Cognitive Analytic Therapy (CAT)
Understanding and changing repeating patterns
A collaborative, time-limited therapy with a Chartered Counselling Psychologist and accredited CAT Practitioner, at London Bridge and online.
Book a free 30-minute consultation Read on
- ReformulationMaking sense of the patterns, together, in words and a map
- RecognitionNoticing them as they happen, in daily life and in sessions
- RevisionFinding and practising different ways of responding
What is Cognitive Analytic Therapy?
Cognitive Analytic Therapy (CAT) is a collaborative, time-limited psychological therapy. It helps you understand how earlier experiences shape the way you think, feel and relate now, and how to recognise and change the patterns that keep you stuck.
CAT was developed in the NHS by Dr Anthony Ryle. It brings together ideas from cognitive, behavioural and psychoanalytic therapies, combining the relational depth of analytic work with the clarity and focus of cognitive approaches. The result is a therapy that is structured, but also reflective.
Patterns that once made sense
CAT starts from a simple idea. Many of the ways we cope were learned in early relationships, where they helped us get by. Over time they become habits of thinking, feeling and acting that run quickly and automatically. CAT calls these procedures.
Later in life the same procedures can keep us stuck. We find ourselves back in familiar places, taking on too much, holding back, expecting criticism, however hard we try to do things differently.
How we relate to others, and to ourselves
CAT is a relational therapy. It pays close attention to the patterns between people, which it calls reciprocal roles: pairs such as criticising and criticised, controlling and controlled, or caring and cared for. We learn both sides of these patterns, and we play them out with other people and with ourselves. A harsh inner critic is often one side of a very old conversation.
Open and shared
What makes CAT distinctive is how open it is. Your psychologist doesn’t keep an understanding of you to themselves. It is put into words and pictures, in a letter and a diagram, worked out together and yours to keep. You are a co-author of the therapy, not the subject of it.
Traps, dilemmas and snags
CAT gives names to the common ways people get stuck. Putting a name to a pattern is often the first step to seeing it as it happens, and to stepping out of it.
Traps
Ways of thinking and acting that end up confirming the very thing we fear. Feeling unsure of yourself, you stay quiet in meetings; others overlook you; you feel even more sure that you don’t count.
Dilemmas
False choices that leave only two options, both costly. Either I keep everyone happy, or I’m selfish. Either I’m in complete control, or everything falls apart. If I let someone close, I’ll get hurt.
Snags
Holding ourselves back just as things start to improve: “I want things to be better, but…”. Sometimes it is a sense of not deserving good things; sometimes a worry about what change would mean for the people close to us.
For every pattern we name, we also look for an exit: a different way of responding that you can practise, in your life and in our sessions.
How CAT works
CAT usually runs for 16 to 24 weekly sessions of 50 minutes. We agree the number of sessions at the start, so the work has a clear focus and a planned ending.
-
Assessment and agreeing a focus
In the first sessions we look at what has brought you to therapy now, your history and relationships, and what you want to change. We agree the problems we’ll focus on and how many sessions we’ll have.
-
Reformulation
Early in therapy I write you a letter that puts your story, and the patterns that keep you stuck, into words. We read it together and change anything that doesn’t fit. We also draw a map of the patterns: what sets them off, where they lead and what keeps them going.
-
Recognition
You start to notice the patterns as they happen, in daily life and between us in sessions. The map and brief notes between sessions help you catch them early, while there is still room to choose.
-
Revision
Together we work out exits, different ways of thinking, feeling and acting, and you try them out. Practising them in the therapy relationship, where it is safe to do something new, is often where change takes hold. The exits are added to the map.
-
Ending
The ending is planned from the start, so we can prepare for it and finish cleanly. We each write a goodbye letter reflecting on what has changed, what is still hard and what you’ll take forward.
The tools of CAT
CAT uses writing and diagrams to make psychological ideas clear and shared. They help you think about your own patterns, and they stay with you after therapy ends.
The reformulation letter
A letter in plain language bringing together your history, how your difficulties make sense, and what we are aiming for.
The map
A diagram of your patterns, formally a Sequential Diagrammatic Reformulation: the loops you get caught in, what triggers them, and the exits out of them.
The Psychotherapy File
A short questionnaire describing common traps, dilemmas and snags. Many people find it a relief to see their own patterns described, and it gives us shared words for them.
Diaries and ratings
Brief notes and ratings between sessions help you notice when a pattern starts and see what changes over the course of therapy.
Goodbye letters
At the end we each write a letter reflecting on the work. Many people go back to theirs long after therapy has finished.
What CAT with me is like
Carl is brilliant. I’ve had therapy on and off before which had always felt like catch ups and ‘checking in’. But Carl’s cognitive analytical therapy approach is a thorough, structured and incredibly thoughtful way of getting to the heart of what makes you tick and what tangible ways you can address problems and ultimately be happier. He’s truly helped me and I couldn’t recommend him enough.
CAT with me is collaborative, structured and reflective. You won’t be analysed from a distance. We work together to make sense of what has been happening in your life, and of how past experiences and relationships still shape the way you think, feel and relate today.
In the early sessions we spend time understanding your story: your background, family relationships and the experiences that have influenced how you see yourself and others. From there we begin to notice recurring patterns that may once have helped you cope, but now feel restrictive, self-critical or stuck.
