Introduction
CAT stands for Cognitive Analytic Therapy, which is a form of psychological therapy developed in the United Kingdom. Cognitive Analytical Therapists aim to help clients identify and understand unhelpful patterns in how they think, feel, and act in relationships. The therapist collaborates with the client to map out these patterns and find healthier ways of relating to oneself and others.
According to the Association for Cognitive Analytic Therapy, CAT is a “collaborative programme for looking at the way a person thinks, feels and acts, and the events and relationships that underpin these experiences.”
About CAT The main goals are to develop self-awareness and make changes to improve mental health and interpersonal relationships. CAT incorporates principles from cognitive, psychoanalytic, and analytic therapy models.
Assessing the Client’s Presenting Problems
CAT therapists start the assessment process by asking open-ended questions to understand the client’s symptoms, behaviors, thoughts, and emotions that led them to seek therapy. The goal is to get a broad overview of the client’s presenting problems without making assumptions. For example, the therapist may ask, “What brings you here today?” or “Tell me about the issues you’ve been struggling with lately.”
The therapist listens attentively and uses empathic reflections and summaries to ensure they fully grasp the client’s perspective. According to the Psychology Tools article on CAT, the therapist aims to identify the “target problem procedures” – the recurrent patterns of dysfunctional thoughts, feelings and behaviors causing distress.1 Understanding these procedures provides a framework to develop the therapy goals.
Exploring the Client’s Background
CAT therapists explore the client’s background and history in order to gain a comprehensive understanding of factors that may be contributing to their difficulties. The therapist inquires about the client’s family and early childhood experiences, significant relationships, trauma, medical issues, and substance use history.
CAT incorporates psychodynamic techniques to uncover how early experiences may have shaped the client’s personality and coping mechanisms. The therapist aims to identify important figures in the client’s life and explore the nature of those relationships, as well as any childhood trauma or abuse. This background information reveals how the client relates to others and provides insight into any unhelpful patterns that may have developed over time.
The therapist also gathers information about the client’s physical health, any medications or medical conditions, and current or past substance use. These factors can impact mood, cognition, and overall functioning. Understanding the client’s complete life story allows the therapist to gain a holistic perspective and identify any problematic behaviors or thought patterns.
By exploring the client’s background in an empathetic, non-judgemental manner, the CAT therapist can help the client develop self-understanding and make links between their past and current difficulties. This background information serves as an important foundation for the rest of the therapeutic process.
Source: https://en.wikipedia.org/wiki/Cognitive_analytic_therapy
Identifying Maladaptive Thoughts and Schemas
In schema therapy, the therapist aims to identify and modify maladaptive schemas, or deep core beliefs, that drive a client’s thoughts, feelings and behaviors. Schemas often originate early in life as a result of dysfunctional childhood experiences and get reinforced over time. Common schemas include ideas such as “I’m not good enough,” “No one can be trusted,” or “I’m undeserving of love.”
The therapist probes the client’s assumptions, automatic thoughts, and core beliefs to uncover these maladaptive schemas. They use guided discovery techniques like laddering and downward arrow to dig deeper into the client’s thought patterns. For example, if a client expresses feeling worthless, the therapist may ask “What thoughts are you having that lead you to feel this way?” to identify the maladaptive schema driving the emotion.
Once schemas are identified, the therapist helps the client reality test them and develop insight into how they drive dysfunctions. The goal is to modify rigid, extreme schemas rather than just change surface thoughts and behaviors. Young’s Schema Therapy model outlines 18 common early maladaptive schemas linked to various emotional issues that the therapist screens for.
Linking Thoughts to Feelings and Behaviors
In CAT, the therapist helps the client understand how their thoughts, feelings, and behaviors are interconnected. The goal is to increase the client’s awareness of these connections and how their thoughts impact their emotions and actions.
The therapist may use tools like thought records or diagrams to illustrate the links between thoughts, feelings, and behaviors. For example, if a client has the thought “I’m worthless,” they may then feel sad or depressed, which leads to avoiding social situations. Diagramming these connections can help the client visualize the process and gain insight.
Core techniques used in this stage include guided discovery, Socratic questioning, and cognitive restructuring. The therapist asks probing questions to uncover the client’s automatic thoughts and schemas. By guiding the client to make their own connections, the realizations are more impactful.
Linking thoughts to feelings and behaviors is a pivotal component of CAT. Increasing awareness of these connections allows the client to then work on modifying dysfunctional thoughts and improving their emotional wellbeing and behaviors.
Developing Insight Through Guided Discovery
A key technique in CAT is the use of Socratic questioning to help clients gain insight into their problematic thinking patterns and behavior. The therapist asks a series of thoughtful, probing questions to uncover the client’s assumptions, beliefs, and ways of thinking. This collaborative process aims to help the client recognize inconsistencies, cognitive distortions, and maladaptive schemas in their thinking.
