CAT

What is Cognitive Analytic Therapy (CAT)?

Cognitive Analytic Therapy (CAT) is a collaborative, time-limited talking therapy that helps people understand how their patterns of thinking, feeling, and relating to others can contribute to difficulties in their lives. Rather than focusing on psychiatric labels or isolated symptoms, CAT explores the underlying relational and behavioural patterns that leave you feeling stuck and supports you in finding ways to change them.

CAT is an active and participatory process, inviting you to step back and observe your life from a more objective perspective. Working closely with your therapist, you identify recurring patterns, explore how they developed, and take an active role in deciding what needs to change, whether small adjustments, such as breaking free from avoidance, or larger changes, like finding new ways of relating to others. A key focus is on patterns of relating and the effect they have on your relationships, work, and sense of self.

The therapy is also creative, using tools such as letters from the therapist and a collaboratively developed diagram to help you understand your patterns, recognise traps, and practice healthier ways of coping and relating. This approach ensures that you remain engaged, empowered, and supported throughout every stage of the therapy. As its name suggests, CAT combines two approaches:

  • Analytic: Exploring your past experiences and relationships to understand how they shaped your current patterns and sense of self.
  • Cognitive: Examining your current coping strategies and finding new, more effective ways to manage challenges.

Who is CAT for?

CAT can help with a wide range of issues, including:

  • Stress and low mood
  • Depression and anxiety
  • Eating difficulties
  • Self-harm
  • Relationship problems
  • Personal growth and self-understanding

The therapy focuses on how you relate to others and yourself, and the emotions that arise in those relationships. The relationship with your therapist plays a key role in helping you understand these patterns and feel genuinely understood.

How does CAT work?

CAT explores the patterns that cause problems in your life now, while also considering the influence of your early relationships and experiences. It looks at how you learned to cope as a child often by developing strategies that were once necessary for emotional survival. However, when these same strategies continue into adulthood, they can become unhelpful and limit your growth. For example, if you learned that love came only when you pleased others, you may grow up believing “I’ll only be liked if I do what others want.” This can trap you in a pattern of people-pleasing that leaves you feeling used or unappreciated. CAT helps you recognise these “traps,” understand where they came from, and learn new ways of relating and setting boundaries.

The goal of CAT is to help you understand how your difficulties developed, what keeps them going, and how to make lasting changes in the way you think, feel, and behave.

What happens in CAT therapy?

Early sessions: Understanding your story
In the first few sessions, you will have the chance to tell your story and build a shared understanding of your difficulties. You only need to share what feels manageable and the focus is on building a picture together, not recounting every detail.

You may complete a short questionnaire called the Psychotherapy File, which helps identify common emotional patterns and states of mind. You might also be invited to keep brief notes or mood records between sessions to help you notice patterns as they arise.

Your therapist will write a summary or reformulation letter, which outlines your story, patterns, and areas for change. Sometimes, you and your therapist will also create a diagram that maps these patterns visually. This helps you recognise when you’re “caught” in them and what might help you step out.

Middle phase: Working on change
Once you have identified your main patterns, you will choose two or three to focus on. Together with your therapist, you will explore how these patterns show up in your daily life and relationships including sometimes within therapy itself.
You will be encouraged to notice these moments, reflect on them, and experiment with new ways of thinking and behaving. Between sessions, you may have small tasks or reflections to help put these changes into practice. The therapist’s role is to support you in finding new possibilities and overcoming obstacles to change.

Ending CAT therapy
Because CAT is time-limited, the idea of the ending is kept in mind from the start. As therapy draws to a close, you and your therapist will each write an ending letter to reflect on your journey including what you’ve learned, how you’ve changed, and what you want to take forward into the future.
You will review the tools, letters, and diagrams you’ve created to help you continue your progress beyond therapy. This reflection helps you consolidate your learning and feel more confident managing challenges independently.

Who is CAT helpful for?

