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Dunn, M. and Ryle, A., 1993. Tony Ryle Briefly Interviewed by Mark Dunn. Reformulation, ACAT News Autumn, p.x.
Tony: What do you think it is?
Mark: Well, two things, 1. a theory and 2. a treatment method. The theory is the Procedural Sequence Object Relations Model. The treatment method includes, time limited contracting, assessment including using the psychotherapy file and other short cuts, narrative and diagrammatic reformulation in a shared and collaborative way, working through, and shared summaries. In particular narrative reformulation seems to be effective due to positive reframing which provides a measure of absolution from blame and guilt which reinforces the working alliance. Diagrammatic reformulation seems to be effective because it allows personality structure, procedures and core objects to be integrated by simultaneous perception, ie all the elements being seen together on one piece of paper.
Tony: In my view CAT is an application of an integrated theory, the PSORM. CAT involves explicit active participation of the patient. This is devoted to the joint creation of narrative, descriptive and usually diagrammatic reformulation. These guide therapy in that the first therapeutic task is NOT TO collude / reciprocate patients’ procedures (not so much a corrective emotional experience as the avoidance of a confirmatory one). The second is to apply, and teach patients to apply these descriptions. The three ‘Rs’ are Reformulation, Recognition and Revision, in that order. Interpretation, ie hypothesising about mental processes, is presented as just that, a hypothesis; description is usually preferable.
Mark: In particular it seems to me that time limited contracting has nothing to do with the theory, PSORM, but is either a politico-economic decision based on rationing of resources or a pragmatic decision based upon an assessment of the patient’s ability to work in therapy. Discouraging regression and dependency might best be achieved by collaboration in activity rather than by disallowing or rationing attachment.
Tony: Time limitation has other justifications, ie no regression and quicker engagement.
Mark: It seems also that sometimes the short cut devices such as the file, diaries and life-lines only speed up the assessment process?
Tony: They are not only short cuts; patient agency and also patient participation is enhanced and the power axis lessened.
Mark: Sometimes it seems to be the case that if one gets stuck with a patient one reaches into the toolbox for a different tool or technique, eg artwork, roleplay, etc
Tony: Many specific techniques can be employed but these should ALWAYS be linked explicitly with the aim of procedural revision and / or integration. CAT is not an a-la-carte salad.
Mark: CAT appears to be analytic in so far as it explains the phenomena of the unconscious by attributing predominant characteristics to internalised objects (ie conditional, striving, crushed, abusing), the difference in the characteristics determining the difference in the predominant procedures emanating from them.
Tony: I don’t like this mixed language. We describe from observable and reportable phenomena patterns of interaction and self-care. We summarise these as procedures and deduce the reciprocal role repertoire. These patterns of RRPs determine both relationship and self-management. The language of ‘ot~jects’ is one metaphore but distracts from the primacy of the role of learned patterns of interaction (see Stern on infants). Internal ‘objects become like little ghosts in the machine which achieve spurious independence and agency.
Mark: Is CAT then cognitive in so far as it explains the phenomena of the conscious in terms of procedural sequences?
Tony: No. It is cognitive because it draws on cognitive psychology, ie on current best-fit models of mental functioning. Cognitive in this sense does not equal conscious. Most mental processes are explained by models because most are incompletely understood. The ‘dynamic unconscious’ is only a fraction of all the mental processes which are not accessible to self-observation.
Mark: What, then, is ‘working through’? Is it the process of becoming conscious of negative, destructive, restricting, maladaptive procedures and roles and then the process of internalising new roles and procedures as learned from and approved by the therapist?
Tony: Working through is repeatedly recognising the operation of damaging procedures and elaborating better alternatives. These should not need the therapist’s approval except in the sense that they are real and effective, in the sense of suiting the patient’s (now clearer and possibly revised) wishes. Choice and truth are the guiding ethic.
Mark: What about CAT in other settings, like groups, couples or in long term work?
Tony: CAT can be applied in those settings; the same principles apply. Long term work may employ specific CAT tools but will tend to focus on / get wrecked upon the transference issues.
Mark: Who can CAT be used with?
Tony: CAT is a safe first intervention for any non-psychotic, not hopelessly substance abusing patient, unless symptomatic issues are too powerful or fragmentation too extreme. In such patients prior drug therapy and I or cognitive-behavioural therapy may be indicated.
Mark: Thank you.
Mark Dunn
Tony Ryle