Psych · Psychotherapy
Cognitive analytic therapy
Also known as CAT · Cognitive-analytic therapy · Cognitive Analytical Therapy · Ryle CAT · Sequential diagrammatic reformulation · Reciprocal role procedures
Exam-exhaustive fellowship reference on cognitive analytic therapy (CAT): Ryle integrative model, reciprocal roles, traps/dilemmas/snags, reformulation letter and SDR map, recognition–revision–ending structure, landmark Chanen/Clarke/Treasure/Fosbury evidence, meta-analytic acceptability, and differentials versus CBT, MBT, schema, and IPT. FRANZCP-primary, globally tagged.
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Red flags
- Using exploratory free association without shared reformulation letter, map, recognition, or ending structure and calling it CAT
- Writing a shaming reformulation letter that re-enacts criticising–criticised roles
- Ignoring acute suicide, medical eating-disorder, or diabetes risk while mapping roles
- Claiming CAT is universally NICE first-line by name for all BPD pathways
- Colluding with idealising–idealised roles then abrupt cut-off at ending without goodbye work
- Equating any brief counselling with fidelity-based CAT
Meet the patient
A 31-year-old nurse has cut herself the night before every breakup she has ever had. Each relationship ends the same way: she feels controlled, she pushes back, the partner withdraws, she panics, and the blade closes the distance. She can describe the pattern fluently and still cannot stop it. "I know exactly what I'm doing," she says. "I just can't not do it."[6][11]
The registrar books her for "long-term therapy". The examiner's question is sharper: what brief, structured, collaborative treatment is built precisely for a patient who can see her own loop but cannot exit it? That is CAT's reason to exist.[3][11]
References11ShowHide
- [1]Chanen AM, Jackson HJ, McCutcheon LK, et al. Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial Br J Psychiatry, 2008.PMID 19043151
- [2]Clarke S, Thomas P, James K Cognitive analytic therapy for personality disorder: randomised controlled trial Br J Psychiatry, 2013.PMID 23222038
- [3]Calvert R, Kellett S Cognitive analytic therapy: a review of the outcome evidence base for treatment Psychol Psychother, 2014.PMID 24610564
- [4]Hallam C, Simmonds-Buckley M, Kellett S, et al. The acceptability, effectiveness, and durability of cognitive analytic therapy: Systematic review and meta-analysis Psychol Psychother, 2021.PMID 32543107
- [5]Kellett S, Bennett D, Ryle T, Thake A Cognitive analytic therapy for borderline personality disorder: therapist competence and therapeutic effectiveness in routine practice Clin Psychol Psychother, 2013.PMID 22109975
- [6]Ryle A, Golynkina K Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome Br J Med Psychol, 2000.PMID 10874479
- [7]Treasure J, Todd G, Brolly M, et al. A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioural therapy for adult anorexia nervosa Behav Res Ther, 1995.PMID 7755523
- [8]Dare C, Eisler I, Russell G, et al. Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments Br J Psychiatry, 2001.PMID 11230031
- [9]Fosbury JA, Bosley CM, Ryle A, et al. A trial of cognitive analytic therapy in poorly controlled type I patients Diabetes Care, 1997.PMID 9167106
- [10]Simmonds-Buckley M, Osivwemu EO, Kellett S, Taylor C The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates Clin Psychol Rev, 2022.PMID 35914380
- [11]Ryle A The contribution of cognitive analytic therapy to the treatment of borderline personality disorder J Pers Disord, 2004.PMID 15061342