (remember Procrustes).

8) Therapists need good diagrams which prepare them for every transference pressure and which makes them quick to identify every story or enactment as it presents. The priority is to describe the underlying reciprocal role patterns and the sequences leading to destructive enactments, Colour coding the reciprocal role procedures, whether these are described in a single core or as located in separate self-states, helps. Make it simple enough to be memorable. The same diagram may suit the patient but often a simpler version is adequate or partial diagrams highlighting currently central issues may be used. For some patients the use of images or verbal descriptions in terms of traps dilemmas and snags may work better. Diagrams, as mnemonic devices, are useless unless they are memorable.

9) Exits indicating alternatives to damaging procedures need to be elaborated early. Later, the internalisation of new reciprocal role patterns for which therapy has provided a preliminary model can be usefully indicated.

Tony Ryle

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Full Reference

Ryle, A., 1998. Sequential Diagrams, Reflections and Suggested Revisions. Reformulation, ACAT News Autumn, p.x.

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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.

History and Use of the SDR
Ryle, A., 2003. History and Use of the SDR. Reformulation, Autumn, pp.18-21.

The Development of the Sequential Diagrammatic Reformulation
Parkinson, R., 2008. The Development of the Sequential Diagrammatic Reformulation. Reformulation, Summer, pp.33-37.

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

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

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Sequential Diagrams, Reflections and Suggested Revisions