Cognitive Analytic Therapy (CAT)

CAT (Cognitive Analytic Therapy) incorporates both cognitive and analytical approaches. It is a blend of the pragmatic and the unconscious patterns that impact on our lives and for many is incredibly effective at enabling change.

What is CAT (Cognitive Analytic Therapy)?

CAT involves looking at the way a person thinks, feels and acts, and the events and relationships that underlie these experiences (often from childhood or earlier in life).

CAT is an integrative therapy – with roots within both the ‘cognitive’ and ‘analytic’ families of therapy. It was designed to provide an effective therapy that could be used in a relatively short term way, to help patients deal with often complex and difficult issues.

CAT believes that our thoughts influence how we make sense of past experiences and, consequently, how we manage new emotional difficulties.

Sometimes, the way we respond to important experiences in our lives creates a distorted set of thoughts and belief systems. These distorted thoughts can then go on to create behaviours which aren’t always the most helpful in a situation (these are often known as ‘maladaptive’ behaviours).

The problem with these new maladaptive behaviours is that they can lead us to react in certain ways that mean we may have difficulties with relationships, holding down jobs or just leading a happy and fulfilling life.

What is CAT used to treat?

CAT’s distinctive feature is that it treats multiple symptoms or problems in one therapy via an active, focussed and collaborative process.

CAT treatment is flexible, so it can be used with a wide range of issues and problems and is also personalised to the individual client.

CAT is a NICE approved treatment for a wide variety of conditions, including:

• Anger
• Anxiety
• Depression
• OCD
• Phobias
• Borderline Personality Disorder
• Body dysmorphia
• Substance Addiction
• Relationship difficulties
• Sexual issues

What to expect from CAT

1. Short term - Cognitive analytic therapy is a relatively short-term, time-limited therapy. Like most types of psychotherapy, each session is 50 to 60 minutes long. Sessions are usually held once a week, although you and your therapist may decide having two sessions per week would be a better approach.
2. Structured approach - Most CAT therapists follow a fairly structured protocol for this therapy. However, your treatment will be tailored to meet your specific needs and concerns. Although CAT is often conducted on an individual basis, it’s also suitable for couples and groups.
3. Therapeutic relationship is important - the relationship with the therapist or the psychologist is used to make sense of your situation and help find new, healthier ways to cope with problems or difficulties.

Analytic elements of CAT –

The analytic element of CAT focuses on the relationships in the individual’s life, both with other people and themselves and in particular will look at the following areas:

1. What do we expect from the relationships in our lives and what have we learnt from previous relationships?
2. CAT is interested in our internal relationship with ourselves and how this relates to our external relationships with others – often the two are related.

For instance, if one of your parents left home at an early age, you may have ‘learnt’ to expect to be abandoned. The theme of abandonment may be something that you experience later on in life, perhaps lots of relationships have ended for you.

You may start to fear this abandonment and go out of your way to do things that will stop it from happening – these behaviours can cause distress and may cause ongoing problems in relationships (creating a cycle of fear and abandonment).

An individual may also have a subconscious expectation that they may abandon themselves and this could play out by not trusting oneself, not committing to things and finding it hard to see things through.

Cognitive Psychology aspects of CAT –

The cognitive aspects of CAT assume that how we think can condition how we feel, act and our sense of ‘reality’. In addition how we act can affect our thoughts and feelings.

In this way, patterns of thoughts and actions can become self-perpetuating and CAT can be really helpful in understanding these links and developing ‘exits’ to these patterns.

The blending of the two –

In traditional analytic therapy, part of the therapist’s role would be to make interpretations about a client’s unconscious processes.

In traditional cognitive therapies, part of the role of the therapist would be to look at unhelpful patterns of thinking and acting.

CAT blends the cognitive and analytic approaches, taking both a pragmatic approach, typical of cognitive therapy, and a relational approach, which explores a person’s sense of self typical of an analytic approach.

The therapist will describe problematic patterns in the client’s ways of thinking, behaving and relating helping them to understand their difficulties more clearly, recognise patterns as they arise, and find ways to change them.

CAT also differs from other therapies in that a key element of the therapy is that the therapist openly shares their understanding, often in the form of letters or diagrams, that summarise the central features of the client’s problems and proposes what the therapist and client should focus on in their remaining sessions.

Is CAT right for me?

It can be really hard to know which therapy is the right one for your current circumstances. It’s normal for people to find one type of therapy works at a particular time in their lives, but then change to another type later on.

In CAT, the client will focus on issues and work with their therapist to understand the deeper patterns that underlie them.

The key indicators that cognitive analytic therapy might be a good choice for you include:

• You want to build a trusting relationship with your therapist. This is key for most therapies but in CAT you will work closely with your therapist to unpick the reasons you behave in certain ways. CAT uses the relationship between the client and therapist to reflect on how learnt patterns of relating take place both in and out of the therapy room
• CAT asks you to link the past to the present. You want to look at the underlying causes of your problems in terms of your earlier life and relationships.
• You are open to seeing the role you play in your own actions. During CAT therapy you will identify the patterns of behaviour that are impacting your life and holding you back.

Why might CAT be the wrong therapy for me?

• Are you happy to work closely with a therapist? CAT may at times be more directive than some other types of therapy, so being open to working collaboratively with the therapist is important.
• Are you in crisis? People who are going through a particularly challenging time or are very depressed may find it hard to engage with the cognitive aspects of this approach. Homework is often given between sessions – so you will need to be confident that you have the time and space to complete these tasks.
• Are you happy to work short term? CAT therapy normally lasts for about 16 sessions, though that is a guide only. For people with deep rooted trauma or who want to understand at depth their issues, this might not be enough time
• It’s fast paced. Confronting past trauma and painful emotions, particularly at such an intense pace, may not be the best approach for some people, particularly if they are in the early stages of recovery from an addiction, or who have a high risk of relapse. However, this risk may be reduced if they are also involved in an addiction support group and / or a relapse prevention therapy program.

The communication between therapist and client, seeing your story described through the eyes of another, can be a deeply profound experience and enable great healing and change.

Dr Michael Swan

DClinPsych

Clinical Psychologist

Brighton

Dr Michael Swan is a highly experienced Clinical Psychologist currently working for Sussex Partnership NHS Foundation Trust in their Adult Mental Health Service. He has a Doctorate in Clinical Psychology and is registered with Health & Care...