Cognitive Analytic Therapy (CAT) is a collaborative and creative process. It uses written documents and structures to support a productive focus in therapy. By obliging the therapist to be explicit about their thinking CAT greatly increases the value of therapy. In the 4 session “assessment” phase client and therapist agree a working definition of the problem. This provides a shared platform so that the rest of the work can concentrate on modifying problem patterns. The aim of CAT is to make changes, with the expectation that these changes will last, over time. The follow up session allows an overview. Although CAT uses a clear structure it is not rigid. Episodes of therapy are also possible.
CAT was founded in the UK by Anthony Ryle (1927-2016). Ryle worked in the NHS and wanted an effective, short term therapy that was capable of treating patients with complex presentations. As its name suggests, CAT integrates elements of Cognitive Therapy, including Cognitive Behavioural Therapy, with elements of Psychoanalytic Therapy. From Cognitive Therapy Ryle took the notion of habitual patterns of thought/behaviour/feelings, which have to be understood if change is to be achieved. From Psychoanalysis Ryle took the influence of past experiences and the way these can become embedded into a person’s make up, sometimes without their being aware. At the time Ryle wrote his books on CAT (1982-2002) such an integration was innovative. Ryle also brought other influences to bear – Kelly’s Personal Construct Theory, family therapy, Vygotsky’s notions of language acquisition and Bakhtin’s ideas about the self forming as a result of a dialogue with other people. He also emphasised, like Mann, the importance of thinking about the ending of therapy, since this echoes other endings in the client’s life.
Ryle did not endorse the “blank screen” approach that had been central to Freud’s method of Psychanalysis. Ryle embedded structures into CAT, which oblige the therapist to explain fully and transparently what they are thinking, and then co-operate with the client to modify and refine these suggestions into a “formulation”, a working map which they then both use as a focus to guide the remainder of the therapy.
Structure of Cognitive Analytic Therapy
CAT was originally designed as a 16 session model, structured as follows –
- Initial session to agree to work together
- Sessions 1-4 “survey phase”. Therapist gathers information and tests any emerging ideas by sharing them.
- Session 5: therapist reads a 2-page draft letter (called a “reformulation”) of what he/she thinks is happening in the client’s life. The client comments on this.
- Session 6: therapist reads amended reformulation. This proposes up to four “target problems”, the patterns that support them and goals to overcome them. This becomes a thematic reference point for future sessions. Homework (usually observation) is based on these.
- Session 7: therapist shares a draft diagramatic version of the reformulation, showing patterns of thought and feeling. The client comments on this.
- Session 8: therapist shares amended diagram. This, again, provides a useful focus for future work.
- Sessions 9-14: working and re-working around the four “target problems”. Over the weeks these are likely to recur in and out of the therapy room. The client’s skill at noticing and revising these patterns increases. In this phase other therapy modalities can be used depending on preference of client and therapist – art therapy, narrative, mindfulness, etc.
- Session 15: client and therapist read goodbye letters to each other, stating what has been learned.
- Session 16: final meeting.
- Follow up session after about 3 months.
My training in Cognitive Analytic Therapy
I completed the 2-year CAT Practitioner Training with Catalyse (formerly known as CAT North). I was awarded the ACAT CAT Practitioner Diploma in 1998.
Cost of CAT
Change for the Better: Self-help Through Practical Psychotherapy. Elizabeth Wilde McCormick 1990.
Cognitive Analytic Therapy: Active Participation in Change. Anthony Ryle 1990.
Cognitive Analytic Therapy and Borderline Personality Disorder. Anthony Ryle 1997.
Introducing CAT: Principles and Practice. Anthony Ryle 2002.