Therapy with a Map: Interview with the Author

Steve Potter, 2022. Therapy with a Map: Interview with the Author.  Reformulation 55, p. 9-14.

Therapy with a map. In conversation with Steve Potter

Talking therapies share the common theme of dialogue and wording within the human encounter.  Beyond which cognitve analytic therapy has drawn distinctively on the creative agency of mapping and writing to extend its reach further into the moment of therapy. 

Reformulation sets off to discover why maps are helpful in the course of therapy.  Interview with Steve Potter, author of Therapy with a map (2020)

Ed. – What’s Therapy with a Map about? 

Steve: It is a basic guide to doing CAT in a co-creative open dialogue with a client.  One third is about mapping as a conversational, narrative, relational process.  Another third is about the use of writing and the voice in therapy, and about CAT as a relational approach to developmental trauma. The final third of the book is about the details of doing CAT at the beginning, middle and end of a time-limited therapy.  I hope it is very practical and accessible. It sees CAT as an activity based psychoanalytic therapy using the ideas of reciprocal role procedures to hold and shaping the therapy journey on paper between us using the tools of mapping, writing and voicing. The word map in the title is used loosely to mean having a plan, shape, direction to the therapy.  

Ed. - This integration of the Vygotskian zone of proximal development into the playful Winnicottian therapy space embodies more than just speech in a talking therapy.  I’m wondering if it has become more than reinforcement of tactile, visual and sensory modalities but a richer multi-sensory sign-mediated activity.

I think of therapy as taking much from Winnicott with transitional activity and a transitional space with the map as a transitional object for client and therapist.   It is best not engineered like a road map of a fixed network.  It must serve as a fluid, projective, connective project. 

It’s definitely multi-sensory. The co-activity of mapping is tactile, visual and as one client put it “you can see what you are saying and touch what you are hearing”.  I think something containing interpersonally and integrative neurologically is happening when I see my words for an emotion such as sadness or fear on paper whilst also touching them with my fingers and voicing them in my mouth.  The co-authoring process of mapping is an aid to pacing the developing therapeutic conversation.   Are we in the zone not just of what can be understood cognitively but can be felt emotionally?  This is where I talk about hovering and shimmering. Hovering between different views, different ideas and big picture and detail is a key cognitive and dynamic element of therapy that you can only do with the aid of a live mapping and recapping process.  Shimmering equally is the ability to tolerate uncertainty and ambivalence about contrasting intensities of feelings or nuances within the same feeling and hold them in mind (and body) more safely by holding them in view on the map.   

Ed. - Just picking up firstly on the developmental strand: that notion of the touch and the sensory integration of the map that  reminds me of how when I was doing my Duke of Edinburgh Award … suddenly noticing that map reading requires a degree of skill to read a map.  Some of us don’t have these skills. Is this therapy with a map or is it a therapy with learning to read a map?

Steve: I think you are right some of us don’t have the skills for navigating where we are in our lives or where we are going or how we got here.  There is something intentionally reparative or healing about the detailed interpersonal process of mapping making together.  I think we are teaching the client to be their own therapist, moment by moment, by discovering how to be therapeutic together.  Mapping and writing and talking (the point is for them to activate and enhance each other) is our shared activity.   Incidentally, it occurs to me that the map on paper which might be quite elaborate and or messy is not the mental map in the client’s head.   The client, like the therapist, will be lighting on key words, links and gaps.  The whole point of working and reworking the map is partly to develop the therapeutic skills of noticing, naming and negotiating difficult thoughts and feelings but also reducing, refining the look and feel of the map until it has legs on it for the client.       

Ed. - So that feels quite important. The map is the object which has a referential network by the client and perhaps the relationship is what is internalised or encoded through the map.  That’s the sign mediation: the map mediates the relationship between therapist and client. Then the client feels connected to the map and draws self-referential connections.  This is like being nurtured or fed emotionally…  

Steve: If it is not nurturing it is wiser to stop.  I talk a lot about recapping the developing therapeutic conversation with the aid of the map.   The recapping is a key skill of creating that holding environment both interpersonally, dynamically and visually with the map.   I think the process of tidying up a seemingly messy map is a bit like putting the toys away together with children after playing.  It is important not to hurry it and see it as a process of revisiting and reworking what we have just been doing together.  At the time of reformulation letters and diagrams I will suggest it might help if I go away and make a neater version of the mapping we have been doing.    The client sometimes wants to grab the messy map (they have their tidy relationship in their mind of that mess).  And they have an attachment to it. 

