Rep36 Understanding Personality Disorder

particular parenting style. He also identifies
several processes through which schemas are
maintained and affect behaviour, such as
cognitive distortions, avoidance of schema-
related thoughts and behaviour, and the
development of overcompensatory styles
opposite to EMS. 
In therapy, EMS are identified through a self-
18

---

report questionnaire and activated through
imagery and dialogue. Exploration of EMS
focuses on their developmental origins and
attachment issues, while CBT techniques are
used to challenge and invalidate EMS. However,
more use is made of the therapeutic relationship
and there is a greater emphasis on emotional
experience. Young suggests that this approach is
‘constructivist’ in that rather than correcting
cognitive distortions to comply with an assumed
reality, therapy focuses creatively on personal
meanings and narrative and what is adaptive for
the individual.
Cognitive Analytic Therapy (CAT) is an
integrative, short-term therapy drawing on
concepts from psychoanalysis, cognitive research,
and developmental psychology (Ryle, 1997). It
has affinities with object relations theory, while
emphasising actual childhood experiences rather
than unconscious fantasies, and makes use of
CBT techniques while rejecting information
processing models of knowledge and feeling.
The developmental perspective emphasises that
meanings, emotional experiences, and self-
definition evolve in childhood as the
internalisation of external dialogue through
active engagement with others who transmit
their own meanings and those of the culture.
The focus is therefore on how people attempt to
elicit reciprocal and confirming responses from
others in their interactions.
In CAT, the basic descriptive unit is the
procedure, which summarises motivated,
intentional acts or enactments of roles in
relationships as a learned psychological sequence
progressing from perception to enactment and
revision of aims based on evaluation of the
consequences. The procedures of concern in
psychotherapy of personality disorders are those
controlling interpersonal action and self-
management, a central concept being the
reciprocal role procedure (RRP). RRPs are
characteristic ways of interacting with others
based on an individual’s early experiences with
their mother and other significant caregivers.
For instance, a needy child may experience a
satisfying or depriving caregiver, and will
internalise these reciprocal roles (e.g. needy –
depriving). These roles become part of their self-
concept and behavioural repertoire in their
interactions with others. RRPs, therefore, reflect
how we anticipate the role behaviour of others
and the consequences of our role behaviour to
them. Thus, the sequences within RRPs are
governed by internalised dialogue about self-
other and self-self relationships. A characteristic
of people with personality disorders is that they
have a restricted and often self-defeating
repertoire of RRPs. RRPs may, for example,
induce others to take a reciprocal nurturing role
through self-injury. They may also dictate the
enactment of two poles in a relationship unit, for
example those of caregiver and care-receiver, or
those of abuser and victim. 
A component of RRPs is the experience or
construal of roles, described as self-states. In
borderline personality disorder, self-states may
become partially dissociated RRPs into which the
person may switch abruptly to avoid
unmanageable feelings. These dissociated self-
states usually entail a dominant RRP in which
attempts to elicit confirmation from the other
are intense. Failure to elicit confirmation is a
source of disappointment and often rage. 
CAT is collaborative and descriptive rather
than interpretive. Presenting problems are
linked to cyclical patterns of procedures
originating from and returning to the patient’s
RRPs through procedural loops that maintain
and reinforce dysfunctional patterns.
Identification of these patterns is facilitated by
the construction of sequential diagrams of the
main recurrent patterns. These are agreed with
the client and become the basis for targeting the
problem procedures that need to be revised.
Revision aims at disconfirming expectations of
relationships in RRPs and the integration of
dissociated self-states through self-reflection, self-
monitoring, and CBT procedures.