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Cognitive Analytic Therapy

COUNSELLING CENTRAL LONDON As children, we are sometimes faced with situations which cause us emotional difficulties for which we have to create our own coping strategies. 

Although these strategies may work for us at the time, as we get older they become fixed, repeating and often harmful patterns which no longer bear any relevance to our current situation and which leave us asking ourselves, ‘Why do I always end up feeling like this?’. Frequently they will impact on our relationships and cause us to make the same mistakes again.

What is Cognitive Analytic Therapy and how can it help?

Simply put, Cognitive Analytic Therapy (CAT) is a form of therapy in which the client and the therapist work closely together to establish how an individual’s emotional or psychological problems arose, precisely what their maladaptive patterns of behaviour look like and just how effective or otherwise their strategies have been in dealing with the difficulties with which they were and are now faced.  As in most cases the patterns stem from the client’s earlier years and their relationships with significant others, this involves reaching back into their childhood.  Once these have been identified, the aim of the therapy is to find new and better ways of coping which are relevant to their current lives and which will help them to overcome self-defeating thinking and behaviour and serve them long into the future.

CAT focuses its attention on relationships, as not only are these a prime motivation in life, but they also determine to a large extent who we become.  It is designed to enable patients to gain an understanding of how they relate to others and what learned behaviours and perceptions from their own lives contribute to the way in which they interact.  By enhancing their ability to recognise unhelpful behaviours, clients learn how to adopt an active, problem-solving stance and to develop social and relationship skills which help them to manage their lives more effectively. 

How is Cognitive Analytic Therapy different to other types of therapy?

One of the ways in which Cognitive Analytic Therapy differs from other types of therapy is in that it uses what is called ‘reformulation’.  This is basically a written document which describes the problems and the patterns which have led to the individual’s current difficulties.  It contains a narrative component re-telling the patient’s history, and a descriptive component which addresses past and present relationships, including the evolving relationship between the patient and therapist and the patient’s relationship with him or herself, current damaging behaviours, as well as a diagrammatical representation of how past experiences still influence and cause problems in the present.  

The reformulation is arrived at jointly between the patient and the therapist and it is used throughout therapy as a guide to and description of interactions which lead to the transference and counter-transference of emotions.  In addition, it acts as a basis for patient homework which allows the individual to work quickly on recognising unhelpful behaviours.  The psychotherapy file is normally given to the client at the first session and the discussion of the patient’s responses contributes to the reformulation document itself. 

What happens in this type of therapy?

At the start, the therapist will normally agree the number of sessions with the patient, which would typically be 16 in total but could be more or less depending on the circumstances.  After the first session, the client will be asked to take away and complete the psychotherapy file which contains instructions on self-monitoring of mood changes and symptoms and initiates the task of learning self-reflection.  By the end of the first four sessions, the therapist then presents the client with a reformulation letter which identifies the personal meaning which the client attaches to their experience and which describes the problem behaviours that are perpetuating distress and dysfunction.

During the course of the sessions themselves, the therapist uses a range of cognitive and psychoanalytical techniques to assist the client in reformulating, recognising and revising current roles and behaviours in order to achieve a different and better means of relating to others and a healthier set of coping strategies.

Who can benefit from Cognitive Analytic Therapy?

Cognitive Analytic Therapy has been used successfully across a range of problems and has proved to be particularly effective for treating eating disorders, depression, anxiety, trauma, self-harm and relationship problems.  Like Cognitive Behavioural Therapy, it can be used to equally good effect with individuals, couples and groups.

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