Ed. - What does this say to the therapist who is striving for the perfect map? 

Steve:  I think striving for the perfect map is a symptom of something in the supervision or training that thinks there is a correct way to do things.   It tends toward doing the therapy and the mapping for the client rather than with the client.  CAT theory is practice-based, and the ideas are only as good as their moments of lived use in the therapy room. Reformulation must be built around the lots of little steps idea that follow Vygotsky’s catchphrase for the early learning relationship: what we think through and understand together today the client will think through and understand on their own tomorrow.   I think there is room in CAT for what I call a therapy map.  In the chapter on reformulation  I describe it as a tidier, more formulated map drawing from earlier sketches.  [Potter 2020]* We have sometimes called it a fridge door map meaning it is a map that is clear enough to spot patterns being enacted day by day.  In that sense it is a portable, educational aid for the client to think their way into the role of being their own therapist. 

Ed. - Should we be using the term SDR [Sequential Diagrammatic Reformulation]? 

Steve:  I would rather not for three reasons.  Firstly, it is mystifying and alienating to use acronyms like that for the client and the therapist.  Much simpler to call them loops or patterns or traps or snags etc.  Secondly it is no longer correct since most of our mapping now is based upon roles, procedures and orchestrations of multiple self-states.  For those who need acronyms it should be the MSSM.  Thirdly it pushes the therapist to think in terms of mapping as delivering a product and not being in a process. The mechanisms and processes of change in CAT are not the finished product of the therapy map - the so called SDR. The process of change is in the ongoing moments of developing the maps together and revisiting them either as one overall map or different maps of different stories, stages and troubles in my life.   The reformulation letter is the integrating tool in CAT, and it requires supervision and careful attention outside the session.   In my book I give as much attention to therapeutic writing as I do to mapping.  You might say mapping is the creative ground out of which writing emerges.  CAT has made a great contribution to the co-creative process of writing and of finding therapeutic words and the therapeutic power of revoicing, rewording and re-storying our life stories.     

Ed. - It feels very relational compared to the concrete layering of the SDR as a formal tool and I’m wondering for cognitivists in CAT who would perhaps embrace using the map mostly to depict a procedural sequence – how can they embrace this more relational approach through mapping? 

Steve: I am always struck by how similar CAT therapists are in what they actually do, compared to what they profess doing.  There are moments when the therapy dialogue is more cognitive and moments when it is more relational.  I think the CAT communities around the world contain a mix of more psychoanalytic and more cognitive practitioners.

For me there is not an opposition between cognitive and psychoanalytic ways of thinking and working.  It is an integration of both.  Through writing the book, I have come to understand the cognitive analytic integration as relational awareness which comprises a grid of three dimensions: what is going on within me, between me and intimate others interpersonally and within, between and around me socially and contextually.   In the book and on my website www.mapandtalk.com/grid. I have detailed these three dimensions vertically to make a grid of nine items crossed with three qualities of relational awareness.  And this is my point.   The qualities are hovering in more cognitive relational ways, shimmering in more mixed emotional and dynamic ways and acting or participating in behavioural ways.  The unintended fruit of CAT therapy is a realisation for me that it is not therapeutic if not all the nine items of the grid are engaged in a dynamic social and personal tension.  

Ed.- It feels like you’re describing your concept of orchestration: of orchestrating the cognitive components and respectfully drawing them in at the right moment but being able to hold back instead of leaning too hard on the cognitive slant at the expense of the relational.    

Steve: This points to the history of the model and Ryle’s movement from the reciprocal role idea to a more cognitive and procedural sequence idea that was never fully integrated in the procedural sequence object relations model.  As Leiman says in practice they are not easily integrated.   

I have always needed a third conceptual tool to link the procedural and the reciprocal and the idea that has helped me is to think of integration as orchestral.   I think we can put the more cognitive behaviour procedural focus with the more dynamic relational focus of reciprocal roles by looking for the helpful and harmful orchestrations of self and identity around limiting reciprocal role procedures.  I think of the different steps to the procedures and the different role positions as instruments in the orchestra of the self.   I don’t think it is just the traps and snags and dilemmas that we are trying to map. It is also the trauma defying, trauma driven partial orchestrations that are my routine attempts to get the act together of being the person I am.       

