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EMERGING REALIZATION Theoretical considerations (one model shortcomings, translation into another conceptual language) Practical experience Integrative (unsatisfactory effectiveness approaches of one standard modality) in psychotherapy Therapeutic pragmatism (maximization of effectiveness, abbreviation of treatment) Integration = eclecticism Integration = coexistence of 2 or 3 discordant models Integration = formation of an overarching context giving coherence & coordinating treatment SOURCES OF THEORETICAL INTEGRATION IN C.A.T. PSYCHOANALYTIC COGNITIVE PSYCHOLOGY (problem solving, cognitive mediation of action) THEORY VYGOTSKY (object relations theory) (social activity theory) CAT COGNITIVE – KELLY (personal construct theory) BEHAVIORAL THERAPIES (planning & measu- rement of change, self-monitoring) BAKHTIN (dialogical model) ARTIFICIAL INTELLIGENCE (feedback, flow charts) COGNITIVE ANALYTIC THERAPY (CAT) Brief, integrated, structured cognitive therapy A. Ryle, early ’80s case reformulation - text - diagrammatic - aims 1 16 4-6 FU sessions material sessions material self-monitoring self-monitoring questionnaires progress chart WRITTEN / VISUAL AIDS USED IN CAT (VYGOTSKIAN “TOOLS”) PATIENT’S THERAPIST’S questionnaires & tests case reformulation letters (good-bye l. & others) text biographical accounts sequential diagrammatic (of self-characterizations self-states, reciprocal roles, self-monitoring of symptoms problematic procedures) & problematic procedures letters (good-bye l. & others) diary keeping instructions progress rating INDIVIDUAL TECHNIQUES USED IN CAT ALWAYS WITHIN THE CONTEXT OF THE CAT UNDERSTANDING COGNITIVE: concept formation & elaboration, cognitive distortions treatment, etc PSYCHODYNAMIC: clarification, confrontation BEHAVIORAL: exposure, thought stopping, role playing, self-monitoring, self-assertion, etc OTHERS: Gestalt, etc PATIENT’S CONTRIBUTIONS good enough, depriving, conditionally good rejecting coping deprived, abandoned AIM: fearful collect coping obsession experiences & (“down in the dumps”) acknowledge them thought stopping alone, vulnerable, cognitive restructuring, ignorant, incompetent confrontation bulimia empty, hopeless response prevention a failure depressed, undeserving obsession (bad, “unworthy Christian”) thought stopping Self – self role procedures CAT is NOT opposite to the use of medication when it is deemed necessary The use of medication is treated as a tool carrying & creating meaning within the context of reciprocal role relationships between patient & therapist fragile autonomy M ideal care-giver, helpful sage thankfully needy, submissive ideally cared for improvement threatened, menacing intruder relatively in control, counter- regains self-esteem attacking M passive resistance (“forgetting”, incosistant) deterioration active rejection (stop) needy