Sep 15, 2011 - object position with regard to the presenting problem to a changed relationship that can be named subject position (empowerment, better ...
CAT as integrative therapy Mikael Leiman 4th International CAT conference Kraków, Poland September 15-17, 2011 15.9.2011
Mikael Leiman
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“Collaborative Action Therapy” • Reformulation as the heart of CAT practice – Respect the client’s zone of proximal development • Create with the client • Use portable formulations and descriptions
• Flexible ways of working – – – – 15.9.2011
Push where it moves Avoid getting stuck in a harmful counter position The three R’s (Reformulation, Recognition, Revision) Any technique that the client can use is permissible Mikael Leiman
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Dilemma in theory • Reformulation was originally based on integrating Repertory Grid findings with object relations concepts – Dyad Grids and reciprocal roles
• Traps, dilemmas, and snags were portable descriptions of repetitive action patterns – Three sources: behavioural therapy, grid studies, psychoanalysis
• Procedural sequence model (PSM) as an explanatory framework for dilemmas, traps, and snags – A cognitive sequence model – How do cognitive and object relations views relate to each other? 15.9.2011
Mikael Leiman
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Back to Relational CAT • All actions have an object (internal or external) • Actor and object are reciprocally positioned • There are no actions without a counter positioned objects (a thought object, a material object or a thing, another person, etc.) • Activity may be described as sequences of reciprocation; the counter-positioned object directs the person’s movement in the sequence 15.9.2011
Mikael Leiman
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Traps as reciprocal sequences • Placation trap – “Feeling insecure and worthless (position 1), I accommodate (position 2) to others’ demands or wishes (counter position 2), which makes me resentful (position 3). I act childishly and foolishly (position 4) ending up feeling ashamed of myself and worthless (position 1).” – Notice the self critical reciprocal pattern in the words “worthless” , “childish”, and “foolish” 15.9.2011
Mikael Leiman
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Reciprocal roles in trap worthless
gives in
resentful
angry ??
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critical, judgmental ?
Intra psychic: self to self
expects, wants
Interpersonal
unreasonably demanding ?
Intra psychic
offended/ angry/ dismissive ?? Mikael Leiman
Interpersonal 6
Dilemmas as one-position mini sequences • “Either I keep feelings bottled up or get out of control and make a mess.” • “If I must, then I can’t/won’t.” • “Either looking after or abandoned.” • “If close, then smothered.”
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Mikael Leiman
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Dilemmas as mini sequences helpless
attacking
painful memory
protecting position
unconcerned (bottled up)
naively accepting ??
intolerable position angry, upset (out of control) 15.9.2011
??
Mikael Leiman
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Snags as alternatives to forbidden positions • Aims are abandoned because internal prohibitions or due to the fear that others might oppose them • As dilemmas, snags tend to have a threefold sequence. – Actions are diverted to a permissible reciprocation between actor and objcet – Instead of an “intolerable position”, the avoided alternative is a “forbidden position” 15.9.2011
Mikael Leiman
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From object position to subject position • All psychotherapies strive to bring clients from the object position with regard to the presenting problem to a changed relationship that can be named subject position (empowerment, better self-management, possibility to choose actions instead of compulsive repetition) • All psychotherapies try to create a position from which the problem and the action patterns that maintain it can be observed, first jointly and then individually • All psychotherapies use the double action of expressing and observing, what has been expressed 15.9.2011
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The meta-model of psychotherapy process
Underlying patterns
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Mikael Leiman
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Differences • Models of psychotherapy differ in the ways they conceptualize the relationship between the presenting problem and the underlying action patterns • Technically, they differ in ways by which they structure client expression, self observation, and encourage alternative action patterns – CAT is unique in its way of conceptualizing human activity (the Semiotic Object Relations Theory) – CAT is integrative in its flexible ways of using the techical tools of structuring expression, observation, and action experimentation 15.9.2011
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