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Cognitive Analytic Therapy (CAT)

Cognitive Analytic Therapy (CAT) was originally developed by Anthony Ryle and was formalized in 1984. It integrated psychodynamic therapy with personal construct / cognitive psychology. It is a brief therapy suitable for treatment of a wide range of psychological difficulties. Read more
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What Is Cognitive Analytic Therapy?

Two quotes from Ryle and Kerr (2002) help to position the CAT approach:

“CAT evolved as an integration of cognitive, psychoanalytic and, more recently, Vygotskian ideas, with an emphasis on therapist–patient collaboration in creating and applying descriptive reformulations of presenting problems. The model arose from a continuing commitment to research into effective therapies and from a concern with delivering appropriate, time-limited, treatment in the public sector. Originally developed as a model of individual therapy, CAT now offers a general theory of psychotherapy with applicability to a wide range of conditions in many different settings”.

And:

“The aims of CAT therapists are, in a sense, modest: we seek to remove the ‘roadblocks’ which have maintained restriction and distress and have prevented the patient’s further growth and we assist in the development of more adequate route maps. But we do not offer to accompany the patient along the road. Obstacles to change are of three main kinds: self-reinforcing procedures; restricted, avoidant or symptomatic procedures; and disconnected, dissociated self-processes … Our main aim is to give the minimum sufficient help to those in need”.

Ryle and Kerr (2002) describe how CAT takes three important understandings from psychoanalysis:

  • the relation of early development to psychological structures;
  • recognition of the linkage between psychological distress and patterns of relationships derived from early experience;
  • an understanding of how relational patterns are repeated in and may be modified through the therapeutic relationship.

The theoretical model of CAT is the procedural sequence model (PSM). This allows description of how aims are pursued and may be frustrated. It is used to describe repetitive circular (stuck) patterns of activity. Problematic patterns in CAT are described as:

  • Dilemmas: which limit the possibilities for action or relationships to polarized choices. For example: ‘Either I get what I want and feel childish and guilty, or I do not get what I want and feel frustrated and angry.’
  • Traps: represent the maintenance of negative beliefs by the way they generate forms of behavior that lead to consequences which appear to confirm the beliefs. For example: a pattern of trying to please.
  • Snags: describe where appropriate goals are abandoned or sabotaged because it is believed that their achievement would be dangerous to the self or disallowed by others. For example: ‘I sabotage good things as if I do not deserve them.’

Stages of CAT in Individual Therapy

Ryle, Kellett, Hepple, and Calvert (2014) describe the stages of CAT in individual therapy:

  • Stage 1: Assess suitability for CAT by excluding active psychosis and substance misuse; discuss the nature and duration of treatment (duration: approximately one session).
  • Stage 2: Explores client history, and uses the patient–therapist relationship as well as the Psychotherapy File and Personality Structure Questionnaire in order to create a reformulation of the patient’s difficulties. Patient and therapist collaborate to create a sequential diagrammatic reformulation and narrative reformulation letter (duration: approximately four sessions).
  • Stage 3: The therapist encourages the patient to use diaries and self-monitoring to identify problem procedures. The reformulation is used to understand developments in the therapeutic relationship, and to assimilate memories and feelings accessed as result of the work. Awareness of the end of therapy is maintained (duration: bulk of remainder of therapy).
  • Stage 4: Therapist and patient reflect upon the implications of ending therapy and record thoughts and feelings in goodbye letters.

References

  • Ryle, A., & Kerr, I. B. (2002). Introducing cognitive analytic therapy: Principles and practice. Chichester, UK: John Wiley & Sons.
  • Ryle, A., Kellett, S., Hepple, J., & Calvert, R. (2014). Cognitive analytic therapy at 30. Advances in Psychiatric Treatment, 20(4), 258–268.