Читать книгу Introducing Cognitive Analytic Therapy - Anthony Ryle - Страница 49

Although the preceding discussion of concepts of Self reflects to a considerable extent the individualistic concerns of our present Western culture, any model of psychotherapy including CAT should nonetheless be able to offer an account of cultural variance in the development and “disorder” of the Self. The detached and increasingly aspirational individualism of the Western world would be inconceivable in more traditional societies. The distinction between these extremes has been described in anthropological terms as that between “egocentric–contractual” and “sociocentric–organic” modes of social being (Shweder & Bourne, 1982). In terms of the model outlined, the Self, its procedures, and sense of narrative, would be experienced in a traditional, closed culture as largely defined by existing relationships with others, implying both powerful attachments, fusions, and sustenance but also restrictions (see Stevens, 1996 and see, e.g., Bhugra & Bhui, 2018; Kirmayer, 2005; Kirmayer & Ryder, 2016; Markus & Kitayama, 1991; Mills, 2014). This contrasts with the “inflation” of the detached self in our contemporary culture, manifest pathologically in those with, for example, “narcissistic” disorders, both “vulnerable” and “grandiose” (see Chapter 10). Many recent authors have highlighted this “narcissistic” trend as a feature of our “post‐modern” culture and have expressed concern about its deleterious effects on our (common) well‐being (e.g., Frosh, 1991; Gordon, 1998; Samuels, 1985; Symington, 1999; Tacey, 1997; Twenge & Campbell, 2009).

Models of psychotherapy must consider these issues if not resolve them. We believe that this is an area where the CAT model may have something to offer. Any model of psychotherapy should be able to generate some meaningful account of cultural and ethnic diversity as manifest in the range of individuals and their problems who may, or may not, experience them as “mental” problems, or present for “treatment” (see, e.g., Bhui & Morgan, 2007; Burman, Gowrisunkur, & Sangha, 1998; 2007; Dalal, 1992; Krause, 1998; Kirmayer, 2005; Mills, 2014; Paris & Lis, 2013; Tseng, 1999). In some cultures, emotional distress may be experienced and present as somatic symptoms, in some as overt anxiety or depression. In others, including our own, distress may also be “repressed” through, for example, “coping” or “soldiering on” role procedures. Expression of distress may vary considerably over time within a given culture. A century or so ago in Europe, for example, “hysterical” or “conversion” disorders were more common, at least in certain classes, as addressed by authors such as Charcot, Janet, and Freud (see e.g., review by Schwartz, 1999).

Another example of how culture is manifest in terms of self‐identity is evident in the ways in which meaning is ascribed to gender. The diversity, increasing understanding, and cultural acceptability of variously gender‐related “identities” is a clear, and in the West still rapidly changing, example of how understandings, cultural values, and morals are internalized and enacted. These issues require an appropriately sensitive and flexible model to address them. (Some of these issues are addressed further in Chapter 9.) We would argue that some form of “culture mapping” should be at least implicit within any model of psychotherapy and that psychotherapists should ideally aim to be free of normative cultural values. Although this represents an important aim it can clearly never, by definition, be fully achieved given our own varying cultural formation. But CAT's practice of collaborative reformulation does aim to reflect on and make joint sense of what each patient brings to therapy, including their cultural assumptions and formation, and including in relation to our own. Every CAT diagram should in fact represent effectively a “micro‐cultural” reformulation. Consideration of these issues led to a renowned cultural psychologist such as Bruner to suggest that Homo sapiens should be considered as a “localized species” (Bruner, 2005).