What is Cognitive Analytic Therapy (CAT)? – Patient information leaflet

Cognitive Analytic Therapy (also known as CAT) is a talking therapy that mainly focuses on the way we relate to ourselves and to other people. It can help with a wide range of difficulties, for example, experiencing depression, anxiety or low self-esteem; feeling repeatedly let down, hurt or rejected; doing things that are harmful or self defeating as a way to stop feeling overwhelmed by strong feelings.

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What is Cognitive Analytic Therapy (CAT)?

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  • What is Cognitive Analytic Therapy?

    Cognitive Analytic Therapy (also known as CAT) is a talking therapy that mainly focuses on the way we relate to ourselves and to other people. It can help with a wide range of difficulties, for example, experiencing depression, anxiety or low self-esteem; feeling repeatedly let down, hurt or rejected; doing things that are harmful or self-defeating as a way to stop feeling overwhelmed by strong feelings.

    It is based on the idea that as children (and throughout our lives) we cope with difficult situations we find ourselves in by developing strategies to manage them. These strategies – or patterns of how we think, feel and act – help us cope and can be necessary for our emotional survival earlier in our life. However, if we continue to use them even when they are no longer needed these patterns may lead to difficulties. We may become stuck in these patterns and come to feel they are now problems themselves.

    If you had learned in your childhood that you only received love and care by pleasing others you might believe that ‘only if I do what others want will I be liked’. This trap of ‘pleasing others’ as an adult might lead to people mistreating you. Only when we begin to recognise these patterns do we have opportunity to consider alternative ways of coping with our difficulties – for example learning other more useful ways of standing up for ourselves and relating to others. CAT guides you towards noticing your patterns and beliefs, working with you to develop more choices that help you change and grow.

  • How can CAT help me?

    CAT is tailored to your individual needs and goals, and helps you make sense of your own story and your own circumstances.

    CAT involves working with a therapist to look more closely at patterns of thinking, feeling and behaving, so 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.

  • What preparation is needed?

    You do not need to prepare for CAT. However, it may help to think through what you feel your main difficulties are and what you hope to gain from therapy. You also need to be prepared to make a commitment to attend regular weekly appointments.

  • What happens at the first appointment?

    A CAT therapist will ask you why you are seeking therapy and talk to you about what this involves. This session gives you the opportunity to:

    • find out if CAT is likely to be helpful for you
    • decide if you are happy to work with the therapist
    • ask any questions you may have about the therapy.
  • What does the therapy involve?

    Early sessions
    CAT has a strong focus on the therapist working jointly alongside you so that your voice and opinion is heard every step of the way. In the early sessions, you will have opportunity to tell your story, gradually building up a picture of your difficulties together.

    The therapist does not need to know every detail, and you can just share what you feel is manageable. During this process, you will work alongside your therapist to begin noticing and mapping out patterns that keep you feeling stuck in negative cycles of emotion, repeating things you do not want. You will also be enabled to think about how these patterns developed.

    You may be asked to complete a questionnaire called the Psychotherapy File. This gives examples of patterns and states of mind people often describe.

    You may also agree to do some tasks between sessions, e.g. monitoring moods and patterns. These patterns may also arise during therapy, with your therapist. It will be helpful to discuss these openly with your therapist.

    Agreeing what to work on
    You and your therapist will discuss and agree what the main problems are that you want to work on together. After the early sessions, it is helpful to put together a letter which summarises what you’ve found out, and helps you keep track of how you plan to change things. Your therapist might draft a letter to you, or you might choose to write it together. Your therapist may also draw a diagram as a visual summary of the patterns to be clear about the patterns you are working on, and to help you recognise when you are in them.

    The middle phase of CAT therapy
    From this point, CAT gives you the space to begin to focus on two or three patterns you want to change. Monitoring between sessions and exploring things further during sessions helps you notice when you are using these patterns.

    As you become better at spotting patterns, it can become easier to think about new more helpful ways to be. Your therapist supports you in discovering and trying out new possibilities for change. You and your therapist will work together to overcome obstacles which often get in the way of change.

    Ending CAT therapy
    CAT is usually a time-limited therapy and the therapist will help you keep the idea of the ending in mind, even from the start of your meetings. Towards the end of therapy this will be something that you and your therapist will talk about more.