As described by Ryle and Kerr (https://en.wikipedia.org/wiki/Cognitive_analytic_therapy), the therapist acts as a “curious explorer” seeking to understand the client’s inner world. Questions are open-ended, with the goal of guiding self-discovery rather than lecturing the client. For example, if a client expresses self-critical thoughts, the therapist might ask questions like “What evidence do you have that this belief is true?” or “How would you respond to a friend who spoke about themselves this way?” This process aims to facilitate clients’ awareness of their own cognitive patterns.
Through guided discovery and Socratic dialogue, the client gains insight into how their thoughts, feelings, and beliefs influence their behaviors and interpersonal struggles. Developing this self-understanding is considered essential for clients to be able to implement the needed changes in their thinking and actions.
Modifying Dysfunctional Thoughts
One of the main goals of CAT is to help clients identify and modify dysfunctional thoughts and beliefs that contribute to psychological distress. The therapist will work to challenge negative automatic thoughts and teach cognitive restructuring techniques.
Cognitive restructuring involves guiding the client through a process of evaluating their automatic thoughts and beliefs. The ABC model is often used, where A stands for the activating event, B stands for belief, and C stands for the emotional and behavioral consequence. The therapist helps the client identify the link between their thoughts/beliefs about an event and the resulting emotions or actions.
Once dysfunctional thoughts are recognized, the therapist can assist the client in challenging them. This may involve examining the evidence for and against the thought, considering alternative explanations, and putting the thought in perspective. The goal is to help the client develop more balanced thinking patterns. The ABC model provides a structured way to modify irrational or unhelpful thoughts.
Cognitive restructuring takes practice, as clients must work to replace negative thinking habits with healthier ones. CAT provides support and guidance to develop more realistic and adaptive thought patterns over time.
Setting Therapeutic Goals
An important part of CAT is collaboratively identifying desired outcomes and progress markers with the client. The therapist and client work together to determine realistic, achievable goals for therapy based on the client’s presenting problems and underlying issues uncovered during the assessment phase. Goals are tailored to the individual and focus on specific behavioral changes the client would like to make or problems the client hopes to overcome.
Goals in CAT may relate to things like reducing self-harm behaviors, improving relationships, decreasing depression or anxiety, modifying unhelpful thinking patterns, or increasing self-esteem. However, the goals are not pre-determined but rather developed jointly between therapist and client. This collaborative goal-setting process gives the client autonomy and investment in their own treatment path.
The therapist assists the client in breaking down larger goals into smaller, more manageable steps. These steps act as progress markers that enable the client and therapist to tangibly track improvements during the course of therapy. Goals and progress markers are revisited throughout treatment to assess the effectiveness of interventions and adjust them as needed (Potter, 2020).[1]
Practicing New Skills Between Sessions
Homework assignments are a core component of CAT therapy. The therapist will assign practice exercises for the client to apply between sessions, in order to reinforce the new skills and thought patterns. Examples of CAT homework include:
– Thought records – The client tracks automatic negative thoughts and identifies distortions or thinking errors. They practice challenging the irrational beliefs and replacing them with more balanced perspectives.
– Behavioral activation – The therapist gives homework to gradually increase enjoyable activities, social interactions, exercise, etc. This activates a sense of pleasure and mastery which lifts mood.
– Problem solving – The client is instructed to break down a problem into steps and brainstorm potential solutions. Applying this outside of sessions builds confidence.
– Role-plays – Practicing assertiveness or social skills through role-plays, rehearsed in session, helps overcome anxiety in real-world situations.
– Relaxation – Learning relaxation techniques like deep breathing, visualization, or progressive muscle relaxation as homework lessens anxiety.
– Journaling – Writing expressively about thoughts and feelings each day fosters insight and emotional processing.
By generalizing new skills into daily activities through homework, clients progressively counter habitual thought patterns. The regular practice causes neural pathways supporting healthy functioning to strengthen over time.
Reviewing Treatment Progress
Periodically throughout the course of therapy, the CAT therapist will review progress and make adjustments to the treatment plan as needed. According to Balmain (2021), CAT therapists aim to “establish a shared understanding of the problems” in the initial stages of therapy and then mutually agree upon “tasks and goals for therapy”. As therapy unfolds, the therapist and client revisit these goals and treatment targets to evaluate whether they are still relevant or need modification (Balmain, 2021).
The recursive process in CAT provides opportunities for therapist and client to assess what is and isn’t working. As clients gain insight and make changes, some problems may resolve while new challenges emerge. By periodically reviewing progress, the client and therapist can adjust goals or methods and tailor the therapy to the client’s evolving needs and circumstances. This collaborative process aims to keep treatment focused and effective.