What is Cognitive Analytic Therapy (CAT)? 

CAT is a therapeutic approach that combines psychodynamic explorative principles and the CBT skills in dealing with clients presenting problems. It is therefore a medium term therapy; usually occurring over 8 - 24 sessions (a hybrid of short-term CBT and Long-term Psychodynamics). Therapy involves trying to understand how we currently cope with emotional distress and difficulties in relationships with others. 

Ryle and Kerr (2002) suggested that CAT takes three important understandings from psychoanalysis:

1. the relation of early development to psychological structures;
2. recognition of the linkage between psychological distress and patterns of relationships derived from early experience;
3. an understanding of how relational patterns are repeated in and may be modified through the therapeutic relationship.

The theoretical model of CAT is the procedural sequence model (PSM). This allows description of how aims are pursued and may be frustrated. It is used to describe repetitive circular (stuck) patterns of activity.

Problematic patterns in CAT are described as:

• Dilemmas: which limit the possibilities for action or relationships to polarized choices. For example: ‘Either I get what I want and feel childish and guilty, or I do not get what I want and feel frustrated and angry.’
• Traps: represent the maintenance of negative beliefs by the way they generate forms of behaviour that lead to consequences which appear to confirm the beliefs. For example: a pattern of trying to please.
• Snags: describe where appropriate goals are abandoned or sabotaged because it is believed that their achievement would be dangerous to the self or disallowed by others. For example: ‘I sabotage good things as if I do not deserve them.’

Stages of CAT in Individual Therapy

The stages of CAT in individual therapy are:

• Stage 1: Assess suitability for CAT by excluding active psychosis and substance misuse; discuss the nature and duration of treatment.
• Stage 2: Explores client history, and uses the patient–therapist relationship as well as the Psychotherapy File and Personality Structure Questionnaire in order to create a reformulation of the patient’s difficulties. Patient and therapist collaborate to create a sequential diagrammatic reformulation.
• Stage 3: The therapist encourages the patient to use diaries and self-monitoring to identify problem procedures. The reformulation is used to understand developments in the therapeutic relationship, and to assimilate memories and feelings accessed as result of the work. Awareness of the end of therapy is maintained.
• Stage 4: Therapist and patient reflect upon the implications of ending therapy.