Chapter 6 The Reformulation Sessions

Question 0

Reformulation requires of therapists what two key CAT/therapuetic abilities?

Answer 0

Empathy towards the patient whilst also thinking reciprocally

Question 1

Reformulation focuses primarily on what?

Answer 1

The acquisition and enactment of RRPs

Question 2

How might case formulation be defined?

Answer 2

As the selection and arrangement of data according to the therapist’s theoretical understanding of the issues to be addressed in therapy

Question 3

A key attribute of the psychotherapy file is that it encourages the patient to practise…?

Answer 3

Putting thoughts to feelings

Question 4

A reformulation letter should contain what eleven elements?

Answer 4

Emphasis on the provisional nature of the letter
An outline of childhood experiences whilst avoiding reinforcing this as a wholly objective account
A summary of the main history and what brought the patient to therapy
Acknowledgement of subjective experience
Acknowledgement of strengths
Links between past and present state
Consideration of what has been learned in initial sessions
Use of patient images and metaphors
Description of TPs and TPPs and focus on current patterns - snags, traps, dilemmas
An outline of the work of therapy and reference to the impact of the patient’s procedures on the therapuetic relationship
A realistic suggestion of what might be achieved in therapy

Question 5

Recognising countertransference feelings can become an immediate way of recognising what?

Answer 5

The patient’s expectations of reciprocating procedures or attempts to elicit them

Question 6

SDR sets out to describe what two central aspects of CAT?

Answer 6

Core reciprocal role repertoires derived from the past and which are now repeated in current procedures

Question 7

The idea of ‘core pain’ is analogous to James Mann’s (1973) what?

Answer 7

‘Chronically endured pain’

Question 8

In constructing an SDR, procedures in relation to what should be considered?

Answer 8

The self and others

Question 11

The term ‘self state’ refers specifically to what CAT concept?

Answer 11

The Multiple Self State Model of BPD

Question 12

Once states of mind are reliably identified, what should therapists aim to do next?

Answer 12

Begin working on RRPs

Question 13

Re ‘self states’ the therapist should help the patient to do what?

Answer 13

To describe the dominant mood or behaviour of each state and also the sense of self and others
Recognise the degree to which feelings are accessed or cut off and the accompanying symptoms

Question 14

Both poles of the RR pattern may be described by patients as subjectively experienced states, but in other cases only one pole will have been recognised as experienced subjectively. How might this be understood?

Answer 14

As the reciprocal being perceived in, or elicited from (in psychoanalytic terms ‘projected into’), others

Question 15

Partial dissociation between RRPs is indicated diagrammatically by what method?

Answer 15

By locating core repertoires in separate boxes which define the separate self states

Question 16

As as a theoretical concept, ‘self state’ should be distinguished from which similar terms?

Answer 16

‘State’, ‘state of mind’, ‘state of being’, which describe the subjective experiences associated with playing a particular role in relation to others or an aspect of self

Question 17

Abrupt state switches, a common feature of BPD, reflect which three types if instability?

Answer 17

Response shifts in relation to the same reciprocal
Role reversals while in a given self state, for example from victim to abuser
Self state switches

Question 18

The aim of an SDR is to explain all major problematic role procedures in what terms?

Answer 18

In general terms

Question 19

“The self is a confederacy of states rather than a…?

Answer 19

…single nation”

Question 20

What are the four types of cores used in sequential diagrams?

Answer 20

Basic: single RRP
French Loaf: RRPs co-exist, mobilized appropriately, smooth transitions
Split Egg and SSSD: abrupt transitions, often inappropriate, some roles exteme
Dialogic Sequence Analysis: traces rapid shifts between roles and RRPs

Question 21

When thinking about reciprocal role patterns it can be useful to note what three elements?

Answer 21

Descriptions of past and present relationships
How the self is cared for, managed and judged
The emerging relationship with the therapist

Question 22

In general exits are left until recognition has occurred. In what two sets of circumstances might an exception be made?

Answer 22

Where symptoms or other procedures threaten the therapy

Where serious self-harm is a possibility

Question 25

RRPs ought also to consider what other outcomes of a given procedure?

Answer 25

Positive outcomes

Question 31

What four important theoretical concepts ought SDRs to embody?

Answer 31

An emphasis on the reciprocal nature of procedures
That each role is implicitly or explicitly directed to its reciprocal
That the reciprocal may be part of the self or another
That a given RRP may be manifest in procedures described in either pole