1. CAT as integrative therapy
Mikael Leiman
4th International CAT conference
Kraków, Poland
September 15-17, 2011
Mikael Leiman

2. Collaborative Action Therapy
Reformulation as the heart of CAT practice
Respect the client’s zone of proximal development
Create with the client
Use portable formulations and descriptions
Flexible ways of working
Push where it moves
Avoid getting stuck in a harmful counter position
The three R’s (Reformulation, Recognition, Revision)
Any technique that the client can use is permissible
Mikael Leiman

3. Dilemma in theory
Reformulation was originally based on integrating Repertory Grid findings with object relations concepts
Dyad Grids and reciprocal roles
Traps, dilemmas, and snags were portable descriptions of repetitive action patterns
Three sources: behavioural therapy, grid studies, psychoanalysis
Procedural sequence model as an explanatory framework for dilemmas, traps, and snags
How do C & A relate to each other?
Mikael Leiman

4. Back to Relational CAT
All actions have an object (internal or external)
Actor and object are reciprocally positioned
There are no actions without a counter positioned objects (a thought object, a material object or a thing, another person, etc.)
Activity may be described as sequences of reciprocation; the counter-positioned object directs the person’s movement in the sequence
Mikael Leiman

5. Traps as reciprocal sequences
Placation trap
“Feeling insecure and worthless (position 1), I accommodate (position 2) to others’ demands or wishes (counter position 2), which makes me resentful (position 3). I act childishly and foolishly (position 4) ending up feeling ashamed of myself and worthless (position 1).”
Notice the self critical reciprocal pattern in the words “worthless” , “childish”, and “foolish”
Mikael Leiman

6. Reciprocal roles in trap
critical,
judgmental ?
Intra psychic: self to self
worthless
expects,
wants
gives in
Interpersonal
unreasonably
demanding ?
resentful
Intra psychic
offended/
angry/
dismissive ??
angry ??
Interpersonal
Mikael Leiman

7. Dilemmas as one-position mini sequences
“Either I keep feelings bottled up or get out of control and make a mess.”
“If I must, then I can’t/won’t.”
“Either looking after or abandoned.”
“If close, then smothered.”
Mikael Leiman

8. Dilemmas as mini sequences
painful memory
helpless
attacking
protecting position
naively
accepting ??
unconcerned
(bottled up)
intolerable position
angry, upset
(out of control) ??
Mikael Leiman

9. Snags as alternatives to forbidden positions
Aims are abandoned because internal prohibitions or due to the fear that others might oppose them
As dilemmas, snags tend to have a threefold sequence.
Actions are diverted to a permissible reciprocation between actor and objcet
Instead of an “intolerable position”, the avoided alternative is a “forbidden position”
Mikael Leiman

10. Reciprocal relation to presenting problem
Mikael Leiman