Cognitive Analytic Therapy (CAT)
Cognitive analytic therapy (CAT) is a collaborative method that looks at the way a person thinks, feels and acts, where these patterns come from, and how they might be being upheld in an individual's life. There is a strong focus on relationship patterns.
As a form of therapy, it was developed in the UK by Dr Anthony Ryle in the context of providing effective and affordable time-limited therapy within the NHS. As with cognitive behavioural therapy (CBT), this therapy is short-term (usually 16 weeks, but ranges between 4 - 24), structured and directive.
Clients take an active role in their own process of healing, and learn to make associations and analyse their own responses through ‘homework’, such as diary keeping, progress charts, etc. The therapist works in collaboration with the client, focusing on changing negative thought patterns and behaviour, and teaching alternative strategies for coping.
One of the defining features of cognitive analytic therapy is the use of reciprocal roles (RRs). The emphasis is put on relationships between people, rather than problems occurring solely within the individual. RRs may begin in early life (for example, how a child interacts with his/her parents), and may be repeated in adult life.
It is important that there is an empathetic relationship between the client and therapist, to help the client make sense of their situation and find ways of changing (in CAT these are called "exits").
Though there are many similarities between CBT and CAT, both being time-limited and fairly directive therapies, in CBT there is arguably more of a focus on present day thoughts and behaviours whereas CAT takes a more long-term view and is more likely to look at your relationship patterns throughout your lifetime.
What can cognitive analytic therapy help with?
- Depression
- Social anxiety
- Anxiety
- Relationship problems
- Attachment insecurities
- Self-harm
- Substance abuse
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What happens in cognitive analytic therapy?
Cognitive analytic therapy is considered a brief form of therapy, generally running between 4-24 weeks.
It is also more structured than other types of therapy, consisting of different phases. The early phases are the 'reformulation phase' where you will have the opportunity to talk openly to your therapist about what is troubling you.
In these early stages you may be asked to complete a 'psychotherapy file', a questionnaire that divides experiences into Traps, Dilemmas, Snags, and Unstable States of Mind.
Traps describe the unhelpful cycles that can arise between negative thought patterns and dysfunctional behaviours. Developing awareness of these spiralling thoughts is the best first step to freeing yourself from them.
Dilemmas describe the situations that you may stay in, even if they aren't good for you, from avoiding a potentially worse alternative. Oftentimes, dilemmas are the result of 'either/or' and 'if/then' thinking.
Snags describe the fear of potential future consequences that inhibit you from making choices or engaging in more healthy behaviours. Snags might come from within, or you may feel snagged by external circumstances and other people.
Around the fourth or fifth session, you will work with your therapist on a 'reformulation letter', which outlines a shared understanding of the problems that you are bringing to therapy to work on.
You and your CAT therapist will then work on mapping out your problems on paper, to help you contextualise and visualise them in a different way.
Cognitive analytic therapy aims to raise your awareness of the patterns that repeat across the different relationships and difficulties in your life. Your therapist might encourage activities between sessions to help you track these patterns. Your therapist may also raise when they see it happening in session between the two of you.
The ending is built into the course of cognitive analytic therapy – usually three or four sessions will be dedicated to this process.
Training as a cognitive analytic therapist
Training as a CAT psychotherapist takes four years. The first two years qualify someone as a CAT practitioner, after which they are able to start seeing private clients. The second two years are further training to qualify as a CAT psychotherapist.
Trainees on accredited CAT courses are expected to have supervision and personal therapy as part of their training.
All therapists and counsellors on Welldoing are verified annually as members of reputable professional associations, in order to verify a high standard of training.
Relevant organisations
Last updated October 2024
What is CBT?
What is behavioural therapy?
CAT for managing anxiety
My experience of CAT for borderline personality disorder
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