Cognitive analytic therapy

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Anthony Ryle · 1979 · United Kingdom

What it is

Cognitive analytic therapy (CAT) is a time-limited, relational, integrative psychotherapy developed in the UK by Anthony Ryle, a general practitioner and analytically trained psychotherapist, for use in the NHS. It grew from Ryle's 1970s repertory-grid research on therapy transcripts and his 1979…

Format

• Format. Individual, weekly, time-limited; the number of sessions is agreed at the start. 16 sessions is the usual contract; 24 sessions (with three or more follow-ups) for more complex clients, e.g. personality disorder; 8-session brief forms are used in primary care/IAPT; 1, 4 and 12-session forms…
• Follow-up. Sources differ: one session at about three months (Blunden 1993; White & Hepple 2020 for 16 sessions), or one at one month and one at three months (Wikipedia); usually none in the 8-session IAPT form.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• non-completion as a procedure (see Section 5).
• splitting between staff, each holding one pole of a role pair.
• distress during history taking; slow down within the client's tolerance.
• switches in session; overwhelm or dissociation at flashpoints (see Section 5).
• relapse into a core loop; refer on or offer a further contract per service policy.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.