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Clinical and service implications of a cognitive analytic therapy model of psychosis

Kerr, I.B., Birkett, P.B.L. and Chanen, A. (2003) Clinical and service implications of a cognitive analytic therapy model of psychosis. Australian and New Zealand Journal of Psychiatry, 37 (5). pp. 515-523. ISSN 0004-8674


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Cognitive analytic therapy (CAT) is an integrative, interpersonal model of therapy predicated on a radically social concept of self, developed over recent years in the UK by Anthony Ryle. A CAT-based model of psychotic disorder has been developed much more recently based on encouraging early experience in this area. The model describes and accounts for many psychotic experiences and symptoms in terms of distorted, amplified or muddled enactments of normal or ‘neurotic’ reciprocal role procedures (RRPs) and of damage at a meta-procedural level to the structures of the self.

Reciprocal role procedures are understood in CAT to represent the outcome of the process of internalization of early, sign-mediated, interpersonal experience and to constitute the basis for all mental activity, normal or otherwise. Enactments of maladaptive RRPs generated by early interpersonal stress are seen in this model to constitute a form of ‘internal expressed emotion’. Joint description of these RRPs and their enactments (both internally and externally) and their subsequent revision is central to the practice of CAT during which they are mapped out through written and diagrammatic reformulations.

This model may usefully complement and extend existing approaches, notably recent CBT-based interventions, particularly with ‘difficult’ patients, and generate meaningful and helpful understandings of these disorders for both patients and their treating teams. We suggest that use of a coherent and robust model such as CAT could have important clinical and service implications in terms of developing and researching models of these disorders as well as for the training of multidisciplinary teams in their effective treatment.

Item Type: Article
Copyright, Publisher and Additional Information: © 2003 Blackwell Publishing Ltd. This is an electronic version of an article published in Australian and New Zealand Journal of Psychiatry, complete citation information for the final version of the paper, as published in the print edition of Australian and New Zealand Journal of Psychiatry, is available on the Blackwell Synergy online delivery service, accessible via the journal's website at www.blackwellpublishing.com/journal.asp?ref=0004-8674 or www.blackwell-synergy.com
Keywords: cognitive analytic therapy, psychosis
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Psychiatry (Sheffield)
Depositing User: Repository Officer
Date Deposited: 16 Nov 2005
Last Modified: 04 Jun 2014 10:49
Published Version: http://www.blackwellpublishing.com/journal.asp?ref...
Status: Published
Refereed: Yes
Identification Number: 10.1046/j.1440-1614.2003.01200.x
URI: http://eprints.whiterose.ac.uk/id/eprint/514

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