Cognitive Analytic Therapy (CAT)
Understanding and Changing Repeating Patterns
Cognitive Analytic Therapy (CAT) is a collaborative, time-limited psychotherapy that helps people understand how their earlier experiences shape current patterns of thinking, feeling and relating and how those patterns can be recognised and changed.
Developed by Dr Anthony Ryle in the NHS, CAT integrates insights from cognitive, behavioural, and psychoanalytic traditions. It combines the relational depth of analytic therapy with the clarity and focus of cognitive approaches, offering a structured yet reflective way of making sense of difficulties that seem to repeat.
What Is Cognitive Analytic Therapy?
CAT begins with the view that distress often arises from repetitive procedures habitual sequences of thoughts, feelings, and behaviours learned through early relationships. These procedures once helped us adapt but can later keep us stuck in familiar but unhelpful patterns.
The therapy usually runs for 16 – 24 weekly sessions, each about 50 minutes, and follows three linked phases:
Reformulation – Therapist and client co-author a written and diagrammatic understanding of the client’s history and present difficulties, identifying recurring patterns (“traps”, “dilemmas”, “snags”) that maintain distress.
Recognition – Through reflection and discussion, the client learns to notice these patterns in daily life and within the therapy relationship.
Revision – Together, therapist and client experiment with new ways of thinking, feeling, and behaving developing alternative “exits” from entrenched loops.
CAT is distinctive for its use of letters and visual maps to make psychological ideas clear and shared. These documents promote reflection, transparency, and an enduring sense of ownership of the work.
Theoretical Foundations
CAT is a procedural–relational model built from several overlapping traditions:
Object-relations theory → reciprocal roles and procedural transference
Early caregiving experiences are internalised as relational templates. Ryle reformulated these as reciprocal roles (RRs)—dyadic patterns such as criticising ↔ criticised or caring ↔ cared-for—that shape identity and relationships. In CAT, transference is viewed procedurally: the live re-enactment of these roles in therapy, discussed openly to create new relational choices. (Ryle 1985; Ryle 1998; Ryle & Kerr 2002)Constructivism and Personal Construct Theory → collaborative reformulation
Influenced by George Kelly (1955), CAT assumes people are “personal scientists” who interpret experience through evolving constructs. Reformulation—the jointly written letter and Sequential Diagrammatic Reformulation (SDR) expresses these hypotheses to be tested and revised collaboratively.Cultural–semiotic psychology (Vygotsky, Leiman) → tools for reflection
Written and visual materials are psychological tools that extend thinking, support reflection, and foster an internal dialogic stance. They help clients “think about thinking” and mentalise their experience. (Leiman 1994; Ryle 2004)Cognitive and behavioural science → procedures, loops, and exits
From learning theory, CAT inherits the procedural analysis of emotion-cognition-action sequences. Typical maladaptive patterns are described as traps, dilemmas, and snags, and therapy identifies concrete exits that revise these sequences. (Ryle 1979; Ryle 1982)Attachment and developmental psychology → internal working models and mentalising
CAT situates reciprocal roles within attachment theory and contemporary mentalisation research, emphasising how early care, safety, and attunement shape the capacity for self-reflection and affect regulation. (Bowlby 1969/1982)Model formalisation → from PSM to PSORM
Ryle’s Procedural Sequence Model (PSM) described goal-directed mental and behavioural processes. Its later evolution, the Procedural Sequence Object-Relations Model (PSORM), integrated object-relations theory, enabling CAT to link interpersonal development with cognitive structure and change.
CAT in Practice
CAT offers a structured, reflective, and relationally active framework suitable for a wide range of presentations, including repetitive interpersonal patterns often described as personality difficulties; chronic anxiety or depression maintained by self-criticism, shame, or guilt; histories of trauma, neglect, or inconsistent care; self-harm, suicidal or self-sabotaging behaviours; and professional or workplace patterns such as perfectionism, over-responsibility, and imposter feelings.
