What is Cognitive Analytical Therapy (CAT)?

In CAT we look beyond the diagnosis and symptoms to understand the whole picture of life and how someone has adapted and survived.

People who engage with CAT often find it most helpful when they have a desire to explore and understand current, and historical, relationships (both with themselves and others).

At the heart of CAT is the therapeutic relationship which is seen as central for making sense of difficulties and working towards change. CAT is a collaborative, structured and time-limited therapy with the client’s agreed goal at the centre.

You can find more information on these links:

We’ve made a short introductory video about CAT:

An introduction to cognitive analytic therapy

Hi, I'm here to give you a quick introduction to cognitive analytic therapy or CAT.

Cognitive analytic therapy is a talking therapy that helps with change by addressing repeating patterns which may keep you stuck in life and may have been there for many years.

CAT is structured, time limited and collaborative. It combines the most useful elements from different therapies including cognitive and psychodynamic approaches.

CAT is used in many settings, but in mental health it's particularly helpful for mood and anxiety problems, difficulties in relationships with others, or with yourself, and more complex problems like those resulting from childhood and adult trauma and adversity.

Sometimes CAT can help offer a different approach where other therapies have not led to a complete recovery.

How does CAT work?

CAT typically lasts 16 sessions with variations between 8 and 24 sessions depending on what the ends are. It follows a clear structure with three main phases.

First is the reformulation phase. Here you and your therapist explore your past experiences to understand how early relationships and life events shaped your current patterns. Together you create a reformulation letter that summarises these patterns and where they came from and highlights the challenges you face.

This phase is about agreeing a clear problem and goal to work on, making sense of how unhelpful coping strategies developed over time, and provides a clear focus for understanding and change for the remainder of therapy.

Second is the recognition phase. Next you work on recognising these patterns in your everyday life. You and your therapist create a CAT map, or a diagram, to track how those patterns play out day-to-day in the form of thoughts, feelings and actions. The aim is to spot those patterns as they happen so that you can pause and give yourself more options.

Often this also means noticing moments in therapy too, so using the therapeutic relationship to help develop your understanding.

Third is the revision phase where you focus on changing these unhelpful patterns. You practice new ways of thinking and relating. The goal is to empower you to continue making positive changes even after therapy ends.

This phase normally includes a goodbye letter reflecting on your journey and preparing you for the future.

What makes CAT unique is its focus on understanding the roots of your difficulties whilst also offering practical tools for change. It's collaborative. Your therapist isn't there to fix you but to work alongside you helping you become your own therapist.

People often find that CAT can go quite deep, especially with problems that have been there since childhood, but can be done relatively briefly to help you leave therapy and get on with your life.

Finally, you can find out more about CAT in the What is CAT? information leaflet. You can also visit the ACAT website.

Download the audio transcript

Who is Cognitive Analytical Therapy for?

CAT can be used with people with many types of psychological problems, but is particularly suitable for people with:

  • Repeating patterns in relationships that cause difficulties (with self and/or others).
  • People who might meet the criteria for a diagnosis of personality disorder.
  • People who use coping strategies that can be harmful (e.g. overdosing or self-harming).
  • Multiple problems and diagnoses.
  • Complex trauma (e.g. resulting from sexual, physical and/or emotional abuse).
  • When the person has struggled to benefit from previous therapeutic interventions, for instance due to feeling “stuck” with making changes, or due to difficulties forming a working partnership.

Engaging in CAT requires a commitment on behalf of both the therapist and the client who set out to work together. For people to gain the most from CAT, timing is important. As such starting CAT may not be the best option in the following circumstances:

  • Those receiving, or referred for another psychological treatment at the same time. Or who have recently completed another therapy (where some time may be needed to make use of the previous therapy).
  • Where excessive use of alcohol or drugs may interfere with therapeutic change. A period of stability free from substances may be necessary before referral.
  • People who are acutely unwell to the degree that it may interfere with their capacity to undertake therapy.
  • Where there is a sufficiently high degree of risk that might suggest therapy is unsafe in a community setting.

How can I get referred?

Information about referrals, including the referral form, are on our main Centre for Specialist Psychological Therapies page.