Cognitive Analytic Therapy (CAT) is a collaborative therapy which looks at the way a person thinks, feels and acts, and draws links between this and past events and relationships (often from childhood or earlier in life). CAT brings together ideas and understanding from both cognitive therapies and psychoanalytic approaches into a single user-friendly therapy.
It is a time-limited therapy, and is usually offered in courses of between 16 and 24 weekly sessions (but briefer models are also available depending on a person’s circumstances/needs).
CAT is tailored to a person’s individual needs and to their own manageable goals for change. CAT is a relational therapy which means that it uses the therapeutic relationship to notice and examine repeating problematic patterns. CAT tends to favour looking at patterns of relating (to others, to ourselves, and to the world), and identifies the way our habitual responses impact upon our relationships and our life in general.
Once these patterns have been identified, the next task is to develop recognition of them in your daily life (this also includes noticing them in the therapy session too). By recognising and naming a person’s patterns of relating when they arise during the therapy session, we together consciously and respectfully experience the pattern ‘live’ and so have the unique opportunity to share our thinking, which aids the growth of new self-awareness. This then allows a person to make different choices (departing from automatic, well-learned responses) which can then be tried and tested in the safe environment of the therapy session. These revisions are known as ‘exits’ in CAT.
At the heart of CAT is the collaborative nature of the therapeutic relationship, so you will find that it is less prescriptive than other kinds of therapy. CAT encourages the client to explain their issues in their own way, and to be involved in deciding their own goals for therapy and what changes they want to engage with. On the one hand, CAT is therefore a flexible approach (i.e. tailored to a person’s specific set of struggles); whilst on the other, it has a framework that therapists work within, so in some ways it is also quite a structured form of therapy, but one that allows room for creativity and the individual nature of each of us.
How was CAT developed?
CAT was developed in the early 1980’s by Dr Anthony Ryle at Guy’s and St Thomas’ Hospital in London. CAT developed as a public health response to the mental health needs of a busy inner London area, and this concern with access and equity remains at the heart of the model. He felt it important to offer a short-term focused therapy that could access the deep patterns of a client’s past like psychoanalytical therapy, but in a quicker and affordable format which could be offered through the NHS.
In a nutshell, CAT is about:
- Forming a trusting relationship with your therapist which allows you to work together to explore the difficulties you are facing
- Identifying your current problems and how they affect your life and well-being
- Looking at the underlying causes of these problems in terms of your earlier life and relationships
- Understanding how you learned to survive sometimes intense and unmanageable feelings by relating to others and yourself in particular ways
- Identifying how these same (once) useful patterns may now be holding you back. These patterns of relating dictate the way one acts in relationships, career, and day to day life, and can serve to reinforce negative beliefs about oneself or others.
- Learning to make different and more positive choices to learned patterns is seen by CAT as key to changing beliefs and attitudes and moving forward.
- The first 4-5 sessions focus on the above and culminate with a therapeutic letter that draws together what has been discussed and understood. This letter is called a ‘reformulation letter’ and is instrumental in guiding the rest of the therapy.
- Along with the letter, we also draw out the patterns identified and create a co-produced ‘map’ which is used throughout the therapy as a way of helping recognition and change.
- The middle sessions of the therapy focuses on recognition and later revision (ways of doing things differently) that aim to may make your life better.
- The last quarter of the therapy will focus in on ‘endings’ and paying attention to how you have experienced endings in your life. As the end therapy approaches, we spend time processing this with the aim of experiencing a ‘good enough’ therapeutic ending. As part of this, we will both write ‘goodbye’ letters reflecting on the therapeutic relationship and process as well as a way of saying goodbye.
- This phase also looks at how best you can continue to move forward after the therapy has ended.
- For 16 session CATs, there will usually be a 2-3 month follow-up appointment after the therapy has ended. This is to support a person to keep the learning alive in their life.
- For 24 session CATs, there may be several follow-ups spaced apart, and this is something that will be discussed and decided collaboratively.
For more information:
For much more information about CAT, please go to the Association for Cognitive Analytic Therapy (ACAT) website: www.acat.me.uk
The ACAT website holds a full list of accredited CAT therapists (therapist/practitioners and psychotherapists) who are current members of ACAT and this can be found under the Register of Members: http://www.acat.me.uk/page/register+of+acat+members