Cognitive Analytic Therapy (CAT) is a form of brief psychotherapy that is useful for a wide range of problems. As its name suggests, it brings together understandings from cognitive psychotherapies (such as CBT) and from psychoanalytic approaches into one integrated, user-friendly therapy.
Cognitive Analytic Therapy (CAT) was developed by Dr Anthony Ryle, from within and in response to the needs of the British National Health Service (NHS).
The usual length of therapy is between 16 and 24 once weekly sessions. The usual length of each session is 50 minutes.
The first few sessions are spent gathering information about the problems that the client wants to focus on, and the life story of the client. Both therapist and client begin during these sessions to try and make links between the two, to begin to understand where the problems may have come from. Around session 4 – 6, the therapist will write a draft letter (called a ‘reformulation letter‘) which aims to put down in writing these understandings. The client will then take away the draft letter and think about changes that they may wish to make to it. The aim is to end up with a collaboratively derived and agreed document that describes the problems that are the focus for the therapy and a theory about how they came about and why they are still there. The latter ‘theory’ is put in terms of how CAT understands human beings, which briefly is as follows.
As human beings we are all born to be ‘hard wired’ to attend primarily to relationships with other human beings and to organise our understanding of others, ourselves and the world within the framework of the relationships we encounter – the most important ones of which, for most of us, are our parents. The other thing that human beings are good at is to adapt our behaviour to situations we find ourselves in so as to be as comfortable as possible. This often means that we develop ‘habits’ of thinking, feeling and behaving as children that keep us as safe and as comfortable (or least uncomfortable) as possible. These habits often serve us well as children, and like most habits we forget that we do them. Some of these habits are less helpful when we become adults though, and enter the big, wide world. Indeed, sometimes these habits can then create more problems than they solve.
A CAT reformulation letter aims to describes the problems, give a brief narrative of the client’s life including their early life, and to tease out what these ‘habits’ were for that person, and in what way they may be creating or maintaining the problems in that person’s current adult life.
Once these habits, or patterns, have been recognised in the letter they are also represented in a diagrammatic form which is also often created with, and certainly explicitly shared with, the client. This diagram becomes a kind of map which can be used by the therapist and client as a tool during the therapy and which (like the letter) the client is given to take away with them.
The middle phase of therapy is spent helping the client recognise the identified problematic patterns as they arise in their current life, and in beginning to discuss what the client may want to do differently in such circumstances. The client is encouraged to experiment with different responses and to see what happens. Usually a different behaviour on the part of the client results in a different outcome, and more helpful outcomes are called ‘exits’ which can be added to the diagram.
At the end of the therapy, the therapist will write the client a ‘goodbye letter’ summarising what has happened during the therapy and saying goodbye. The client is also invited to write a ‘goodbye letter’ to the therapist.
One aspect of CAT that is not easily captured in the above description is the focus throughout on the importance of relationships in our psychological life. This includes the relationship the client has with themselves, and the relationship the client has with the therapist.
For more information visit the website of the Association for Cognitive Analytic Therapy www.acat.me.uk