The CAT practitioner aims to work with the patient to identify procedural sequences; chains of events, thoughts, emotions and motivations that explain how a target problem (for example self-harm) is established and maintained. In addition to the procedural sequence model, a second distinguishing feature of CAT is the use of reciprocal roles (RRs). These identify problems as occurring between people and not within the patient. RRs may be set up in early life and then be replayed in later life; for example someone who as a child felt neglected by parents perceived as abandoning might be vulnerable to feelings of abandonment in later life (or indeed neglect themselves).

Various psychotherapies have been used to treat many conditions including mood disorders such as depression and bipolar disorder, Personality disorders, eating disorders, anxiety disorders, and addictions.

Psychotherapies are also used to treat people who may not have a diagnosed mental illness, but need help coping with some kind of life stressor, such as stress from work or family, dealing with disease or health problems, or any kind of major life change, such as the death of a parent, divorce or personal trauma.

CAT has been shown to lead to subjective improvement in people with anorexia nervosa. It has also been shown to produce significant improvements in adolescents with a diagnosis of Borderline Personality Disorder (BPD). CAT has also been shown to improve patients' management of diabetes. Case series and single case studies have also been published describing the use of CAT in dissociative psychosis, the treatment of offenders, brain injury, deliberate self-harm, dissociative identity disorder and Histrionic personality disorder.

The model emphasizes collaborative work with the client, and focuses on the understanding of the patterns of maladaptive behaviors. The aim of the therapy is to enable the client to recognize these patterns, understand their origins, and subsequently to learn alternative strategies in order to cope better.

The approach is always time-limited, typically taking place over 8-24 weekly sessions (the precise number being agreed at the start of therapy). Sixteen sessions is probably the most common length. In the first quarter of the therapy (the Reformulation phase) the therapist collects all the relevant information, asking the patient about present day problems and also earlier life experiences. At that point the therapist writes a reformulation letter to the client. This letter summarizes the therapist's understanding of the client's problems. Particular attention is given to understanding the connection between childhood patterns of behavior and their impact on adult life. The letter is agreed between patient and therapist and forms the basis for the rest of the work.

After the reformulation letter the patient may be asked to complete diaries or rating sheets to record the occurrence of problems and their context. During this period (known as the Recognition phase) patient and therapist construct a diagrammatic formulation to illustrate the unhelpful procedures which maintain problems for the patient. The aim of this phase is to enable the patient to recognize when and how problems occur.
In the second half of the therapy work moves into the Revision phase, where 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 taking an overdose. An exit might involve expressing the anger in some way as an alternative to self-injuring behavior.

At the end of the therapy, patient and therapist each write "goodbye letters" which they exchange, summarizing what has been achieved in the therapy and what remains to be done. After the end of the agreed number of weekly sessions, planned follow-up sessions take place to monitor and support the changes that have been made. Typically, a 16-session CAT might be followed up by a single session one month after the end of therapy, and a final one three months later.

Pros for this therapy

Psychotherapy can help you make dramatic changes in your life. Psychotherapy seeks to discover and address the underlying causes of psychological issues. Psychotherapy allows you to explore your symptoms and defenses in a constructive manner. Psychotherapy is a great tool to lead you to awareness, which can allow you to make the dramatic changes that will help you to move forward.

Comparative studies have suggested CAT to be at least as effective as other forms of brief psychotherapy, person-centered therapy and cognitive behavioral therapy and interpersonal psychotherapy.

Cons for this therapy

There are very few cons for psychotherapy, however patients who are in an acute psychotic state or severely depressed and suicidal may need hospitalization and medication to be initially stabilized. Patients with anorexia, severe personality disorders, or other organic brain diseases such as schizophrenia may need medical attention as well. All courses of psychotherapy should be supervised by a psychiatrist as part of a comprehensive treatment plan.

CAT may not be effective in dealing with psychotic disorders such as schizophrenia and bipolar disorder.

Since therapy can bring up painful memories or feelings, sometimes people may need to wait until their lives are stabilized before therapy can be successful. Other times, if therapy is successful and someone makes a life change, this may be difficult for some old relationships to sustain. While most people will be happy that someone is undergoing therapy for self-improvement, there will always be people who do not like the 'new' person, and this will put a strain on, and sometimes end, a relationship, which can be painful.

Cognitive analytic therapy was developed by Anthony Ryle. This brief therapy was developed in the context of the National Health Service in the United Kingdom with the aim of providing an effective and affordable psychological treatment.

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner.

Psychotherapy aims to increase the individual's sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialog, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

Cognitive Analytic Therapy (CAT) is a form of psychotherapy which 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.

Review Date: 
February 15, 2012