Cognitive analytical therapy (CAT) is considered a type of therapy that puts together ideas originating from cognitive therapy. It takes into considerations the past events and experiences to understand why a person feels, thinks, and behaves the way they do, before giving them the required solutions and helping them cope new ways (Sundeep et al, 2017). The therapy was developed by Dr. Ryle in the 1980’s with the intention of addressing the needs of the National Health Services (NHS) and therefore came up with an integrated model of psychological therapy, which is based on cognitive, psychoanalytic and social learning theories (Sundeep et al, 2017). Cognitive analytical therapy aims at assisting an individual to understand the origins of his/her distress and how to cope with them. Cognitive analytic therapy can take between four and twenty-four weeks based on the nature of the problem being explored when one considers a time-limited therapy, as the programs under Cognitive analytical therapy are tailored to individual needs.
Cognitive analytical therapy involves several stages/sessions for an elaborate and effective way of solving a problem. Sessions 1-4 involves understanding the problem and previous history of the client. Session 5 -12 involves developing a formulation diagram to ascertain unhelpful patterns and developing exits from them through the formulation of tools and diaries. Session 13-16 entails going on with the work of therapy and coming up with an explicit focus on ending therapy and loss. The review and follow up take up to 3months (Sundeep et al, 2017).
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CAT is used as a consultative approach whereby families, staff, and clients can benefit from it by way of having discussion or developing jointly a CAT formulation diagram (Nelson-Jones, 2011). The main aim is to increase understanding and compassion for clients and creating the awareness of the Client’s distress. The formulation diagram is critical in ensuring client’s history, current problems are related with the client direct experiences representing the pattern of relationship and ways of coping to maintain the client’s problems and distress (Nelson-Jones, 2011). It is important in explaining why some interventions may not be working or why the client feels stuck concerning the issue at hand.
CAT is known to have distinctive features that make it suitable for the process of therapy (Stephen and Peter, 2011). The key elements of the therapy is that it encourages active and collaborative way of dealing with the client, it uses the relational approach which allows the client’s distress to be analyzed in detail to determine whether it is consequential, it works within the limits i.e. client’s currents psychological capability in increment of self-reflection and sense of making themselves to have an idea concerning their feelings and actions. Cognitive analytical therapy equally focuses on past experience and relationship patterns. The therapy offers validation of the client, enhancements in therapy, recognition development and unhelpful patterns revisions to help anticipate and resolve potential threats to therapy, and lastly, the method is in explicit position to address issues of ending and loss.
Cognitive analytical therapy is a very important tool of analysis in the National Health Service sector as it has been applied in many scenarios related to counseling and psychotherapy cases (Nelson-Jones, 2011). From this theory, many clients have benefited and many have given their feedback on the effectiveness of the process and affirmed that the type of evaluation is indeed very essential in the examination of human distress and past histories. A lot of research work has been carried out to affirm this perspective and scholars are still doing their best to confirm the claims (Carolyn et al, 2011). From the empirical researches done by different scholars, it is evidently clear that the method is effective in its application hence recommended highly for use. Its formulation can be ascertained to bring forth reliable and consistent results concerning the outcomes of the client’s problem. The therapists apply CAT to deal with distress related cases and evidently from the empirical research carried out, it recorded improvement as compared to the other alternative methods (Carolyn et al, 2011).
The evidence base collected for the treatment of hypersexuality disorder (HD) is a confirmation of effectiveness of cognitive analytic therapy (CAT) with extended follow-up. Cruising, pornography usage, masturbation frequency and associated cognitions and emotions were among the many variables under measure being carried out daily in a 231-day time series (Stephen and Gillian 2013). A/B method of CAT evaluation was used following a three-week assessment baseline (A: 21 days), where treatment was delivered via outpatient sessions and (B: 147 days), which included follow-up period lasting 63 days. Results revealed that the utility of the CAT model for intimacy problems showed promise and lots of potential (Stephen and Gillian 2013).
