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by Dr. Becky Spelman on 25/04/2019

What is Cognitive Analytic Therapy and how can it help me?

Cognitive Analytic Therapy (CAT) calls for active collaboration between the patient and the therapist, and it draws on understandings and techniques drawn from cognitive and analytic practice. For instance, techniques such as goal setting and Socratic questioning (when the therapist asks the patient questions that are intended to help them to explore, to discover, and to learn) are implemented in the context of cooperative work between patient and therapist. Other techniques that can be employed include the concept of the zone of proximal development (the difference between what the patient can achieve on their own, and what they can achieve with appropriate support) and scaffolding (the idea that the patient can make progress through their own efforts with some coaching and guidance from someone in a position to offer it).

The therapist works closely with the patient to figure out how their problematic behaviour (for example, alcoholism, an eating disorder, problems with anger management, self-harm, etc.) is maintained. They also work with them to figure out what problems do not originate with the patient in and of her- or himself, but in relationships that they have, or have had. For example, various types of problematic behaviours can be traced to important relationships in the patient’s past. If their parents were violent and abusive, for instance, this may have given rise to a lack of ability to trust others, or if they were bullied about their weight in school, this might have contributed to the development of an eating disorder. By understanding the origins of the problematic behaviours, and by recognising patterns and behaviours in their own lives, the patient can begin to overcome them by understanding them and taking control.

How many CAT sessions do I need?

CAT is an inherently time-limited approach to therapy, so patient and therapist agree at the outset how long they will work together, typically engaging in between eight and twenty-four weekly sessions.

Is CAT a proven therapy?

CAT, which is offered at the Private Therapy Clinic, is a proven approach to a wide range of disorders that can give patients a sense of being in control of their own lives and help them to move forward in a healthier way.

Below are the 4 stages of Cognitive Analytic Therapy – reformulation, recognition, revision and termination:


As they acquire a better understanding of the issues at hand, the therapist writes a “reformulation letter” to their client. This letter summarises the understanding of the patient’s problems that the therapist has reached, often with a focus on how their experiences during childhood may have contributed to unhelpful behavioural patterns in their adult lives. Provided the patient generally agrees with the therapist’s insights, this letter provides a foundation for the remainder of the work.


During the latter stages of therapy, the patient can be asked to complete diaries or provide other written material that records when they have engaged in problematic behaviour, and what was happening at the time. Using this information, the patient and therapist work together to understand what situations and behaviours tend to maintain problems, so that the patient can develop a better sense of being able to recognise when problems arise.


In the revision phase of the therapy, the patient and therapist work together to figure out ways in which the patient can step out of unhelpful behavioural patterns that have been causing them problems. For example, if certain situations in their lives tend to lead to their engaging in destructive behaviour, such as self-harm or excessive drinking, they can learn how to identify the situations before things escalate, to remove themselves from them, and to engage in a more useful set of behaviours.


At the end of the pre-agreed therapeutic period, the patient and therapist each write down a summary of what they have achieved together, and what the patient still needs to do. They may agree to have a finite number of follow-up sessions (such as a session a month after therapy ends, and another session after a further three months) to evaluate and support the positive changes that the patient has made in their life.

How can I get Cognitive Analytic Therapy in London?

If you would like to talk to someone about having cognitive analytic therapy in London, please get in touch with us at the Private Therapy Clinic by telephone at: +4402038820684 or book online.

We are based in London and other locations. We can also treat anyone via phone or Skype.