![An open garden shed where a hand-drawn map of looping arrows lies on the workbench beside two letters and a sand timer](https://viacara.com/img/content/approaches-cognitive-analytic-therapy-feature-light.webp)

# Cognitive Analytic Therapy (CAT)

Learn how cognitive analytic therapy (CAT) maps the patterns you keep repeating, what its letters and diagram are for and what the research shows.

## What is cognitive analytic therapy?

Cognitive analytic therapy, or CAT, is a talking therapy. It looks mainly at the way you relate to yourself and to other people.

The name holds two traditions together. One is the cognitive side, including [cognitive behavioural therapy](https://viacara.com/approaches/cbt/). The other is psychoanalytic work.

CAT starts from childhood. As children we find ways to cope with hard situations, and we need them then. Kept up long after, the same patterns can become the problem.

You tell your story, and your therapist listens for the patterns in it. Together you name them, draw them, and look for a way out.

Sources: [ACAT: CAT overview](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-1), [ACAT: CAT summary](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-2)

## Where it comes from

Tony Ryle, a doctor, developed CAT in the early 1980s at Guy's and St Thomas' Hospital in London. He wanted a short, focused therapy the health service could offer.

He had read the notes of therapies that had ended. People kept failing to revise patterns they could not see. Ryle sorted those patterns into three kinds: traps, dilemmas and snags.

Next he described the patterns to new patients, early on. They began to recognise them, and to revise them. His trainees went on to form the Association for Cognitive Analytic Therapy.

Sources: [ACAT: CAT summary](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-2), [ACAT: CAT history](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-3)

## How it *works*

CAT calls your templates for relationships reciprocal roles. You learn them growing up, and they guide how you react to people.

Say you hold out your hand and the other person keeps their arms folded. Greeting and being greeted turns into rejecting and being rejected.

Ryle named three patterns that keep people stuck. A trap is a vicious circle: what you do about feeling bad ends up confirming the feeling.

A dilemma is a narrow choice. Both ways look bad, so you keep taking the one you know. A snag is a brake: you want a better life, but something stops you claiming it.

Early on you may fill in a questionnaire called the Psychotherapy File. It gives examples of the patterns people often describe.

Working with a *shared map*

- **Map together** You explore how earlier relationships connect with patterns in your life now.
- **Notice the pattern** You use the map to recognise familiar responses during the week and in sessions.
- **Try another response** You and your therapist explore alternatives to the patterns you have noticed.

CAT uses a shared map and letters to support the work. These tasks can overlap.

Sources: [Jenaway: relationship roles](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-4), [ACAT: traps and dilemmas](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-5), [ACAT: CAT overview](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-1), [Jenaway: CAT sessions](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-6)

## What *sessions* look like

Courses usually run to eight, sixteen or twenty-four sessions. Appointments are weekly, and last fifty to sixty minutes. You agree the number at the start.

The first meeting is an assessment. You can ask questions, and see whether this therapy and this therapist suit you.

In a sixteen-session course, the first five are the reformulation phase. You go over your early life, perhaps using a timeline. Your therapist then offers you a letter summing up what you have found.

You make a map together as well. Your therapist draws the repeating cycles as you tell your story. The ways out of them are called exits.

The middle sessions are the active phase. You use the map to spot a pattern while it is happening. What goes on between you and your therapist counts too.

In the last sessions you each write a goodbye letter. A follow-up appointment usually comes two to three months later.

Sources: [ACAT: CAT overview](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-1), [Jenaway: CAT sessions](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-6), [ACAT: diagrams and maps](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-7)

![The hand-drawn map up close, with one green arrow leading out of a loop](https://viacara.com/img/content/approaches-cognitive-analytic-therapy-mid-light.webp)

In CAT, you and your therapist draw your patterns as a map, so you can spot them and find a way out

## How it differs from CBT and psychodynamic therapy

ACAT sets the three side by side. CBT works mainly on problems here and now, with homework between sessions. The relationship with your therapist is not usually a focus.

[Psychodynamic therapy](https://viacara.com/approaches/psychodynamic/) runs longer, with less structure. You talk about whatever is on your mind. Your relationship with your therapist is a key focus.

CAT sits between them. Sessions are somewhat structured, and you work on your goals between them. You make a map, exchange letters, and treat what passes between you as information.

