Cognitive Analytic Therapy, also known as CAT, is a weekly, time-limited therapy for a period of normally between 16 and 24 weeks. It was developed about 30 years ago by Dr Anthony Ryle to meet a need in the NHS for a therapy to deal with more complex cases. It is a relational model with a mix of both cognitive and analytical approaches and is suitable for a range of mental health difficulties including anxiety, eating disorders and depression.
The CAT approach is an active one and you work collaboratively with your therapist to consider how patterns of interacting in early childhood may be adversely impacting upon your relationship with yourself, and others, as an adult. The framework which helps to contain the therapy consists of four phases.
The four phases of Cognitive Analytic Therapy
The first is known as reformulation where your therapist talks to you about what you want to work on in therapy and explores your life story and family history. CAT sees us as relational beings so the key relationships we form in early childhood can still affect us as adults; some in a good and productive way, but others in a way that can negatively impact upon our emotional and psychological well-being. For example, if a child had a very strict parent who closely controlled their behaviour then the child may learn to comply and give into others’ needs before their own. As a young child with very little power this compliant behaviour would have been a strategy that helped the child to deal with the controlling parent. However, if this tendency to comply with others’ wishes generalises to most relationships as an adult then it can leave an individual feeling resentful and hard done by as they are neglecting their own needs in order to respond to the needs of others.
The reformulation phase usually takes about five to six weeks and at the end of this first section your therapist will write you a letter setting out their understanding of the issues you have brought to therapy, your family history and life story as well as some of the unhelpful patterns you have identified and mapped out together. You are invited to comment on the letter and to make any changes to ensure it fairly represents your situation and what you have shared with your therapist. An important aspect of CAT therapy is its open and collaborative nature where you work alongside each other to gain an understanding of why you act in certain ways so you can acknowledge and change any unhelpful patterns in the future.
After reformulation, the next phase of CAT is known as recognition. At this point the focus shifts from your early past to your more recent relationships by considering examples of where the unhelpful relational patterns you’ve identified may be playing out. So, continuing with the controlling/compliant example, there may be a situation at work where compliant behaviour with a controlling colleague may be adversely affecting an individual’s ability to assertively state their needs, leaving them feeling resentful and unheard. During recognition the generic patterns mapped out in the previous phase can provide an ‘observing eye’ where you are able to step back, see and name what is happening. This stage of the CAT framework is about compassionately noticing what is going on without any push to change. Understanding what triggers these unhelpful patterns of interaction is an important step before the next phase known as revision.
Revision is about trying new ways of interacting and seeing how they work. In CAT terms we often describe these as exits as they are ways of exiting old and unhelpful behavioural procedures. For example, a normal behavioural response for the controlling/compliant example at work may be for an individual to always stop what they are doing at another’s request e.g. “Can you do this for me now?” “Yes, I’ll do it straight away”. This compliant response can put time pressure on an individual as they have their own work to do. A revised response may be “I’m working on a deadline at the moment but I’ll be happy to look at that for you tomorrow if that would work?” Revising embedded ways of thinking and behaving can take time and it is normal to slip back into our old and well-worn ways of being. The difference with the CAT model is that you will often notice when this has occurred and this can give you the power to do things differently the next time.
The final phase in the framework is ending. CAT takes the ending of therapy very seriously as the ending of any relationship including therapeutic ones can be difficult. The aim is to have a good ending where you and your therapist review what has happened over the course of the therapy, highlighting your successes as well as the areas you still want to work on. Before the end you will be invited to write a goodbye letter to your therapist to share at your final session and they will do the same for you. Your letter does not have to be long, in fact in can be a few bullet points of things you want to take away from the therapy and remember. These letters, together with the reformulation letter and any procedural patterns with exits mapped out, provide you with a record of your progress and useful information you may want to visit from time to time going forward once CAT has finished.
CAT isn’t for everyone, as it can be a tough therapy, which looks at early childhood experiences and how these may be negatively affecting your relationships with yourself and others today. It is active and your therapist may give you tasks to complete in between sessions such as keeping a journal. It also requires a willingness to self-reflect and to consider the possibility of personal change by trying out new ways of being in the world.
I am an accredited CAT Practitioner and Supervisor and offer individual therapy sessions as well as supervision for CAT Practitioners and Trainees. If you would like to learn more about CAT please contact me at firstname.lastname@example.org for a free introductory appointment.