Cognitive Analytic Therapy (CAT) can be helpful for people experiencing a wide range of emotional or relationship difficulties. It focuses on understanding the issues that brought you to therapy and the underlying patterns that keep them going, rather than using traditional psychiatric labels. This approach treats each person as an individual, not just a diagnosis.

CAT may be particularly useful if you:

  • Experience depression, anxiety, or low self-esteem
  • Often feel let down, hurt, or rejected in relationships
  • Find yourself repeating self-defeating or harmful behaviours to cope with strong emotions

It can also help with difficulties such as:

  • Addictions
  • Disordered eating
  • Obsessions and compulsions
  • Phobias
  • Relationship problems
  • Self-harm
  • Stress

What are the benefits and risks of CAT therapy?

While Cognitive Analytic Therapy (CAT) can’t change painful experiences from your past, it can help you understand how they have shaped your current patterns of self-care, relationships, and coping. Through this understanding, you can begin to take more control and make positive, lasting changes for the future.

Like all talking therapies, CAT can have both benefits and challenges. At times, focusing on difficult experiences or emotions may make you feel worse before you start to feel better. Your therapist will support you in understanding and managing these feelings as they arise.

Making changes in how you relate to others can also feel unsettling, especially if people close to you find your new boundaries or behaviours confusing. Therapy can be an intense process, and the relationship you build with your therapist often feels very meaningful. Because of this, endings in CAT are given special attention. As therapy draws to a close, you and your therapist will take time to reflect on your progress, the emotions that come up, and how to carry forward what you’ve learned.

How Long Does CAT Therapy Last?

Cognitive Analytic Therapy (CAT) combines cognitive and analytic approaches and is a time-limited therapy with a clearly agreed ending with the ending itself being an important part of the process.

CAT is usually offered for 8, 16, or 24 weekly sessions, depending on your needs and the complexity of your difficulties. The most common format is 16 sessions, though shorter or longer versions can be arranged. You and your therapist will agree on the number of sessions at the start of therapy.

Each session typically lasts 50 to 60 minutes and takes place once a week.
After therapy ends, you will usually be offered a follow-up appointment about two to three months later to reflect on how things have been since finishing. If you have had a longer (24-session) CAT, you may be offered a few additional follow-up meetings to help you ease out of therapy more gradually.

What is the difference between CAT and CBT?

Both Cognitive Analytic Therapy (CAT) and Cognitive Behavioural Therapy (CBT) are designed as short-term, structured approaches that aim to equip you with practical skills and strategies to manage psychological difficulties more effectively in the future.

Where they differ is in their focus and framework. CBT primarily centres on understanding the connection between your thoughts, emotions, and behaviours in the present moment. It helps you identify unhelpful thinking patterns and replace them with more balanced, realistic ones, leading to changes in how you feel and act day to day.

CAT, on the other hand, takes this a step further by looking at how these patterns developed particularly through your past relationships and early experiences. It explores how ways of relating to others and to yourself were shaped by earlier interactions, such as with caregivers or significant people in your life. Over time, these patterns can become repeated “relational templates” that influence how you respond in current relationships and situations, often without realising it.

In CAT, the therapist and client work together to map out these recurring relational patterns sometimes called “traps,” “snags,” or “dilemmas.” By recognising them, you can begin to understand how they play out in your current relationships, including the therapeutic one, and experiment with new, healthier ways of connecting and responding.

So while CBT focuses mainly on what you think and do now, CAT adds a relational and historical lens, helping you understand why these patterns emerged and how they continue to shape your experiences of yourself and others.

How I might use CAT

I will do an assessment firstly to find out if CAT is likely to be helpful for you. CAT is tailored to your individual needs and goals, and helps you make sense of your own story in your own circumstances.

By looking more closely at patterns of thinking, feeling and behaving, you will:

  • clarify which ones are helpful or unhelpful
  • understand the effect they are having
  • make sense of how they developed and why you needed them
  • start to develop new more helpful patterns, and
  • develop a better relationship with yourself and others

The aim is to reduce the distress you experience in your relationships with others, and with yourself.