As therapy goes on, we map these patterns together. The map becomes a practical guide, showing how certain thoughts, feelings and actions tend to repeat, and where there might be new ways forward. This is often a turning point: you start to recognise the patterns as they unfold, in everyday life and in our sessions, which gives you room to choose something different.
Towards the end we reflect on what has changed and what has been learned, and on the steps you want to keep taking after therapy ends. The goodbye letters capture this, and serve as a reminder of what you’ve understood and achieved.
People often describe CAT with me as both structured and personal: a clear framework that still allows depth, warmth and flexibility.
My experience in CAT
I trained in CAT at the Halliwick Centre, St Ann’s Hospital, on a course accredited by the Association for Cognitive Analytic Therapy (ACAT), gaining a Postgraduate Diploma accredited by Sheffield Hallam University. I have been an accredited CAT Practitioner with ACAT since 2012, and an accredited CAT Supervisor since 2014. In the NHS I led the CAT service in the Lewisham Integrated Psychological Therapies Team at South London and Maudsley, working with people with complex and long-standing difficulties. I also supervise other psychologists and therapists in CAT.
CAT is my principal model. Sometimes it is the right fit on its own; sometimes I draw on it within a broader integrative approach. We decide together which suits you.
Who CAT can help
CAT suits people who keep finding themselves in the same place, however hard they try, and who want both to understand why and to do something different.
You might choose CAT if you recognise:
- the same relationship patterns repeating: taking on too much, keeping the peace, feeling let down, keeping people at a distance
- a harsh inner critic, or shame and guilt that won’t let up
- anxiety or low mood that keeps coming back
- perfectionism, over-responsibility, burnout and imposter feelings at work
- long-standing difficulties with how you see yourself and relate to others, sometimes described as personality difficulties
- the lasting effects of difficult or inconsistent care earlier in life
CAT is used for a wide range of difficulties in the NHS, including severe and complex ones. In my independent practice I work with adults whose difficulties can be safely supported in weekly outpatient therapy. I don’t offer crisis support, or specialist treatment for some difficulties; the details are on the Psychological therapy page.
If you need urgent help, contact your GP or NHS 111, or call Samaritans free on 116 123. In an emergency, call 999 or go to A&E.
How CAT compares with other therapies
People often come to CAT having found CBT too narrow or technique-based, or open-ended psychodynamic therapy too unstructured. CAT sits between the two: it helps you understand why difficulties keep recurring, and works actively on changing them, within a clear time frame.
| Aspect | CBT | CAT |
|---|---|---|
| Focus | The thoughts and behaviours that keep symptoms going | Patterns of relating to others and to yourself, learned over time |
| Aim | Change unhelpful thoughts and behaviours | Recognise and revise the patterns that keep you stuck |
| Methods | Challenging thoughts, exposure, skills practice | Reformulation letter, mapping, recognising patterns, exits |
| Role of the therapist | Coach and educator, often directive | Collaborative co-author and reflective partner |
| The relationship | A supportive setting for learning skills | Central: patterns that show up between us are explored as they happen |
| Length | Often 6 to 20 sessions | Usually 16 to 24 sessions |
| Often suited to | Specific, symptom-focused problems such as panic, phobias and insomnia | Recurring relationship patterns, self-criticism, recurrent low mood, long-standing difficulties |
| Aspect | Psychodynamic | CAT |
|---|---|---|
| Length and structure | Often open-ended, sometimes over several years | Time-limited, with clear phases |
| Stance | More reserved and interpretive | Active, collaborative and transparent |
| Focus | Unconscious conflict, defences and transference | Recognisable patterns of relating, and the exits from them |
| Methods | Free association and interpretation | Letters, diagrams, recognition and revision |
| What happens between you | Interpreted by the therapist | Named and explored together as it happens |
| How change happens | Insight through interpretation | Recognising patterns and practising new ways of relating |
| Your role | Reflecting, in a therapist-led process | Co-investigator and co-author |
These are broad generalisations: practitioners in every tradition vary, and the right therapy depends on you and what you’re facing. We can talk it through at your consultation.
Questions about CAT
How long does CAT take?
Usually 16 to 24 weekly sessions of 50 minutes. We agree the number at the start, based on what you want to work on, so you know the shape of the therapy from the beginning.
Can I have CAT online?
Yes. I offer CAT in person at my room near London Bridge, and online on Zoom. The letters and map work just as well online; I share them on screen and send you a copy.
Will my health insurance cover CAT?
Many health insurers cover therapy with an HCPC-registered psychologist. Check with your insurer whether you need a GP referral and how many sessions they will authorise. There is more on the Fees and locations page.
Will I have to do work between sessions?
A little. Much of the useful work happens as you start to notice patterns in daily life, and short notes or ratings help with that. It is never homework for its own sake, and we agree together what is useful.
Is CAT evidence-based?
CAT was developed and refined in the NHS, where it is widely used. Its research base is smaller than CBT’s, but growing, and includes randomised controlled trials and studies with people with complex, long-standing difficulties.
How do I know whether CAT is right for me?
Talk it through with me. At the free consultation I’ll tell you honestly whether I think CAT would help, whether another approach would suit you better, or whether your needs would be better met elsewhere.
Is CAT right for you?
The best way to find out is to talk it through. In a free 30-minute consultation on Zoom you can describe what has been difficult and ask any questions, and I’ll explain how CAT might help.
Book a free 30-minute consultation
Or call 07494 503557 or email carltaylor@ppslondon.net