Ed.- Does that return to the use of the relational anchor to a transitional object in a relationship where I can lean heavily in trying to map out the procedure? Or recognise the relational stance or position that we are both … probably on the map?

Steve: A favourite process question for CAT therapists is Where are we on your map?  It is highlighting that patterns depicted on the map can happen in the therapy room.  In the book I stress greatly the importance of such moments but also suggest a five-minute routine in every session to map our progress.  I say, “Let’s just check where we are and what’s going on between us by mapping the moment.”  If this is done from the earliest sessions it builds an acceptance and readiness that when something difficult or therapy threatening does get enacted, we can more easily stop and map out where we are.  

Similarly, I use the idea of a five minutes for time out with some clients where we write to where we think the therapy is going for us just now. I tend to call it a‘Dear therapy letter. It is a very effective way of checking how the therapy is being orchestrated and often therapeutic moments arise when client and therapist read out their Dear therapy letters and see more dispassionately (for both) whether the therapy is working or not.    

Ed. - It reminds me of an experience I had with a client who I thought I was mapping with the client and perhaps for the client. After 40 minutes the client stands up to tell me: after you finish could you please stop doodling.

Steve: (laughs) My version of that is a client who said the map was not so helpful for them but it was clearly helping me so that was good enough for him and I should keep mapping.  It is true that the reformulation letter may serve its largest purpose in helping the therapist gather their thoughts.  I often think when we have drafted a reformulation letter, we should read it from the reader’s point of view and the client as reader may be very different to therapist as reader.  

Ed. - And can those moments be mapped? 

Yes, these moments of misalliance and misunderstanding need mapping because they are often tip of the iceberg moments.  The misunderstandings, and moments of  projection and transference are in play all the time and what I call process mapping in the book refers to the importance of mapping them.  Sometimes I think the sum of mechanisms and processes of change in CAT therapy is a handful of such moments noticed, named and negotiated.  All the work of reformulation, recognition and revision is distilled into these moments.   The job of the goodbye letter and the final sessions of a time limited therapy is to draw out the therapy story around these moments.  In my book I call it the healing narrative.   

Ed. - Perhaps for me this is one reason why the map feels so relevant in doing the contextual work of child & adolescent work.  The whole mapping process is grasped very quickly within a child or teenager’s zone of proximal development.  That is a map can be mapped without words using images using blocks; 3-D toys or a dolls house.  I’m thinking about Vicky Petratou who has written about the House of Self States in which the mapping is written in a very visceral form as lived experience within a house…..of course there are limitations such as those without homes such as refugees who have no concept of a home. Yet for the majority of us we are able to feel our way into a map.   This feeling our way is perhaps a more authentic way to intrepidly explore something with the client – both of us in the curious observer position.  Do I have permission to be a curious observer?  Or on the contrary perhaps I am like a NASA astronomer who looks at a map and expects something to be there and if it is not there then the map violates my sense of knowing and so there is no negotiation with the map. 

Steve:  You make me think how much our work with the client’s and therapist’s words and societies language is through analogy, symbols and metaphors.  The very word map is an analogy.  It is not to be taken literally.  It is interesting translating CAT concepts into other languages.  In French the literal word for map is Carte but that does not have the same fluid analogical play as in English. The alternative words plan, schema have other connotations.  I realise map may have become a looser more fluid word in my mind than other people’s. For me the word maps we make are analogical spaces where the loose layout and arrangement of the words invite play and projection, discovery and recovery.  At best they are arrangements that help hold and tell one story but can be transported or invite transition back and forth between several stories across time and place.   In the broadest, most unpretentious and ordinary sense of the word there is something poetic about them. 