Personality disorders were confirmed to affect at least 50% of psychiatric outpatients. Treatment studies performed in patients with borderline personality disorder confirmed that structured psychosocial interventions for people with borderline personality disorders appear to have similar efficacy whereby the study revealed that there is some evidence of non-structured, non-specialized treatments offered by psychiatric general services being ineffective and harmful in patients with personality disorders (Tara et al, 2018). The report goes ahead to recommend the use of cognitive analytic therapy which is a time-limited, integrative psychotherapy, and appears to be effective for a range of personality disorders and superior to treatment as usual. Its practical nature and relatively short time limit makes it suitable for front-line clinical services (Tara et al, 2018).
Brown & Clark (2014) compared the effectiveness of up to 24 sessions of CAT or manualised good clinical care (GCC) in addition to a comprehensive service model of care with 78 adolescents with emerging Borderline Personality Disorder (BPD). From their empirical analysis, they found out that CAT is very important and effective method in early intervention for BPD and is superior to both manual-based good clinical care and treatment as usual. Their results also showed that CAT and GCC are effective in reducing externalizing psychopathology in teenagers with sub-syndromal or full-syndrome borderline personality disorder.
Stephen et al (2011) compared CAT to diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult with type 1 diabetes patients. Results of the comparison suggested that the effects of CAT produced a more prolonged effect with regard to diabetes management. This was evident in a significantly greater probability i.e. (P = 0 .002) in reduction of blood sugar levels at 9 months, a significant probability of (P <0.05) increased knowledge about diabetes.
Stephen and Gillian (2013) highlighted the usefulness of CAT for offenders, based on two case studies. After doing a very extensive and intensive research, they ascertained that CAT language and concepts helped provide an understanding of the offender’s relationship to the victim and helped with the comprehension of the offender’s motivations for committing the offence and helped focus and direct clinical input and behavioral management in such cases.
- Anthony Ryle, Stephen Kellett, Jason Hepple and Rachel Calvert (2014). Cognitive analytic therapy at 30, Advances in Psychiatric Treatment, 20, 04, (258).
- Brown, G. P., & Clark, D. A. (2014). Assessment in cognitive therapy.
- Carolyn Pitceathly, Iñigo Tolosa, Ian B. Kerr and Luigi Grassi (2011). Cognitive Analytic Therapy in Psycho‐Oncology, Handbook of Psychotherapy in Cancer Care, (27-38).
- Nelson-Jones, R. (2011). Theory and practice of counselling and therapy. London: SAGE.
- Rachel Calvert and Stephen Kellett (2014). Cognitive analytic therapy: A review of the outcomeevidence base for treatment, Psychology and Psychotherapy: Theory, Research and Practice, 87, 3, (253-277).
- Stephen Kellett and Gillian Hardy (2013). Treatment of Paranoid Personality Disorder with Cognitive Analytic Therapy: A Mixed Methods Single Case Experimental Design,Clinical Psychology & Psychotherapy, 21, 5, (452-464).
- Stephen Kellett and Peter Totterdell (2011). Taming the green‐eyed monster: Temporal responsivity to cognitive behavioural and cognitive analytic therapy for morbid jealousy, Psychology and Psychotherapy: Theory, Research and Practice, 86, 1, (52-69).
- Stephen Kellett, Dawn Bennett, Tony Ryle and Anna Thake (2011). Cognitive Analytic Therapy for Borderline Personality Disorder: Therapist Competence and Therapeutic Effectiveness in Routine Practice, Clinical Psychology & Psychotherapy, 20, 3, (216-225).
- Sundeep Kaur Sandhu, Stephen Kellett and Gillian Hardy (2017). The development of a change model of “exits” during cognitive analytic therapy for the treatment of depression, Clinical Psychology & Psychotherapy, 24, 6, (1263-1272).
- Tara McFarquhar, Patrick Luyten and Peter Fonagy (2018). Changes in interpersonal problems in the psychotherapeutic treatment of depression as measured by the Inventory of Interpersonal Problems: A systematic review and meta-analysis, Journal of Affective Disorders, 226, (108).