What is Cognitive Analytic Therapy ?

Cognitive Analytic Therapy, also known at CAT, is an integrative model of therapy which, as its name suggests, draws upon both cognitive and psychoanalytic theories. At its centre is its assertion of the importance of early life experiences and the roles and strategies we develop in response to these. As such it is a theory of how we are as people, rather than a theory of specific disorders or problems. (Corbridge, Brummer and Coid, Cognitive Analytic Therapy - Distinctive Features, 2018, p 7). CAT is a flexible and intuitive therapy and therapeutic approach used as a “direct”, individual or group therapy with clients, and as an “indirect” approach, for example team reflective practice or team consultancy.

Individual (or group therapy)

The main focus of Cognitive Analytic is the way in which our early life experiences, and the important events in our lives, all go towards shaping the kind of person we are. Most importantly, on the basis of these experiences, we develop beliefs about relationships, and ways of behaving, both towards others and towards ourselves. The work in therapy is trying to find out what patterns you have learnt and which of them are helpful, and which ones are causing problems now.

Examples of unhelpful paterns 

  • Repeatedly feeling let down, hurt or rejected

  • Experiencing depression, anxiety or low self-esteem

  • Avoiding things

  • Struggling to be assertive

  • Repeatedly feeling vulnerable

  • Doing things that are harmful or self-defeating as a way to stop feeling overwhelmed by strong feelings

CAT involves working together with a therapist who helps you to:

  • Identify unhelpful patterns of thinking, feeling and behaving

  • Make sense of how they developed and why you needed them

  • Start to develop new more helpful patterns, and

  • Develop a better relationship with yourself and others

Team Reflective practice /Team consultancy

CAT also has a well-established approach to team-based reflective practice/team consultancy which is used throughout the UK. This can be particularly helpful for clients with complex presentations who may struggle to form collaborative relationships and whose difficulties may play out in the team and systems around them.

CAT can help by helping to clarify the team task, through formulation and and care/treatment planning, with a focus on “doing with, not doing to” the client. In this way CAT can offer a non-blaming, supportive and containing framework for both staff and clients, which intern offers a non-collusive stance with regard to problematic or unhelpful patterns. Importantly It offers a shared language for formulation which is acceptable and accessible to a wide range of professional backgrounds, and can reduce interdisciplinary tensions.

Frequently Asked questions

Whats the difference between CBT and CAT?

CAT stands for Cognitive Analytic Therapy and CBT for Cognitive Behavioural Therapy. There are similarities between these therapies – both are brief therapies with a limit on the number of sessions; both will offer a focus on a limited range of goals and may use similar ways of helping you keep track of your difficulties, e.g. keeping a diary of a particular problem you want to tackle or how you are making changes. Both are collaborative approaches – working actively with the therapist on your difficulties.

People referred for CBT may have been diagnosed with disorders such as anxiety, panic, depression, obsessive compulsive disorder etc. CBT has specific, research proven ways of working with such clients using different techniques appropriate for their presentation. People who want to work with their therapist on actively changing their problems tend to do well here.

On the other hand, CAT works more interpersonally on relevant, jointly identified issues by creating a working relationship between client and clinician where together they:

  • describe the issues affecting the client

  • to understand their origins in previous relationships and experiences, and importantly, use the relationship between the client and therapist to reflect on how those learnt ways of being take place both in and out of the therapy room: the aim here is to practise both recognition (awareness) and change, both in and out of the room

  • then work focuses on changes that the client wants to make now that they feel they have a description and an understanding that makes good sense to them.

CAT offers a safe and clinically effective therapy intervention for people who wish to work through these underlying issues. Sometimes, people who have symptoms of, for example, anxiety or depression, have a history of abuse, trauma or neglect underlying their symptoms. A relationally focussed therapy like CAT can be helpful as it accesses and reflects on how the difficulties come up in normal life, and that includes the relationship between therapist and client: the goal here is to respectfully and progressively understand and name the difficulties together, as safely as possible.

CAT is mostly offered to individuals, but it can also be used effectively with couples, in groups and to help teams understand the ‘system’ in which they work.

How can CAT help me?

Therapy will help you explore how you manage your relationships and cope with feelings or difficult situations. By looking more closely at patterns of thinking, feeling, and behaving, you will:

  • clarify which ones are helpful or unhelpful

  • understand how they developed

  • discover what makes you keep repeating them

  • find alternative, more effective ways to manage negative experiences or feelings

The aim is to reduce the distress you experience in your relationships with others, and with yourself.

What preparation is needed?

You do not need to prepare for CAT. However, it may help to think through what you feel your main difficulties are and what you hope to gain from therapy. You also need to be prepared to make a commitment to attend regular weekly appointments.

What happens at the first appointment?

The therapist will ask you why you are seeking therapy and talk to you about what this involves. This session gives you the opportunity to:

  • find out if CAT is likely to be helpful for you

  • decide if you are happy to work with the therapist

  • ask any questions you may have about the therapy

What does the therapy involve?

