What is Cognitive Analytic Therapy (CAT)?

CAT is an integrative therapy that combines cognitive and analytic approaches to explore the problematic ways individuals think, feel, and behave. It offers a collaborative framework for understanding the origins of emotional distress, which are often rooted in early life experiences or childhood. The therapy helps individuals recognize how these difficulties are maintained by learned coping strategies and patterns of relating to themselves and others (Ryle & Kerr, 2020).

CAT may be particularly beneficial for those struggling with interpersonal problems or difficulties in relationships, as it focuses on understanding and changing relational patterns (Calvert & Kellett, 2014).

How Does CAT Work and Is It Effective?

A typical course of CAT consists of approximately 16 sessions, structured as follows (Ryle & Kerr, 2020):

• Sessions 1–4: The therapist and client discuss current difficulties and developmental history, including significant life events. The therapist provides a "reformulation letter," which summarizes a shared understanding of how past experiences may influence present problems.

• Sessions 5–12: Together, the client and therapist develop a visual "formulation diagram" to map out unhelpful patterns. Tools such as diaries are used to increase awareness of these patterns, and new coping strategies and ways of relating are collaboratively developed.

• Sessions 13–16: The focus shifts to the ongoing work of therapy and the process of ending therapy, which is particularly important for individuals with a history of difficult endings or losses. Goodbye letters are exchanged and read aloud to mark the conclusion of therapy.

• Follow-up: A review session is typically scheduled three months after the end of therapy to assess progress and maintain gains.

Effectiveness of CAT

Research indicates that CAT is effective across a variety of diagnoses, with particularly strong evidence for its use in borderline personality disorder and complex cases involving comorbidity (Calvert & Kellett, 2014; NICE, 2020). Clients often find CAT relatable and accessible, and dropout rates are notably low compared to other therapies, highlighting its acceptability and engagement.

References

• Calvert, R., & Kellett, S. (2014). Cognitive Analytic Therapy: A Review of the Evidence for its Efficacy. Psychology and Psychotherapy: Theory, Research and Practice, 87(3), 253–277. https://doi.org/10.1111/papt.12020

• National Institute for Health and Care Excellence (NICE). (2020). Borderline Personality Disorder: Recognition and Management (NICE Clinical Guideline CG78). https://www.nice.org.uk/guidance/cg78

• Ryle, A., & Kerr, I. B. (2020). Introducing Cognitive Analytic Therapy: Principles and Practice (3rd ed.). Wiley-Blackwell.

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