What is Cognitive Analytic Therapy?

by Andrea M. Darcy

As its name implies, Cognitive analytic therapy (CAT) brings together theories and practises from both cognitive therapies and psychoanalytic approaches. A time-limited therapy, it is usually offered in courses of between 16 and 24 weekly sessions.

The aim of Cognitive analytic therapy is to be an integration of useful, focused techniques that are quickly effective yet are also able to be uniquely tailored to best suit an individual’s needs and goals.

It also prides itself on being client-friendly, with a strong focus on therapy being a collaboration between therapist and client.

With a fair amount of studies already done, CAT is increasingly evidence-based, and does feature in the National Institute for Health and Care Excellence (NICE) for Borderline personality disorder and eating disorders.

How is Cognitive Analytic Therapy Different to Other Forms of Psychotherapy?

Like most types of psychotherapy, Cognitive analytic therapy looks to a client’s past and to the patterns they have developed that are causing them to think, feel, and act in ways that stop them from being happy in the present.

But CAT tends to favour looking at patterns of relating, and the way a client’s habitual responses to others have on their relationships and their life in general.

Cognitive analytic therapy sees itself as more collaborative and less prescriptive than other kinds of therapy. This manifests in encouraging the client to explain their issues in their own terms, and to be involved in deciding their own goals for therapy and what solutions they want to engage with. But CAT does have a framework that therapists work within, so in some ways it is quite a structured form of therapy, if allowing room for creativity and idiosyncrasies.

CAT also focuses very strongly on the therapeutic relationship itself as a tool of change and a way to both see present problems with relating as well as experience new ways of relating.

Main tenets of Cognitive Analytic Therapy

So what are the main thoughts behind CAT therapy?

Labels aren’t necessarily helpful.

A core value of CAT is that clients are more than their challenges and diagnoses. This is why CAT focuses heavily on reformulation. Over the first 4 or 5 sessions the therapist and client together map out what the client feels are his or her issues and patterns, how they feel they have tried to deal with them, and what they want to change through the process of therapy.

Language is important.

One of the ways CAT is client driven is in the language used. It supports that the client, not the therapist, should choose the language to describe what they are dealing with and that there should not be any therapy jargon involved.

The client is a collaborator.

The client is involved in all stages of their therapy. They decide what their issues are, the words they like to use to describe them, and what they want to get from their therapy. The client also decides if they’d like to integrate creative tools in their therapy, such as writing, painting, and movement.

Relating patterns are at the root of many issues.

The process of CAT therapy is to help clients identify and understand the patterns of relating they developed as a child as a means to survive and cope, but which are now simply holding them back in life. These patterns of relating dictate the way one acts in relationships, career, and day to day life, and can encourage one to have negative beliefs about themselves or others.

Learning to make different and more positive choices to learned patterns is seen by Cognitive analytical therapy as key to changing beliefs and attitudes and moving forward.

The client therapist relationship is an important tool of transformation.

All forms of psychotherapy highly value the therapeutic relationship, with the trust that develops being the main vehicle for the therapist to understand the client’s world. CAT puts an especially strong emphasis on the healing potential of the client therapist relationship.

By recognising and naming the client’s patterns of relating when they rise in the therapy room, then together consciously and respectfully experiencing the pattern and sharing all that they are both thinking, a client experiences new self-awareness. This allows them to make different choices which can also be tried and experienced in the safe environment of the therapy room.

What Issues Is Cognitive Analytic Therapy Recommended For?

• anxiety and depression
• overwhelming stress
• a history of abuse, trauma and neglect
• eating disorders
• addictions
• low self care
• relationship difficulties including sexual difficulties
• self harm
• obsessions and phobias
• bipolar issues
• borderline personality disorder
• learning difficulties
• low self-esteem due to long term physical conditions
• bereavement and loss
• anger management issues

How Did Cognitive Analytic Therapy Come Into Existence?

CAT was developed in the UK during the 1980’s by Anthony Ryle, a Consultant psychotherapist working within the National Health Service (NHS) at Guy’s and St. Thomas’ Hospital in London. The area was at the time deprived and ethnically diverse. Ryle saw a real need for a 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.

Ryle was also interested in a therapy that could change, even as the need of clients and therapists grew and changed. He claims that CAT was later influenced by Vygotskian ideas, a strand of developmental psychology.

Originally designed to be non elitist and jargon-free, CAT has, over time, developed its own jargon that could be seen as complicated. And yet its core values are clear – the client’s choices matter and they are a collaborator, not a ‘patient’.

How are CAT and CBT different?

Both Cognitive analytic therapy and Cognitive behavioural therapy are short-term therapies with a limited amount of sessions between therapist and client. Both thus see the client only focusing on a limited number of goals. Another similarity is that CBT involves a client keeping track of their own progress, and a CAT therapist might also encourage their client to track their progress, such as suggesting they keep a diary.

Both therapies are also recommended for depression and anxiety. So then what is the difference? In part, it is in one of focus.

CBT is particularly focused on the link between actions, thoughts, and feelings. It focuses on thoughts and actions in the here and now, and how by changing them, one can change how they feel.

CAT, on the other hand, does look back into the past. It focuses on what the problems and challenges are, how they started, and especially how they are relational. This includes both the relationship to oneself, others, and, during the course of therapy, with the therapist.

What Does CAT offer to Clients?

The following are the suggested benefits of Cognitive Analytic Therapy:

• feel heard and understood
• form and experience a trusting relationship (with the therapist)
• understand the thoughts and behaviours behind previous diagnoses and labels
• learn to think about oneself in a different way
• identify and understand what one’s issues really are
• connect earlier life experiences to the challenges one is now having
• notice and comprehend patterns of relating developed as survival mechanisms
• see how such patterns no longer serve but hold one back
• try new patterns of relating in a safe and supportive environment
• learn to identify and choose more positive alternatives in life
• improve relationships with oneself and others

What is a Cognitive analytic therapy session like?

The first session involves deciding how many weeks you will work together for. From there on out, sessions are held weekly, and like other forms of therapy will be from 50 minutes to an hour in length. It might also be decided in the first session if you are going to monitor a certain mood or psychological symptom.

The first few sessions then involve the therapist learning about your life. You share what you feel are your main challenges in the present, as well as what has happened in your past. The therapist will encourage you to take note of what is working for you, and what brings you joy, so that a balanced view is found.

By session four or five, the therapist will present you with a ‘reformulation’ letter. This is essentially a gathering and translation of all the information you have shared.

There is a focus on patterns, especially of relating. You’ll be assisted in ‘mapping’ your problems out in writing. Work will continue on recognising how such patterns surface, even in the therapy room, and how new ways of thinking and acting can be tried. Ways to monitor patterns between sessions can be explored.

The therapist will be respectful but very honest with you. Cognitive analytic therapy is about open collaboration, and they will encourage you to also be open.

Different creative techniques like writing, painting, and even movement might be integrated.

Cognitive analytic therapy is unique in that it is concerned the ending of therapy be positive, so it encourages both of you to write goodbye letters when your time together is done.

Have further questions about Cognitive Analytic Therapy? Or want to share your experience with it? Do so below, we love hearing from you.

Photos by Hartwig HKD, Matryosha, Joe Houghton, Enokson