Stages on a CAT Therapy Journey

In addition to the previous blog What is Cognitive Analytic Therapy, this blog by Alison Jenaway takes a different angle. She describes CAT as a journey, and outlines some of the places it may take you.

Having Cognitive Analytic Therapy (CAT) is a bit like going on a journey with your therapist. You may be travelling back to your childhood, or other important times in your life, to think about your experiences and what you learned from them. You will be travelling around your current life to explore your relationships now and how they may reflect the experiences you had growing up. Lastly, you will hopefully be taking some new turnings onto roads that you have not been on before, trying out new ways of relating to yourself and others.

No two therapy journeys will look exactly the same but there are some typical places that you and the therapist will stop off at along the way.

A typical CAT therapy journey is shown below:


This is likely to be a session where you tell the therapist a bit about yourself to check:

  • Whether CAT is the right sort of therapy for you, and whether you are ready for an active therapy like CAT. You can read about how you can work out if you are in a good place to make use of CAT here.
  • It also gives you a chance to get to know a bit about how the therapist works, to ask any questions that you may have, and to check that you feel comfortable with them before you commit to a full course of therapy.

Sessions 1 to 5: The Reformulation Phase

Understanding how you got to be where you are now

  • During these early sessions you and the therapist will be exploring your early life experiences, perhaps using a timeline to show significant events in your life.
  • The therapist will be particularly interested in the kinds of reciprocal roles, or relationship roles you get into (for an explanation about relationship roles, click here)
  • They may ask you to fill in some questionnaires, such as the psychotherapy file, to pick up on any particular patterns that may be causing you problems.
  • As you are talking, the therapist may start to map out on a piece of paper the relationship roles and the patterns that make sense to youRead more about diagrams and maps by clicking this link.
  • At the end of this phase, the therapist is likely to offer you a letter which will be a summary of all the things that you have talked about so far and a suggestion of what the two of you will be working on for the rest of the sessions.  Read more about letters in CAT by clicking here.

Sessions 6 to 12: The Active Phase

During these sessions you and the therapist will be working out how to spot the problem patterns that you want to work on and trying to come up with alternatives:

  • Using your diagram to recognise when you are following unhelpful patterns, to work out how you have ended up in a painful place.
  • Learning new skills, for example relaxation, mindfulness, or how to soothe yourself when difficult feelings come up.
  • Learning how to work out what you want and how to be assertive, skills that will help you make changes.
  • Actively trying to develop a better, kinder, more compassionate “observing eye” as you notice what happens during the week, or during a session.
  • Noticing what happens in the relationship between you and the therapist, and how this may be following some of the patterns on your CAT map.
  • You may need to focus on certain traumatic events in your past that are keeping you stuck and explore them in more detail.
  • You may want help in involving your partner, friends and family in the changes you want to make.  (To read more about how having therapy might affect relationships, click here)

Sessions 13 to 16: The Ending Phase

CAT is a time limited therapy and the aim is to give you tools and a new direction to travel in and tools to help you continue to make the changes that you want in your life. Some of the tasks in the last few sessions are:

  • Thinking about previous losses and endings of relationships in your life and how you managed to deal with them.
  • Reviewing what you have got from the therapy and how to keep any changes going.
  • Identifying people in your life who you can talk to in the way that you have talked to your therapist.
  • Acknowledging sadness about things that cannot be changed, or that will take a long time.
  • Exchanging Goodbye letters between you and the therapist.

The Follow Up

Your therapist may offer you a follow up appointment at 3 months to check in with you and see how you are getting on without regular sessions. If you have had a longer CAT therapy, you may be offered additional follow up sessions.

Before retirement, Dr Alison Jenaway was a Consultant Psychiatrist in Psychotherapy in the Liaison Psychiatry Service in Cambridge. She is a CAT therapist and supervisor and has been using CAT for around 20 years.  She is a past chair of the national Association for Cognitive Analytic Therapy.

Stages on a CAT Therapy Journey by Alison Jenaway, for ACAT
CC BY-SA 4.0