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?

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.  

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.

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:

• 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 you may wish to discuss with your care team. It may be useful to read the information leaflets of those therapies available to help you decide which approach may be best suited to your needs.

Your key worker can help you if you would like any further information about psychological therapies.

Where can I find more information?

The CAT practitioner local to your area can give you more information.

You can also find more information on-line at www.acat.me.uk

The Department of Health also have a useful guide to talking therapies and the risks involved called “Choosing talking therapies”.

How to be referred

If you would like to be referred for CAT please discuss this with your key worker.

Copies of letters and reports

Recent Department of Health guidance states that you have a right to receive copies of letters and reports sent by us to your referrer and your GP.

If you wish to receive these, please let us know.