Cognitive Analytic Therapy (CAT)

What is Cognitive Analytic Therapy?

Cognitive Analytic Therapy, also known as CAT, is a talking therapy that mainly focuses on relationship patterns.

It is based on the idea that our early life experiences influence the way we relate to other people and how we treat ourselves. This means that sometimes patterns of behaviour, or our expectations of other people’s behaviour, can develop into unhealthy or unhelpful repeating patterns, as well as those that are healthy and helpful.

Expecting or experiencing problematic relationship patterns can be overwhelming and can result in:

  • repeatedly feeling let down, hurt or rejected
  • experiencing depression, anxiety or low self-esteem
  • avoiding things
  • struggling to be assertive
  • repeatedly finding yourself in vulnerable positions.

CAT involves working with a therapist to clarify and understand:

  • any problems you may be experiencing
  • unhelpful patterns of thinking, feeling and behaving.

The therapy work is tailored to your individual needs and to your own manageable goals.

How can CAT help me?

CAT is a safe, widely used therapy that is often used with people:

  • living with depression, anxiety or eating problems
  • who self harm
  • with personal or relationship problems.

During therapy you will explore how you manage your relationships and cope with feelings or difficult situations. This will involve identifying patterns of thinking, feeling and behaving. By looking at these patterns more closely, you will:

  • clarify which ones are helpful or unhelpful
  • understand how these patterns have developed
  • discover what makes you keep repeating them
  • find alternative, more effective ways of managing to stop negative experiences or feelings from recurring .

The aim of this is to minimise the distress you experience within your relationships with others and with yourself.

What preparation is needed?

You do not need to prepare for this therapy. 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 make a commitment to attend regular weekly appointments.

What happens at the first appointment?

The therapist or practitioner 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?

You will work together to develop diagrams or “maps” that clarify both the problematic patterns and the healthy/helpful ones. This will involve thinking about the relationship you have with:

Early therapy sessions will involve hearing your story and trying to understand if some of your problematic patterns may have been learnt in your childhood. The therapist does not need to know every detail and the work 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 a negative cycle of emotions. Your therapist will write, with you, a letter describing your story and your patterns, to help you choose what you want to focus on in the therapy.

After the first session you will be asked to complete a questionnaire or psychotherapy file asking you what problems or patterns you commonly experience. You may also be given homework tasks such as monitoring your mood or behaviour patterns. This may help you to spot patterns in relationships with:

  • yourself
  • your therapist
  • other people in your life.

The rest of the therapy is about trying to recognise and change the patterns that are causing problems.

You and your therapist exchange a “goodbye” letter at the end of the therapy. This will reflect on the therapy, how you feel about this ending and looking to the future.

How long does it last?

CAT is a ‘brief’ form of psychotherapy. Your therapist will tell you how many sessions are being offered at the beginning of your therapy. This is commonly between 16 and 24 sessions. Appointments are usually weekly and last for 50 minutes.

What follow-up is needed?

You will normally be offered a follow-up appointment in two to three months. This is to review how things have gone for you after therapy has finished.

What are the benefits?

You will:

  • develop tools (e.g. letters, diagrams) that will help you understand yourself
  • have a clearer understanding of your problematic patterns and the healthy parts of yourself
  • work jointly with your therapist so you feel your voice/opinion is heard
  • be supported by your therapist to help develop a positive therapeutic relationship.

This can help you feel you have more control in patterns of self-care, self-harm and relationships with others. It can also help you to make positive changes.

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 challenging as you may decide to make changes in your relationships that are better for you but some people (friends and family) may not like these changes.

What are the alternatives?

There is a range of alternative psychological therapies which include, among others, interpersonal therapy, cognitive behavioural therapy, psychodynamic and psychoanalytic therapy. It may be useful to read the information leaflets available to help you decide which approach may be best suited to your needs.

Your care co-ordinator or lead professional can help you if you would like any further information about psychological therapies.

Adapted from Tees, Esk and Wear Valleys NHS Foundation Trust 'What is cognitive analytic therapy?'

Share your views

If you would like to share your views around CAT, you can take part in a short, anonymous survey created by the Association for Cognitive Analytic Therapy (ACAT). The survey is open to all, but researchers are particularly interested in the views of people who are either curious about CAT as a therapy for themselves or someone they know, or have some sort of experience of CAT as a patient/client/carer.

Real Life Experience

After several years of struggling with mental health problems and a repeated pattern of crisis admissions, I was referred for CAT therapy with a psychologist. I was originally offered 24, hour long sessions but we ended up working together for a longer period.

We used the first few sessions for me to explain some of the problems I had been having both recently and throughout my life and to talk about my understanding of them, or lack of it! After these initial sessions, the psychologist then wrote a letter which summarized my difficulties. She shared this with me to make sure she had understood properly. She was very empathetic and compassionate, I really valued the opportunity to be listened to and have my feeling validated. She wasn’t interested in the labels that I had collected from services but wanted to understand me and how I experienced things.

The focus of our work together was then to enable me to get a better understanding of myself; to think about how and why I repeatedly behaved in such a destructive way and where the hurt and the distress had come from. We used ‘maps’ to describe some of the patterns of thinking, feeling and behaving and talked a lot about how these ways came to be. I appreciated the space to reflect on the most difficult aspects of my past with someone who I trusted. However this work was hard and very emotional and I often struggled to cope between sessions.

We worked towards the ending of our relationship and she again wrote a letter documenting some of the things we had worked towards. As I came to make more sense of myself I was able to let go of some of the shame. The focus was more what had happened to me rather than what is wrong with me. This process of exploring some of these issues really started my journey towards recovery and a deeper understanding of myself motivated me to make changes.