Louise Elwell, 2017. Using The Parent-Adult-Child Model Alongside CAT. Reformulation, Winter, p.43.
Twelve years ago, when I started a communication skills group for day-patients where I work, (Cardinal Clinic), I started to use the basic Transactional Analysis model with group members to think about their position, whether Parent-derived, Child-derived, or Adult, in the communications we were working on. (Fundamentally, this is object relations, as integrated into our SDRs and our CAT work, but differently presented.) I was very interested by how quickly people made use of the model to think about relationships, communications, or sometimes just themselves. I have gone on to use it in my individual work with clients, especially where confusion in relationships needs addressing rapidly, and it often proves extremely useful to our work. I always try to make sure now that I offer it at some point in the treatment. Once, although I almost invariably use the CAT model, we ended up simply using the PAC model, as it addressed the client’s needs to work with his family to change long-standing patterns of expectation and behaviour. In fact he ended-up sharing the model with them: it worked well.
In CAT terms, I think it can elaborate the Exit Procedures work. More specifically it actually proposes a way forward immediately with a model for how one might proceed with others, especially in difficult relationships, how to communicate in these, and why. So like our Reformulation, it provides an analysis, a rationale and a map. My version of it focuses on power relations, because I find it is very helpful for clients to have a way of negotiating these confidently; this is frequently an issue for them, for everyone in fact! And of course, this new confidence increases a sense of efficacy and therefore self-esteem; thus mood is usually also improved. The version that I have over time developed for myself and my clients complements the Reformulation and the thrust of its work. The model also lends itself to clarity about the different levels of functioning, which is always helpful. Thus suggestions/interpretations along the lines of ‘it may be that at the Adult level you are thinking and feeling that this is the right way forward, but at the Child level, you are still upset and wanting to keep yourself safe’,(i.e. inner conflict), become clearer I believe. The model is also very useful for monitoring ‘self-talk’.
I present the P-A-C model at any point that it appears to be helpful, as with the SDR, sitting alongside the client and drawing it out with them. We discuss it as we go, and I use coloured pens, which makes it more fun and therefore more memorable. But the notes alone would probably mean little without real discussion beforehand, and might just seem like another thing to grapple with.
I have simplified some of the language used in T.A.. Just as I tend to use the terms ‘patterns’, ‘questionnaire’ and ‘diagram’ in CAT, I believe the less jargon we use with patients, the more readily usable a model is, and being usable is the aim. (I am always heartened to remember Freud did not coin the terms Ego, Id and Superego, which I think are daunting and smack of exclusivity; they came from the English translation from the German. He used much simpler, everyday terms.) You will see, there is no place on the diagram, as it stands, for idealised parent/child; this keeps it simple and quickly recognisable, but one could use the diagram creatively, with colours, or otherwise, if needs be! However, I think that simplicity is of the essence.
These are my first notes on it, written for a client who asked for them. It is hard to be both very concise and clear enough – writing a book would have been much easier I think! – so I would welcome feedback. Or indeed if you would like a copy of the notes, and/or a larger diagram, please contact me: firstname.lastname@example.org. With thanks to Ben Elwell for the diagram.
Using a template to draw diagrams in Cognitive Analytic Therapy
Jenaway, Dr. A. and Rattigan, N., 2011. Using a template to draw diagrams in Cognitive Analytic Therapy. Reformulation, Summer, pp.46-48.
A credit-card sized SDR and its use with a patient with limited language skills.
Fitzsimmons, M, 2000. A credit-card sized SDR and its use with a patient with limited language skills.. Reformulation, ACAT News Autumn, p.x.
K.I.S.S. (Keep It Simple. Stupid) - Reflections on Using CAT with Adolescents and a Couple of Case Examples
Jenaway, A., 2009. K.I.S.S. (Keep It Simple. Stupid) - Reflections on Using CAT with Adolescents and a Couple of Case Examples. Reformulation, Winter, pp.13-16.
A case study of cognitive analytic therapy with a client diagnosed with psychotic depression
John Cartmell, 2017. A case study of cognitive analytic therapy with a client diagnosed with psychotic depression. Reformulation, Winter, pp.22-27.
Clinical Outcomes Of Cognitive Analytic Therapy Delivered By Trainees
Darongkamas, J., Newell, A. Hewitt-Moran, T. & Jordan, S, 2017. Clinical Outcomes Of Cognitive Analytic Therapy Delivered By Trainees. Reformulation, Winter, pp.38-42.
Concepts of the Self, Social Inequality, Culture and Power in reflecting on therapeutic work with Asylum Seekers and Refugees: A Cognitive Analytic Approach
Dr Claire Wilson, 2017. Concepts of the Self, Social Inequality, Culture and Power in reflecting on therapeutic work with Asylum Seekers and Refugees: A Cognitive Analytic Approach. Reformulation, Winter, pp.44-47.
How CAT-Informed Practice Can Help To Improve Mental Health Services
Ben Bell, 2017. How CAT-Informed Practice Can Help To Improve Mental Health Services. Reformulation, Winter, pp.33-37.
On Learning From Our Patients: Reformulating CAT Training
Robert Marx, Joanne King, Kylie, Mary Wilson-Verrall, Karen Spencer and Annabel J McDonald, 2017. On Learning From Our Patients: Reformulating CAT Training. Reformulation, Winter, pp.13-18.
Perfectly Imperfect: Reflections of a Newly Qualified Clinical Psychologist in using CAT to Explore the Relational Contribution to Binge Eating
Dr Lyndsey Holt, 2017. Perfectly Imperfect: Reflections of a Newly Qualified Clinical Psychologist in using CAT to Explore the Relational Contribution to Binge Eating. Reformulation, Winter, pp.28-32.
When Therapy Feels Like A Roller Coaster Ride: A CAT Perspective
Dr Diane Agoro, 2017. When Therapy Feels Like A Roller Coaster Ride: A CAT Perspective. Reformulation, Winter, pp.19-21.
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