quality education for a healthier scotland psychology sofmh school of forensic mental health brief...
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Quality Education for a Healthier Scotland Psychology SoFMH School of Forensic Mental Health CAT Radically Relational Almost everything we do is acted out in relation to a real, imagined or anticipated other. Lev Vygotsky – Activity Theory. ‘All higher mental functions are internalised social relationships’TRANSCRIPT
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Brief Overview of CATMark C. Ramm, NHS Lothian
Integrative
“A theory based on the integration and extension of ideas and methods used in conventionally opposed approaches”
(Anthony Ryle)
More than just Cognitive and Psychoanalytic
CognitiveBehavioural Psychoanalytic Developmental Social
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Brief Overview of CAT
Distinctive individual psychotherapy
CAT accepted as a distinctive and Independent form of psychotherapy
- Roth & Fonagy (1996)
“An integrated theory of personality and change”
So applicability to a wide range of situations, problems and settings
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health CAT Radically Relational
Almost everything we do is acted out in relation to a real, imagined or anticipated other.
Lev Vygotsky – Activity Theory.
‘All higher mental functions are internalised social relationships’
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
How does CAT approach it ?Relational:
Understands this in terms of Reciprocal Roles (derived from Object Relations)Most distress in human beings is relationship based
self and othersself and self
Dynamic: Understands how people can act very differently at different times and in different contexts
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
DEVELOPMENT
Babies are born attuned to interact with othersEach baby has its own genetic predispositions
The baby interacts with carers who are massively influential - Attachment issues
The infant internalises its experienceForms joint understandings with others Forms concepts about self and others
Formation of Relationship templatesFormation of Reciprocal Roles
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health Developmental Psychology
The ‘self’ emerges from our experiences with others
This forms our basis for our feelings about ourselves and for predicting how others will be
The core premise of CAT is that the child learns acquires and learns to convert interpersonal experiences into intrapersonal processes and templates
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
RECIPROCAL ROLES
Mother or Main Other(Critical & demanding)
SELF (Unworthy & Striving)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
RECIPROCAL ROLES
Mother or Main Other(Critical & demanding)
SELF (Unworthy & Striving)
Other(Critical & demanding)
SELF(Unworthy & Striving)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
RECIPROCAL ROLES
Mother or Main Other(Critical & demanding)
SELF (Unworthy & Striving)
SELF(Critical & demanding)
Other (Unworthy & Striving)
Other(Critical & demanding)
SELF(Unworthy & Striving)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
RECIPROCAL ROLES
Mother or Main Other(Critical & demanding)
SELF (Unworthy & Striving)
SELF(Critical & demanding)
Other (Unworthy & Striving)
SELF(Critical & demanding)
SELF(Unworthy & Striving)
Other(Critical & demanding)
SELF(Unworthy & Striving)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
The self emerges from our experiences with others
This forms the basis for our feelings about ourselves and for predicting how others will be.
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Reciprocal Roles are therefore
The templates for all subsequent relationships
Interpersonal (self - other)Intrapersonal (self - self )
Are the basis of our dialogical selves. Our various internal voices (Implications for understanding psychosis)
Are the ‘origin’ of much Intra-personal conflict and associated distress
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
BALANCED PERSONALITY ORGANISATION
A Reciprocal Role is a block of procedural knowledge about how to ‘do’ a particular relationship and what to expect from it (Denman 2001)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
“RIGID” PERSONALITY ORGANISATIONRestriction and distortion of the Reciprocal Role
Repertoire
Particular Reciprocal Roles have a dominance and extreme polarization or there are a limited in number of Reciprocal Roles.
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Dynamic state dependent functioning
How we think feel and remember is to a large extent state dependent
We move in and out of our states and prefer to be in
some rather than others
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Procedures and the maintenance of problems
The cause of problems in some shape or form is:
The person develops strategies or procedures to cope
Abusing
Abused
Unmet needsNegative emotion
Stress
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Procedures and the maintenance of problems
Abusing
Abused
Unmet needsNegative emotion
StressAvoiding
Ignoring problem,drinking, runningaway (feels better)
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Procedures and the maintenance of problems
Abusing
Abused
Unmet needsNegative emotion
StressAvoiding
Ignoring problem,drinking, runningaway (feels better)
Doesn’t solve
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Procedures and the maintenance of problems
Abusing
Abused
Unmet needsNegative emotion
StressAvoiding
Ignoring problem,drinking, runningaway (feels better)
Doesn’t solve Alternative ReciprocalRoleProcedure
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Self States
Self states connected by procedures and relationships
Dynamic state dependent functioning. How we think feel and remember is to a large extent state dependent. We move in and out of these states and prefer to be in some rather than others
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Self State Disorders
Disruption of integrating proceduresDeficient and disrupted self reflectionDissociation of self-states (Multiple Self States Model)
Confused, Can’t think, Unstable
Dissociation normal
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
Ramm & Mair 2009
Issues disrupting Attachment
Dismissive Avoidant Attachment Styles
Poor Coping Skills
• Poor emotional regulation
• Interpersonal difficulties
• Poor mentalisation
PERSONALITY DISORDER PSYCHOSIS
Quality Education for a Healthier Scotland
Psychology
SoFMHSchool of Forensic Mental Health
CAT
•Formulation & use of Formulation map Recognition, insight & self-awareness (diaries etc)Continued focus on MapDevelop insight
•Change MethodsHuge flexibility and range of therapeutic activity possibleCBT techniques/behavioral experiments/IPTMentalisationOccupational interventions Art workPsychodramaActive use of the therapeutic relationship
•ExitsNew strategies/ways of coping/relationships developed