Cognitive Analytic Therapy

This section is to give an overview of different models, different therapeutic orientations and techniques
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astra
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Cognitive Analytic Therapy

Post by astra » Thu Jul 17, 2008 5:07 pm

Cognitive Analytic Therapy (CAT)

CAT developed in the 1980’s and 90’s as a model integrating aspects of cognitive therapy and psychoanalysis. The first book on CAT was by Tony Ryle in 1990 and represented the culmination of some years of research and practice, developing the model and testing it out clinically (see Ryle, 1990). One of the driving aims of the early proponents of CAT was to develop a common language for psychotherapies to get away from the elitist jargon of existing models (Ryle & Kerr, 2002). Whether this has been achieved or whether CAT has merely created its own elitist jargon is for the reader to decide.

CAT is a very collaborative model, whereby the therapist and client together build a picture of the presenting problems, identify areas for change and work on solutions together. The therapeutic relationship is very explicitly used as a tool in the therapy, for example to show when real life problems are being enacted with the therapist and try out different ways of relating. CAT is a time limited therapy, usually of 16 or 20 sessions, which are contracted from the outset, allowing the ending to always be in mind and be worked towards. Having the ending in mind can help focus the therapy on the target problems. There is a growing evidence base for the effectiveness of CAT as a time limited intervention. For these reasons CAT can be seen as a cost effective model of treatment for use within the NHS (Ryle & Kerr, 2002).

What CAT actually involves is a few sessions of assessment (known as “reformulation”), usually about 4-5 sessions, then a middle phase where the target problems are worked on, then an ending phase where the ending is worked through. In the first session, general information about the client and the problems would be gathered and the client would be given “the psychotherapy file” to complete (see Appendix 2 of Ryle & Kerr, 2002). In subsequent early sessions more information would be gathered on the person’s history, family background, the development of their difficulties, current relationships and so on. This information, together with the completed psychotherapy file would be discussed with the client to begin to identify some of their problematic experiences and the patterns of behaviour that maintain these. At this point CAT seems to come out with a rash of complex jargon about reformulation, reciprocal roles, sequential diagrammatic reformulations, target problem procedures etc and then goes on to abbreviate these into a string of impenetrable acronyms (imho!). However, it is worth persevering beyond the tricky language to see that we all have learnt patterns of behaviour that we tend to fall into, some of which do maintain our problems and stop us making the progress we want to. For example who here has never striven really hard to achieve a goal but still felt they need to try harder to achieve the next goal, and the next, never quite feeling they’ve made it and can be proud of themselves – sounds a bit like the path to clinical training doesn’t it?

Understanding CAT really helps you to think about yourself and how you are in therapy with people. It is demanding for the therapist and the client. After the early sessions the therapist writes a “reformulation letter” to the client and they then work together on a diagrammatic representation of the client’s typical patterns of behaviour which will identify the key problems to be worked on in the middle phase of therapy. The ending includes both client and therapist writing a “goodbye letter” to each other which sums up the therapy and the tasks still to be achieved. The reading out of letters can be enormously emotional for the client as often it is the first time they have ever felt properly heard, understood and empowered to change.

Much of what I have written above comes from the Ryle and Kerr book listed below. It is a complex model and hard to do it justice in a short post like this. For more information on CAT visit the ACAT website http://www.acat.me.uk/index.php or read the books below as a starting point.

Ryle A (1990) Cognitive Analytic Therapy: Active Participation in Change.Chichester: Wiley. This book is currently out of print, however, you can get used copies through the amazon link.

Ryle A & Kerr IB (2002). Introducing Cognitive Analytic Therapy Principles and Practice. Chichester: Wiley

Miriam added:

I like using CAT, as it seems like a step towards more dynamic and process focused work but with a lot of structure around it and a lot of places to draw on CBT and other models. It also helps me a lot to be aware of these issues and use some of the ideas and resoruces in my clinical work even where I don't use the full structure of formal CAT (so, I draw role-pair relationship diagrams quite a lot in consultation or supervision, like I have in the workshop on transference in adoption).

I'd highly recommend CAT and the Active Participation in Change book. To me its more accessible and tangible than dynamic psychotherapy, so was a less threatening first step out of my CBT comfort-zone as a trainee!

Dorothy added:

CAT is an integrative model that was developed in the NHS to address the need for time limited therapy to respond to service demands. It integrates analytic, cognitive and developmental ideas. Ryle has, overtime developed a model driven by theory drawing on Vygotskys work of the ‘zone of proximity’ and scaffolding. Kelly’s Personal Construct model, and object relations are also integrated.

The 2 day introductory workshops (which can be found on the ACAT website above) are reasonably priced and a good opportunity to be immersed in the model experientially and theoretically.

The lack of empirical evidence for CAT is currently being addressed, however there is a great deal of converging evidence from clinical work for a wide range of difficulties. There is a lot of interest in treating Borderline Personality with CAT.

Whilst there is a lot of ‘prescription’ in how the model is implemented, there is a lot room for working creatively. Treatment is always idiosyncratic as it draws ion each client’s reciprocal roles (however these can be somewhat ubiquitous (abused---abuser, controlled---controlling etc.), and how these roles play out (enacted) in all relationships, it is this that is explicitly used in therapy.

I agree with Miriam, that CAT is a very tangible way to work with a dynamic hint or a little more then a hint. Some of the application and explanation does however, have a very cognitive feel.

Astra added: there is another useful book by Elizabeth Wilde McCormick, which can be found here:
It's a much more accessible text than any of the Ryle ones and is really aimed at the client, as a self help manual. I doubt anyone could really do CAT on themselves as it is such a relational model but the book gives some really good explanations of CAT concepts and ideas for exercises you could do with clients. I am now half way through my CAT practitioner training and am finding it so useful in my Adult MH work especially with the more complex clients. I highly recommend it as a model.

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Content checked by qualified Clinical Psychologist on 12/02/2018
Last modified on 12/02/2018
Last edited by Will on Mon Feb 12, 2018 7:55 pm, edited 4 times in total.
Reason: Updated

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