Early sessions

When you first come to CAT therapy you and your therapist will talk about why you have come. Together you will gradually build up a picture of your difficulties. CAT has a strong focus on the therapist working jointly alongside you, so that your voice and opinion is heard at every step of the way.

Early therapy sessions will involve telling and hearing your story. The therapist does not need to know every detail. What you share will be paced according to what you feel able to manage.

With your therapist you will begin to piece together patterns that keep you feeling stuck in negative cycles of emotions, repeating things you don’t want to over and over again. You will also be helped to think about how these patterns developed.

Pen and paper aids in early sessions

You may be asked to complete a questionnaire called the Psychotherapy File. This gives examples of patterns and states of mind people often describe. You can change the examples given so that they more closely describe the patterns in your own life. Your therapist will be interested in finding the most accurate description of your own patterns.

You may also be asked to do some tasks between sessions, such as monitoring your mood or behaviour patterns. This may help you spot patterns in relationships with yourself and other people in your life. Sometimes the same patterns can arise in therapy, between you and your therapist. He or she will be interested in noticing when this happens and trying to make sense of it together.

Your reformulation letter

Once you and your therapist have identified your patterns and how they came about, he or she will write a letter to you. The letter will describe your story and your patterns, to help you choose what you want to focus on in the therapy. You can decide if the letter covers everything and makes sense. The letter is another part of the conversation between you and your therapist. Your therapist will be interested in your thoughts about it. He or she may invite you to make notes on the letter or write back, especially if things feel hard to say face-to-face.

Your diagram or map

CAT therapists often also draw diagrams or maps, using words and sometimes images too. Maps are a visual way of making a summary of the patterns so that it’s easier for you to recognise when you are in them.

Some therapists begin mapping from the first session, and will involve you in this process. Others may offer a map later on.

Sometimes a firm diagram is agreed on after the first letter, once you feel more clear together about the patterns you will be working on.

The middle phase of CAT therapy

From this point CAT gives you the space to begin to focus in on two or three patterns you want to change. Monitoring between sessions and exploring things further during sessions helps you notice when you are using these patterns.

As you become better at spotting them, it can become easier to think about new more helpful patterns. Your therapist supports you in discovering, and trying out new possibilities for change.

Sometimes there are obstacles in the way and together you can explore ways to get round them.

Ending CAT therapy

CAT is usually a time-limited therapy and the therapist will help you keep the idea of the ending in mind, even from the start of your meetings. Towards the end of therapy this will be something that you and your therapist think and talk about more.

As you come to the end of your meetings, you and your therapist exchange an ending letter. This gives you both a chance to reflect on the therapy, what you can take away from it, how you feel about this ending, and the future.

You might make changes to your map, noting new patterns or ways out of the cycles that brought you into therapy. These can be reminders of therapy that you can look back on later.

How long does it last?

CAT is a brief therapy and is usually offered for between 16 and 24 sessions. Sometimes you will be offered a more condensed therapy over 8 sessions. You and your therapist will discuss how many sessions you are being offered at the beginning of your therapy. Appointments are usually weekly and last for between 50 and 60 minutes, although sometimes you and your therapist may decide to move to fortnightly sessions towards the later stages of therapy in order to ease out of therapy a little more slowly.

What follow-up is needed?

You will usually be offered a follow-up appointment two to three months after your last session. This will give you the chance to review how things have gone for you after therapy has finished. If you have had a 24 session CAT, you may be offered a few more follow up sessions.

What are the benefits?

CAT aims to help you:

  • have a clearer understanding of your current problems and how they affect your life and well-being

  • have a better understanding of the causes of these problems

  • make sense of how you survived difficulties in your life by developing strategies or patterns

  • know that these patterns were once useful, but are now holding you back

  • understand how these patterns effect how you are in relationships with other people and also how you are with yourself

  • discover new choices and ways of doing things differently that make life better for yourself and those close to you

  • find out how you can cope and keep on moving forward after therapy has ended

CAT can’t undo painful experiences in the past that have led to difficulties. But it can help you feel you have more control over patterns of self-care, self-harm and relationships with others. It can also help you to make positive changes for the future.

What are the risks?

As with any talking therapy, focusing on your problems may make you feel worse before you feel better. Talking therapy can also be unsettling if you decide to make changes in your relationships that are better for you, but may challenge people close to you. Friends, family, and partners may not feel prepared for the changes you are making and may not like them. Therapy can be a very intense experience and the relationship you make with your therapist can feel very important. Coming to the end of therapy can stir up strong feelings and this is why CAT gives the ending a lot of attention.

What if I feel things are not going well or the therapy does not suit me?

You are always free to leave CAT therapy if you don’t feel it is working well for you. However if you feel unsafe or uncomfortable because of anything that your therapist is saying or doing, it can help to bring this up with your therapist in whatever way feels possible. This can give you and your therapist a chance to try to work out what’s causing the problem, and whether this links to any of the patterns which are a focus for your therapy. Sometimes by talking and thinking together about problems you can find a way through them.