Cognitive Analytic Therapy (CAT)

This webpage is designed to give potential clients some idea of what your treatment with Cognitive Analytic Therapy (CAT) involves.

It is quite a flexible therapy so your treatment may be slightly different from what is described here.

How CAT works

Our early experiences and important events in our adult lives have all helped to shape the kind of people we are. From these experiences we develop patterns of dealing with situations and relationships, and learn how to manage ourselves.

We all try to cope with our lives as best we can, even if things have been very difficult for us.

However, sometimes our old ways of coping don’t work so well for us anymore, and we start to have problems, or symptoms. We may start to feel depressed, anxious or worthless; we may suffer mood swings or have difficulties with eating, or with relationships. It can seem as if we are “stuck”, or “going round in circles”, and it can be hard to change long-standing patterns of feeling, thinking and behaving.

CAT works by trying to find out what our patterns are and which of them might be causing the problems which have brought us to therapy. Once we can recognise these, we have a chance to change these patterns, to give ourselves wider choices and to learn to do things differently.

Like all kinds of therapy, CAT involves you and your therapist working together, to recognise and change unhelpful patterns. You will be taking an active part in getting better.

Timescale of CAT therapy

CAT normally lasts for a set number of sessions, usually between 8 and 24, with many people having 16.

You and your therapist will agree on the number in the first few sessions. The sessions last for 50 minutes, and are usually held weekly, at a time to suit both of you. You may lose booked sessions if you do not attend unless the absence has been agreed in advance (for example holidays) or if you are ill.

Starting CAT

You will need to tell your therapist the main things which are troubling you and which you want to change. Your own ideas about your problems will often be right. While you do not have to talk about anything you do not want to, the more open and honest you can be, the better.

Your therapist will want to hear something about your early life, as well as how things are for you now as an adult. You will be given some questionnaires to assess your difficulties (and also at the end, to check your progress).

In the early sessions you will be focussing on your problems, and also on the people who have been most important to you, or difficult, in your life so far.

Try to give yourself some free time after sessions to think about what has been said. Do share with your therapist any worries you may have about therapy.

In between your sessions

The relationship with your therapist is important, but it is not the only thing which will help you get better.

The therapist will also give you some tasks to do between sessions. For example you will probably be given the “Psychotherapy File” to fill in.

This is to get you thinking in a new way about your problems. Don’t be put off – there are no right or wrong answers, and this information will help both you and the therapist to understand your difficulties better.

Homework is a very important part of helping you to learn to do things differently.

After a few sessions your therapist will write you a letter outlining what you have
discovered together about your problems, the patterns that are keeping them going, and how they have come about. It is important that you understand and agree with the letter, as it will be used as the basis for the rest of your sessions, so take time over reading it.

Please discuss with the therapist things that you don’t understand or don’t agree with – it can be changed. It is never a good idea just to accept what your therapist says if you don’t agree yourself.

However some things in the letter may be painful and difficult to accept, but true. Sometimes it may be helpful for you to show the letter to other people you are close to, but this needs discussing with your therapist first.

The middle sessions of CAT

You and your therapist will be spending the rest of your time on learning to recognise the unhelpful patterns when they occur, and working out how you can do things differently.

Drawing out the patterns can be helpful.

Keeping a diary about when the patterns occur in everyday life is a good way to do this – after a while you may be able to predict when a difficult pattern might occur.

In this respect, CAT is just like life in general – the more you put in, the more you are likely to get out of it. CAT can help you learn how to be your own “therapist”.

Ending CAT

In the last few sessions you will be thinking more about the ending of your therapy and how you feel about it.

Many people’s problems have been with them for a long time and it can seem as if you have had too little time to sort them out.

Like most people you may find ending therapy a bit frightening; some people can feel let down or abandoned.

If you have had difficult endings in your earlier life, it may remind you of these. You and your therapist will talk about this. The more you are able to say about any mixed feelings you have over ending, the less difficult the actual ending tends to become.

Your therapist will write you another letter which looks back at the work you have done together, and towards the future.

You will be invited to write your own letter describing the progress you think you have made, and what you will need to work on once the therapy is ended.

After the end of CAT

CAT therapy is an effective way for many people to start overcoming their problems and changing their lives. You should not expect to feel entirely better after therapy has ended – sometimes things may feel rather incomplete.

However, most people who were improving in CAT find that they go on improving once the therapy has ended.

Keep on with the CAT homework as much as you can. You will be able to talk about your progress at a follow-up session. At this meeting there will be a chance to talk about the best way to manage any further needs you have.