    As you come to the end of your meetings, you and your therapist will write an ending letter. This gives you both a chance to reflect on the therapy, what you can take away from it, how you feel about this ending, and the future.

  • How long does therapy last?

    CAT is usually offered for between 16 and 24 sessions. You will discuss how many sessions you are being offered at the start of your therapy. Appointments are usually weekly and last for between 50 and 60 minutes.

  • What follow-up is needed?

    You will usually be offered a follow-up appointment two to three months after your last session. This will give you the chance to review how things have gone for you once therapy has finished. If you have received 24 sessions of CAT, you may be offered follow up sessions to support you to ease out of the therapy a little more slowly.

  • What are the benefits?

    • CAT can help you understand painful experiences in the past that have led to difficulties (although it cannot undo them).
    • It can help you to feel more in control over patterns of self-care, self-harm and relationships
    • It can also help you to make and grow positive changes for the future.
  • What are the risks and what choices do I have?

    • CAT is a large commitment on behalf of you and the therapist.
    • It takes time.
    • The process of CAT may well have an impact on both you and those around you
    • Change is often difficult and things can become worse before they get better, but this will be discussed throughout therapy.
    • Therapy is not right for everyone, or it may not be the right time for you. It may also be that CAT is not the right therapy for you as there are others which may be more suitable for your needs such as Cognitive Behavioural therapy (CBT), Acceptance and Commitment Therapy (ACT), Interpersonal Therapy (IPT), Psychodynamic Psychotherapy or Family Therapy.

    There is some evidence that suggests a small number of people can actually feel worse after therapy has ended. It is unclear whether this is due to the therapy itself, or other factors; however, it is important that you are aware of the risks so that you can make a fully informed decision about your treatment. This will be considered and discussed between you and the CAT therapist at your first appointment.

    If you do experience any difficulties at any time, it is important that you feel able to share these with your therapist, so that they can help and support you. Your therapist should encourage an open dialogue which will give opportunity to think together about any problems with therapy. This can give you both a chance to work out what is causing the problem, and whether this links to any of the patterns which are a focus for your work. By talking and thinking together, you can often work through problems, but you also have the option of deciding to end therapy.

  • What ethical standards can I expect in CAT therapy?

    CAT therapists are accredited with the Association for Cognitive Analytic Therapy (ACAT) as well as their own professional body, and are bound by the relevant codes of ethical and professional conduct. ACAT’s ethical code of practice Also available on their website

  • What if I have a comment, suggestion, compliment or complaint?

    If you want to make a comment, suggestion, compliment or complaint you can:

    • talk to the people directly involved in your care
    • ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
    • telephone the Complaints Department 0191 245 6672
    • email [email protected] Please note that information sent to the Trust via email is sent at your own risk
    • We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
      You can provide feedback in the following ways:
      – the quickest way for you to do this is to complete our short online survey at
      – complete a Points of You survey, available from staff.

    The Patient Advice and Liaison Service (PALS) also provide a free, confidential NHS advice and support service during office hours:
    North of Tyne – Freephone 0800 032 02 02 (9am-4.30pm)
    South of Tyne – Freephone 0800 328 4397 (9am-5pm)

    If you have any concerns regarding professional practice, relating to your therapist, you have the right to raise such concerns with ACAT by using this form on their website

  • Accessing CAT

    CAT is available in various services across the North East. To explore your options for accessing CAT, please speak to your GP or your Care Coordinator.

    For more information about the Cumbria, Northumberland, Tyne and Wear (CNTW) CAT Service, please see the leaflet Cognitive Analytic Therapy (CAT) Service: introducing our service.

  • References

    Association of Cognitive Analytic Therapy www.acat.me.uk

  • Information about content, other formats and version control

    Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.
    This leaflet is written by the CNTW CAT Service, based on materials from ACAT, Tees, Esk and Wear Valleys NHS Foundation Trust, and feedback from CNTW service users.

    This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre
    Tel: 0191 246 7288

    Published by the Patient Information Centre
    2023 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    Ref, PIC/832/0923 September 2023 V2
    Tel: 0191 246 7288
    Review date 2026