Therapy process
Assessment & contracting – Agree focus, risk plan, and duration (usually 16–24 sessions). Identify Target Problems (TPs) and Target Problem Procedures (TPPs).
Reformulation (weeks 1–4) – Co-construct letter and SDR; name reciprocal roles and maintenance cycles.
Recognition (mid-phase) – Practise “pattern-spotting” in and outside therapy; notice procedural transference; use diaries or SDR reflections to strengthen self-observation.
Revision (late-phase) – Rehearse new responses (“exits”), develop compassionate self-to-self roles, and consolidate learning through revised letters or diagrams.
Ending & follow-up – Planned termination with exchange of Goodbye Letters and optional booster session.
Distinctive tools
Reformulation Letter – Integrates history, understanding, and aims in accessible language.
SDR (diagram) – Visual map of loops, triggers, and exits.
Psychotherapy File / diaries – Structured prompts to monitor patterns.
Goodbye Letters – Consolidate insight and model reflective function.
Comparing CAT and Cognitive Behavioural Therapy (CBT)
Although both are structured and collaborative, CAT and CBT differ in focus, language, and mechanisms of change.
| Dimension | Cognitive Behavioural Therapy (CBT) | Cognitive Analytic Therapy (CAT) |
|---|---|---|
| Conceptual focus | Thoughts and behaviours maintaining symptoms | Relational and self-to-self procedures learned developmentally |
| Goal | Modify unhelpful cognitions and behaviours | Recognise and revise maladaptive relational patterns |
| Method | Cognitive restructuring, exposure, skills practice | Reformulation letters, mapping, pattern recognition, exits |
| Therapist role | Directive coach and educator | Collaborative co-author and reflective partner |
| Therapeutic relationship | Supportive context for skills learning | Central focus—procedural enactments explored in vivo |
| Duration | 5–20 sessions | 16–24 sessions |
| Best suited for | Specific, symptom-focused problems (e.g., panic, OCD, phobia, insomnia) | Complex relational or identity difficulties; trauma; recurrent depression |
Comparing CAT and Psychodynamic Psychotherapy
CAT shares psychodynamic therapy’s interest in formative relationships but differs in its structure, stance, and use of transparency.
| Dimension | Psychodynamic Therapy | Cognitive Analytic Therapy (CAT) |
|---|---|---|
| Duration & structure | Open-ended, often 1–3 years | Time-limited (16–24 sessions) with clear phases |
| Therapist stance | Neutral, interpretive, non-disclosing | Active, collaborative, transparent |
| Focus | Unconscious conflict, defence, and transference | Recognisable reciprocal-role procedures and exits |
| Techniques | Free association, interpretation, analysis of resistance | Reformulation letters, diagrams, recognition, revision |
| Transference work | Interpreted by therapist | Named and explored jointly as procedural enactment |
| Change mechanism | Insight through interpretation | Recognition + relational revision through practice |
| Client role | Reflective, therapist-led process | Co-investigator and co-author of understanding |
Why Choose CAT?
You might choose Cognitive Analytic Therapy (CAT) if you find yourself returning to the same patterns of thinking, feeling, or relating perhaps being self-critical, feeling rejected, or becoming over-responsible in ways that leave you exhausted or stuck.
CAT is well suited to people who want both understanding and action: it helps you make sense of why difficulties recur while also developing new ways of responding. Many clients value CAT’s collaborative, transparent, and structured style, which avoids interpretation from a distance in favour of jointly exploring what happens between therapist and client as it unfolds.
The time-limited format—usually between 16 and 24 sessions—provides clear focus and containment, yet allows enough depth to reach longstanding patterns rooted in early experience.
CAT is often chosen by those who have found CBT too narrow or technique-based, or psychodynamic therapy too open-ended or unstructured. It offers a psychologically rich yet time-efficient approach that balances relational insight with practical change, helping you understand your history while actively revising the patterns that continue to shape your present life.
Evidence and Effectiveness
CAT’s evidence base continues to grow across NHS and academic settings.
