Personality Disorder Support Community

Personality Disorder Support Community

What is Cognitive Analytic Therapy?

Cognitive Analytic Therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. It is a time-limited therapy that was developed with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained NHS.

It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.

Procedural Sequence Model

    The CAT practitioner aims to work with the patient to identify procedural sequences, i.e.

  • Chains of events

  • Thoughts

  • Emotions

  • Motivations

    which explain how a target problem is established and maintained.

Reciprocal Roles

    A second distinguishing feature of CAT is the use of reciprocal roles. These identify problems as occurring between people and not within the patient. Reciprocal roles may be set up in early life and then be replayed in later life.

    For example, a child who was neglected by his or her parents might be vulnerable to feelings of abandonment in later life.

CAT in practice

CAT depends upon a combined effort between therapist and client, and focuses on the understanding of the patterns of maladaptive behaviours.
The aim of the therapy is to enable the client to recognise these maladaptive behaviours, understand their origins, and to learn alternative behaviours to replace the maladaptive ones.

The precise number of sessions, usually between eight and twenty-four, will be agreed at the start of therapy.

The Reformulation Phase

    In the first quarter of the therapy the therapist will ask the patient about present day problems and also earlier life experiences.
    The therapist will then write a reformulation letter to the client. This letter will summarise the therapist's understanding of the client's problems.
    Particular attention is given to understanding the connection between childhood patterns of behaviour and their impact on adult life. The letter is agreed between patient and therapist and forms the basis for the rest of the work.

The Recognition Phase

    During this period the patient may be asked to complete a diary or rating sheet, recording the context of problems and when they occur.
    The patient and therapist will also construct procedural diagrams to show the procedures which maintain problems for the patient.
    The aim of this phase is to allow the patient to recognise how and when problems occur.

The Revision Phase

    In this phase patient and therapist identify and practice exits from the procedural diagram established in the previous phase.
    For example a problematic procedure might move a patient from feeling angry to self harm. An exit might involve expressing the anger in some way as an alternative to self-injuring behaviour.

At the end of therapy, the patient and therapist will exchange goodbye letters. These letters summarise what each feels has been achieved during therapy and what remains to be done.

Once the agreed number of sessions are completed planned follow-up sessions take place to monitor and support the changes that have been made. For example, a 16-session CAT might be followed up by a session one month after the end of therapy, and a final session three months later