Introducing Cognitive Analytic Therapy. Anthony Ryle

processes are described in terms of relationships or dialog with internalized figures or voices, for example the “voice of conscience,” or of “encouragement,” or of “relentless criticism,” although not every role has its recognizable figurehead. Nor is it clear how far the “I” is unitary rather than a federation or from where, in the infant–caregiver conversation, it (I) finds its (my) voice. If individuals come to experience and know themselves through early reciprocal relationships with others and their culture(s), with which role or voice is the “I” identified? One might expect that in the internal dialog with others the child would identify “I” with the child's voice. From a dialogical and relational perspective, however, this “child's voice” would also be understood to be largely constituted by the voices and relational experiences of others. And given that the “I” is more a federation than a single nation, the internalized voices of others can dominate the dialog, defining reality and providing a running commentary of judgment which may determine what aims may (or may not) be pursued. The confusion and conflict experienced by most of us at different times, but especially when psychologically disturbed or damaged, in making sense of these various “voices” (embodied in RRs) and their power and persuasiveness, represents an important, and never fully resolvable, challenge in life or in therapy. Several tensions or paradoxes, including its subjective and more objective aspects, are clearly also evident in such a conception of the Self. These in the end dissuaded writers such as Kohut from attempting any formal definition of such an entity. The concept of “Self” is thus a reification of a complex set of dynamic phenomena and functions. It combines, as William James (1890) noted, the joint existence of the “I” as unitary knower, experiencer, and agent and the “me” as an aggregate of bodily, social, spiritual, and other aspects. It is, as Rycroft (1991) put it, “not only an experiencing subject, but also its own object.” The “self” has been seen as both a structural and an experiential, narrative‐based, fluid entity (de Waele, 1995; Holmes, 1998, Kerr et al., 2015; Meares, 1998; Samuels, 1985) capable of, although later very resistant to, at least some change. More extended reviews of the history of the concept of self from a broader philosophical perspective are offered by Stevens (1996), Armstrong (1999), Seigel (2005), and Elliott (2013), and a review from a more CAT‐oriented perspective, along with its currently understood neuroscientific and psychological underpinnings, is offered elsewhere (Kerr et al., 2015). Within the latter, a more extended, provisional, generic definition is offered. The current CAT understanding of Self, expanded somewhat from that offered in the previous edition of this book in the light of these various advances, is now described as follows (see also Chapter 2 and Glossary):

      The Self in CAT is understood to be a bio‐psycho‐social entity that emerges through a synthetic or dialectical, semiotically‐mediated developmental process involving all of these dimensions. It is understood to be characterized by a sense of agency, coherence, and continuity, of embodiment, of subjective and reflective awareness, identity, and for some by a sense of spirituality. The structure and function of Self is understood to include and integrate such functions as perception, affect, memory, thinking, self‐reflection, empathic imagination, relationality, creativity, and executive function. It is understood to comprise both subjective and experiential as well as observable functional aspects. The Self is also characterized by a tendency both to organize and be organized by experience. It emerges developmentally from a genotypic Self characterized by various innate predispositions, notably to intersubjectivity and relationality, so enabling and needing engagement and interaction with others from the beginning of life. The mature, phenotypic Self is considered to be fundamentally constituted by internalized, sign‐mediated, interpersonal experience and by dialogic voices associated with it (reciprocal roles) and to be characterized by a repertoire of emergent adaptive, “coping,” or “responsive” patterns of action (reciprocal role procedures). Although profoundly rooted in and influenced by early developmental experience, the Self is understood to be capable of a degree of choice and free will. The Self is dependent on others and on social location for its well‐being both during early development and throughout life.

Neuroscience Research and the Self

There has been a profusion of research in recent years from the field of developmental neuroscience relevant to understanding and making therapeutic use of such a concept of Self, in particular with regard to its relational and developmental dimensions. We can only highlight some of this here as it appears relevant, but those who wish to pursue these understandings further may do so through the references offered and related literature. This research includes work by a range of authors over recent years (e.g., Adolphs & Anderson, 2018; Cozolino, 2014; Damasio, 2012; Glover, 2011, 2015; Knox, 2010; Meares, 2012; Moffit & The Klaus‐Grawe Think Tank, 2013; Northoff, 2014; Northoff et al., 2006; Panksepp & Biven, 2012; Qin & Northoff, 2011; Schore, 2012; Siegel, 2012; Toth & Cicchetti, 1998; Tsakiris, Costantini, & Haggard, 2008; Uddin, Clare Kelly, Biswal, Xavier Castellanos, & Milham, 2009). Some of this research postulates firstly the existence of a deeper “core” or “proto” Self located neuro‐anatomically largely around deeper mid‐brain areas such as the superior colliculus and periaqueductal gray (PAG). This concept Panksepp also capitalizes to imply a substantive entity. This core Self, which develops early, is responsible functionally for our fundamental, unconscious, bodily sense of proprioception, and sensorimotor and rhythmic (possibly proto‐musical) awareness of Self and the outside world. Integrity of this domain is likely to be important for subsequent coherence and continuity of the Self both subjectively and clinically. Recent research suggests that higher putative sub‐cortical structures of the Self include the limbic system (involved in emotion processing and recording of associated memories), and the default mode network (DMN) which is active when an organism is otherwise inactive, and is involved in introspection, rumination, processing, and probably in contributing also to a subjective sense of Self (Raichle et al., 2001; Uddin et al., 2009). Research over recent years has suggested that it is principally right brain structures that are involved in more complex aspects of a more “autobiographical” or “idiographic” Self (Damasio, 2012; Panksepp & Biven, 2012; Schore, 2012) and also of (internalized) relational experience, however conceived of (e.g., as “internal objects,” “schemas,” or “reciprocal roles,” or the collective “nos” described from a group analytic perspective (Ormay, 2012). The right brain is increasingly understood as the location of more complex, synthetic, “bigger picture,” often unconscious and intuitive, decision making and creativity. Importantly, these structures develop on the basis of relational experience most critically over the first few years of life, that is to say pre‐verbally and at a stage before retrievable memories are laid down (Corrigan & Hull, 2018; Damasio, 2012; Panksepp & Biven, 2012; Schore, 2012). Relational interactions are also understood to be mediated by and have broader neuro‐biological underpinnings through, for example, the endocrine system and neural hormones such as dopamine and vasopressin (see e.g., Decety & Ickes, 2009; Gantt & Badenoch, 2013) and also to be mediated in part by stress hormones of the hypothalamo–pituitary (HPA) axis, such as cortisol. It is well documented that stress‐related abnormalities of the latter (including antenatally) may be transmitted transgenerationally by epigenetic mechanisms (i.e., involving control of gene “dosage” rather than the structure of DNA) and may have life‐long adverse effects on all aspects of health and well‐being (see Chapter 4 and Glover, 2011). The human capacity for intersubjectivity, empathy, and relationality is also now understood to be mediated in part by networks of “mirror neurones” (Ammaniti & Gallese, 2014; Iacoboni, 2008; Rizzolatti & Sinigaglia, 2007). These may in turn be impaired in disorders such as autism and impairment in the capacity to generate a “theory of mind.” However, some argue rather for the importance of difficulties with emotionally mediated interactions in the genesis of autism (Hobson, 2002). Variations in these various capacities (such as in autistic “spectrum” presentations), although also possibly adaptive and advantageous in certain contexts, may play a greater role than hitherto appreciated in more general problems in living and formal mental disorder (Happe & Frith, 2014; Lloyd and Clayton, 2013; Trevarthen, 2017). The role of the autonomic nervous system with regard to relationality has also been further detailed and described in recent years through an important