Ed. - It made me think of on a philosophical slant about Edmund Husserl’s notion of perception and simultaneity. Seeing the position of empathy connecting or maybe feeling my way into something, is it better when there is some kind of movement like reaching, touching and stretching my hand out writing.  Do I feel the words – do I make sense in a different way whenever I rewrite something for me?  So when you write it and then I rewrite it, or connect or if I touch it or try to turn the page upside down.  The connection through touch and that kinaesthetic aspect of personal identity connecting through simultaneity as a sort of simulation…   

Steve: Yes I agree.  It is the three interlocking S’s (in English) of mapping: spontaneity, simultaneity, and scaffolding.  The process of mapping needs an attitude of spontaneity. We are ready to explore and co-create and we can tolerate to some extent not knowing where it is going.   In the process of mapping or writing, we meet simultaneity in the vital sense that more than one pattern, one story is in play and shimmering and hovering in and out of focus.  This mix of brave spontaneity and unsettling simultaneity is contained by Vygotsky’s or Bruner’s idea of scaffolding.  This is to say the emerging word map on paper between us is holding and guiding us.  We can lean on it for support and by analogy leaning on the word mapping process is leaning on each other which in turn triggers new moments of simultaneity and spontaneity.     

Ed. - A few final questions from others. Have you ever been lost in your own map?

Steve: Well, I cannot make my own map of my own life so easily. I need others to help me do that.  Though I do make little sketches in what I call in the book daily mindful mapping practice.  With clients I am often lost because they are lost.  I think this is where the idea of gaps and blank spaces is important. It might be better to think of mapping as more like leaving a trail of markers (in the metaphorical forest of life) so that when you are lost you can work your way back to familiar ground.  I have always liked the phrase (which is the title of a key paper by the New York relational psychoanalyst, Philip Bromberg) Standing in the Spaces. It is freely available online if you search for it. He views therapy as the quality of being able to ‘stand in the spaces’ between ego states with the client.  He describes the challenge of tolerating the uncertainty that comes with that and no doubt the risk of getting lost. I always wanted to write to him and say what a rich description he offers but that in my view he would be better off with a map than without one.   Of course, he has his rich analytic map in his head and the difference is in how we find ways to share that with the client that are helpful in the moment.  

Ed.- It feels like that position of not knowing is very important.   Yet it’s clear that maps help hold on to information. What is that information that helps the Self? Is it self-realisation? Is it self-discovery?  You’re describing an open curious position of discovery like an itinerant or pilgrim on a journey who is confident in his own tools to find his way and not needing to fix and follow every rigid step in advance as if it was a militarised, disciplined route. 

Steve:  I think there is a tension here between the clients and the therapist need to know where they are going and the equal need not foreclose or over-define things.   I offered the three N’s to sit alongside the three R’s in CAT. The three N’s are notice, name and negotiate.  Mapping helps us notice together and then struggle over the best words to name what we notice.   The process of naming is a process of negotiating not just what we mean but how we are doing and where we are going.   There is more chance of doing this democratically and mutually with the process of mapping to aid us.   

Ed. - So this feels very much like the grounding of the mapping as synonymous with the therapeutic process rather than an additional bolt on. 

Steve:  For me CAT is an activity-based therapy where mapping and writing and giving voice to what is being explored creates a healing relationship.  Without the activity of mapping and of making something together the process is either too hollow or too interpersonally intense and invites dependency or resistance.  

Ed. - How can the use of maps create new journeys?

Steve:  As I put it in the book, we listen to client’s stories and we are listening out for patterns.  The map of the patterns from one story often map on to other stories.  Or the map of the way of telling the story is a template for all the story telling in my world.  

I love the idea of exits in CAT of looking for new points of departure within the steps of pattern.  The curiosity about exits open the possibility of making a future map of the me I would like to be.  

Linked to this is one other idea that has come from writing about therapy with a map.  It is the idea that where there are links, there are also gaps.  The gaps in the pattern making activity of therapy are as important as the links. Professor Emma Smith, a Shakespeare scholar talks of gappiness in Shakespeare’s plays. I take her to mean that the relational imagination of the audience fills the gaps in the play.  The many things we don’t know about Hamlet for example. Shakespeare is the master of leaving the gaps to be filled by our imagination.  I think this is a very helpful way to understand the process of history taking and reformulation in therapy.  There is a gappiness in the client’s memory and in the therapist’s curiosity or in the labels and formulations of previous helpers. This is where the dissociation and the unformulated experience lies.   The gaps indicated by the blank spaces and question marks on the map are as important as the links and neat procedural loops.   In Chapter 8 of the book, I explore how this links to CAT’s relational understanding of developmental trauma.  This is my mantra.  Where there are links there are gaps.   

Ed.- Therapy with a Map.     Thank you. 

Interview with Steve Potter  
Transcripted 11th November 2020

Footnote

* Page 186, Therapy with a Map