Borderline and personality difficulties: Randomised and cohort studies show CAT reduces symptom severity and improves relational functioning (Chanen et al., 2008).
Depression and anxiety: Process and outcome studies demonstrate significant improvement in mood and self-understanding (Bennett & Parry, 2004).
Eating disorders, self-harm, and trauma: CAT provides measurable gains in emotional regulation and self-compassion (Calvert & Kellett, 2014).
Qualitative research: Clients emphasise CAT’s transparency, collaborative tone, and clarity as key to change (Calvert & Kellett, 2014).
While the evidence base is smaller than CBT’s, findings consistently highlight CAT’s capacity to produce both symptom reduction and enduring relational change.
What CAT with Carl Is Like
Working with me in Cognitive Analytic Therapy (CAT) is a collaborative, structured, and reflective process one that aims to help you understand yourself more deeply and make real, lasting changes. You won’t be analysed from a distance; instead, we’ll work together to make sense of what’s been happening in your life, and how past experiences and relationships might still be shaping the way you think, feel, and relate today.
In the early sessions, we’ll spend time understanding your story exploring your background, family relationships, and the experiences that have influenced how you see yourself and others. From there, we’ll begin to notice recurring patterns or themes that may once have helped you cope, but now feel restrictive, self-critical, or stuck.
As therapy progresses, we’ll map these patterns out together. The map becomes a visual and practical guide that helps you see connections clearly how certain thoughts, feelings, and actions tend to repeat, and where there might be new ways forward. This is often a turning point in the work: you start to recognise these patterns as they unfold in everyday life and in the therapy itself, giving you space to choose something different.
Towards the end of therapy, we’ll reflect on what’s changed and what’s been learned the themes that have stood out, the shifts that have taken place, and the steps you want to continue after therapy ends. We’ll often capture this in a written letter, which can serve as a meaningful summary of your progress and a reminder of the insights you’ve gained.
My clients often describe CAT as both structured and personal a clear framework that still allows depth, warmth, and flexibility. It’s a process that helps you make sense of your experiences, build self-awareness, and move towards relating to yourself and others in ways that feel freer, kinder, and more authentic.
Further Reading and References
Beck J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). Guilford Press.
Bennett D., & Parry G. (2004). The accuracy of reformulation in CAT. Br. J. Med. Psychol., 77(2), 197–210.
Bowlby J. (1969/1982). Attachment and Loss Vol. 1: Attachment. Basic Books.
Calvert R., & Kellett S. (2014). Cognitive Analytic Therapy: A review of outcome evidence. Int. J. CAT & Relational Mental Health, 1(1), 4–23.
Chanen A. M. et al. (2008). Early intervention for adolescents with borderline personality disorder using CAT. Br. J. Psychiatry, 193(6), 477–484.
Joseph B. (2001). Psychoanalytic Theories of Object Relations. Routledge.
Kelly G. A. (1955). The Psychology of Personal Constructs. Norton.
Leiman M. (1994). The concept of sign and its role in the analysis of the self. Br. J. Med. Psychol., 67, 49–63.
Ryle A. (1979). The Psychotherapy File. ACAT
Ryle A. (1982). Psychotherapy: A Cognitive-Analytic Approach. Wiley.
Ryle A. (1990). Cognitive Analytic Therapy: Active Participation in Change. Wiley.
Ryle A. (1998). CAT and psychoanalytic object-relations theory. Br. J. Psychotherapy, 14, 283–298.
Ryle A. (2004). Writing and reading letters in CAT. Psychology and Psychotherapy, 77, 493–503.
Ryle A., & Kerr I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Wiley-Blackwell.
Shedler J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.
Ready to take the next step?
07494 503557
carltaylor@ppslondon.net
If you’d like to explore whether Cognitive Analytic Therapy might be right for you, you can:
Book an initial consultation
Read more about other therapies offered
Download the full CAT Information Guide (PDF) – an in-depth resource written by Carl Taylor CPsychol AFBPsS, Chartered Counselling Psychologist, PPS London.