Understanding Cognitive Analytic Therapy (CAT)

If you’ve been offered Cognitive Analytic Therapy (CAT), you might have questions about what it is, how it works, and how it can help. This page explains the basics and answers some common questions.

What is Cognitive Analytic Therapy?

CAT is a structured, time-limited talking therapy. It helps you explore patterns in your thoughts, emotions, and behaviours - especially those that may be rooted in past experiences and relationships — and how they affect your current life and relationships with people close to you.

The relationship with the therapist is a key part of therapy and is often talked about in CAT, as it is a way of helping people think about patterns they might not have noticed. CAT is often recommended for people who struggle with their emotions or relationships with people close to them. CAT is recommended for use in the NHS.

Why is Cognitive Analytic Therapy helpful?

Cognitive Analytic Therapy (CAT) is an evidence-based talking therapy that helps you understand how your thoughts and beliefs (cognition) influence feelings and behaviour,
particularly in the relationships you have with people close to you.

CAT can:

  • Help you make sense of complex emotions or behaviours
  • Improve relationships by thinking about how to relate to yourself and the people around you
  • Notice traps and pitfalls that seem to repeat themselves in different areas of your life
  • Build self-awareness and confidence in managing difficulties

What happens in Cognitive Analytic Therapy?

You’ll work with a trained therapist, usually for 8 or more sessions over several months, depending on your needs. Sessions may include:

  • Getting to know you: Early sessions focus on understanding your experiences, challenges and goals.
  • Mapping patterns: Together with your therapist, you’ll create a “map” or “formulation” of problematic patterns in thoughts, feelings, and behaviours. These ideas are often explored through letters, written to and from the therapist.
  • Exploring the roots: You’ll look at how these patterns developed through early experiences or relationships, and how they play out in your life now.
  • Making changes: Later sessions focus on learning and practicing new ways to respond to challenges and break unhelpful cycles. The final sessions prepare you to maintain progress beyond therapy.

Common questions

How is CAT different from other therapies?

CAT focuses on identifying and changing patterns rooted in your past but active in your present.

Will CAT make me revisit difficult memories?

CAT may explore connections to past experiences and relationships, but the focus is on understanding their impact and finding constructive ways forward. Your therapist will ensure the process feels safe and supportive.

Is CAT suitable for me?

CAT is often helpful for people dealing with relationship difficulties, low self-esteem, anxiety, or emotional regulation issues. Many people find CAT useful, but it’s not the right fit for everyone. Your therapist or mental health team will work with you to assess if it’s a good fit for your needs.

How do I access CAT?

Speak to your mental health practitioner about how to access CAT or other psychological therapies that may suit your individual needs and circumstances. 

Where can I learn more?

Remember, you are not alone.

CAT can be a valuable tool in coping with mental health problems and improving your overall wellbeing.

As a patient

As a service user, relative or carer using our services, sometimes you may need to turn to someone for help, advice, and support. 

Find resources for carers and service users  Contact the Trust