Introducing Cognitive Analytic Therapy. Anthony Ryle

Introducing Cognitive Analytic Therapy - Anthony  Ryle


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and reciprocation continues.

      Oliviera's paper serves as a reminder of the extent to which other children are involved in the acquisition of RRs, but it is important to recognize the particular power of parents who may impose rather than negotiate their RR patterns and who have the power to define the agenda. The parents' personal restrictions and distortions may create idiosyncratic and confusing patterns and they may be unable to supply mediating concepts with which to make sense of some aspects of reality. This last point can be underlined by paraphrasing Vygotsky as follows: “what the child does not do or say with the adult today she will not do or say on her own tomorrow.”

      Further evidence for the powerful way in which observed and experienced role enactments are internalized and re‐enacted by children comes from a fascinating projective test known as the “the teddy bears’ picnic” developed by Mueller (1996). In this test, young children are asked to describe what would happen next during a story about a picnic, using teddy bears and props such as a cart and picnic basket. The range of responses to imaginary situations, such as the cart getting a puncture, is remarkable. In the case of “daddy” teddy bear, for example, the child may describe a calm, reassuring, and problem‐solving response or, at the other extreme, an angry and abusive outburst directed toward “mummy.” These results correlate well with the quality of the family background and with a child's psychopathology, much of which might have been undetected by conventional clinical interviewing. Many other projective tests can be interpreted similarly in terms of RR enactments.

      Although Vygotsky and Bakhtin were contemporaries and worked in overlapping fields they did not collaborate and their perspectives were different in important ways. Leiman (1992, 1997, 2002) introduced the ideas of both into CAT thinking and has drawn on the latter to propose a “dialogic” model of the self (Leiman, 1997) that bears some similarities to those proposed by, for example, Hermans (see Hermans & Di Maggio, 2004) or from a clinical perspective by Seikkula (see Seikkula et al., 2006). Further contributions to the dialogic dimension of CAT have been made since then by a number of writers as noted above. A further, illuminating discussion of the implications of the differences between Vygotsky and Bakhtin is offered by Cheyne and Tarulli (1999) which, although at first reading is apparently rather esoteric, in our view merits consideration. They note that Vygotsky was primarily concerned with the ways in which the skills and knowledge of the culture were acquired by the child. A narrow interpretation of his theory of the social formation of mind would define the parent or teacher as an agent or interpreter of the wider culture, aiming to transmit what the culture values and knows to the receptive child. For Bakhtin, on the other hand, the emphasis is different; for him, open‐ended dialog is seen as the essential and most valued basis of human consciousness: “To live means to participate in dialogue: to ask questions, to heed, to respond, to agree and so forth. In this dialogue a person participates wholly and throughout his whole life: with eyes, lips, hands, soul, spirit, with his whole body and deeds” (Bakhtin, 1984, p. 293). Dialog is a fundamental human activity; every utterance will be directed to an addressee who may be “an immediate participant‐interlocuter in an everyday dialogue, a differentiated collective of specialists … a more or less differentiated public, ethnic group, contemporaries, likeminded people, opponents and enemies, a subordinate, someone who is lower, higher” (Bakhtin, 1986 p. 95).

      To this model of dialog, Bakhtin adds a highly significant idea, that of the third voice or “super‐addressee.” In the address of the first (e.g., parent, teacher, therapist) voice to the second (child, pupil, patient) voice there is this implicit third voice, representing the wider culture or some part of it. The third voice (super‐addressee) legitimizes the first one who is in effect its conduit to the second voice. What is transmitted might be the current paradigm of a branch of science, the membership rules of a club, the articles of faith in a religion, the definition of gender roles, and so on. The social formation of mind, in this view, can be seen as a distillation of the whole range of human history and culture, while being inevitably focused and filtered by the particular time, place, and family into which the child is born.

      It is of interest that whole cultures may be characterized by certain dominant modes and voices in this fashion. Protestant cultures, for example, would be partly characterized by harshly (self) critical (or “Magistral”) voices and the task of therapy may be at times to work explicitly with a patient to question internalized culturally derived voices.

      In Bakhtin's words: “Just as the body is formed initially in the mother's womb (body), a person's consciousness awakens wrapped in another's consciousness” (Bakhtin, 1986, p. 138). In a related understanding, Winnicott's “there is no such thing as an infant” emphasized the need to make the unit of observation in understanding development this infant–caretaker dyadic system rather than the infant alone. In essence, the dialogic approach replaces the “I think, therefore I am” of Descartes with “We interact and communicate, therefore I become.” This dialogic model presents an unproblematic way of understanding the acquisition of a theory of mind.

      In a more overtly “political” contribution, the Bakhtin‐inspired philosopher Terzakis explicates further the enmeshment of the socio‐political with the intrapsychic, as illustrated by the following quote: “We should then talk of official consciousness and unofficial consciousness, official language and unofficial language: this reformulation does not only re introduce the dialogic principle deep into what we tended to consider as strictly the intrapsychic but also reincorporates the artificially isolated island of the self in a great field of social and ideological currents. Behind every individual symptom hides the conflict between opposing significations of the world. The problem of so‐called psychopathology is always in the last analysis a political problem: managing relations between the individual and the group, choosing a moral or political stance” (Fotos Terzakis unpublished, personal communication).


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