Source: [ACAT: alongside other therapies](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-8)

## Who it may *suit*

ACAT names the difficulties CAT is used for:

- Depression
- Anxiety, or low self-esteem
- Feeling let down, hurt or rejected, again and again
- Doing things that are harmful or self-defeating, to hold off strong feelings

It may suit you if you want a clear ending, and are ready to work between sessions. It may suit you less if you would rather talk freely, with no set number of meetings.

Looking closely at your problems can make you feel worse before you feel better. You are free to leave if the therapy is not working for you.

Sources: [ACAT: CAT overview](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-1), [ACAT: alongside other therapies](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-8)

## Finding a CAT therapist

Most CAT therapists qualify in another profession first. Psychologists, counsellors, psychiatrists, nurses and social workers all take it up. Practitioner training then runs over at least two years.

Anyone in the UK can call themselves a psychotherapist or a counsellor. The NHS says to check that a private therapist is on a register accredited by the Professional Standards Authority.

Most CAT therapists already answer to a regulator for their first profession. A CAT psychotherapist can also register with the UKCP, whose register the authority accredits. ACAT keeps its own directory of accredited members.

Sources: [ACAT: therapist qualifications](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-9), [Lally & Naulls 2025](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-17), [NHS: talking therapies](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-18), [ACAT: psychotherapy training](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-10), [PSA: UKCP](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-19)

## The *evidence*

CAT is one of several talking therapies offered in the NHS. NHS England has funded training places in it since 2023.

NICE does not name CAT in its guidance on depression or generalised anxiety. NHS Talking Therapies does not list it.

A 2021 review pooled twenty-five studies. Between the start of therapy and the end, people improved on measures of daily functioning, of depression and of relationships. Those changes held at follow-up.

Nine trials in that review compared CAT with another treatment. CAT came out a little ahead of them. About one person in six left before the end.

about 1 in 6

left CAT before the end

2021 review [Hallam et al. 2021](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-14)

A 2022 review looked at how acceptable people find CAT. Across thirty-four studies, fewer people dropped out of CAT than out of the treatments it was compared with.

An earlier review was more cautious. It found twenty-five outcome studies, five of them randomised trials. Most were small, and against other therapies the results were largely level.

Nearly half of those studies were about personality disorder. Their authors asked for more research on common mental health problems.

A 2023 trial did that. It set cognitive analytic guided self-help against the cognitive behavioural kind, for anxiety. Neither did better at eight weeks, or at twenty-four.

Offered the choice, most people picked the cognitive analytic workbook.

If you are weighing up a few options, our [guide to the different approaches](https://viacara.com/guides/understanding-approaches/) sets them side by side.

Sources: [ACAT: CAT in the NHS](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-11), [ACAT: practitioner training](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-12), [NICE NG222](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-20), [NICE CG113](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-21), [NHS England: talking therapies manual](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-22), [Hallam et al. 2021](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-14), [Simmonds-Buckley et al. 2022](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-15), [Calvert & Kellett 2014](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-13), [Kellett et al. 2023](https://viacara.com/approaches/cognitive-analytic-therapy/#ref-16)

On this page

[What is cognitive analytic therapy?](https://viacara.com/approaches/cognitive-analytic-therapy/#what-is-cognitive-analytic-therapy) [Where it comes from](https://viacara.com/approaches/cognitive-analytic-therapy/#where-it-comes-from) [How it works](https://viacara.com/approaches/cognitive-analytic-therapy/#how-it-works) [What sessions look like](https://viacara.com/approaches/cognitive-analytic-therapy/#what-sessions-look-like) [How it differs from CBT and psychodynamic therapy](https://viacara.com/approaches/cognitive-analytic-therapy/#how-it-differs-from-cbt-and-psychodynamic-therapy) [Who it may suit](https://viacara.com/approaches/cognitive-analytic-therapy/#who-it-may-suit) [Finding a CAT therapist](https://viacara.com/approaches/cognitive-analytic-therapy/#finding-a-cat-therapist) [The evidence](https://viacara.com/approaches/cognitive-analytic-therapy/#the-evidence)

Related

[Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) [Psychodynamic Therapy](https://viacara.com/approaches/psychodynamic/) [Schema Therapy](https://viacara.com/approaches/schema-therapy/) [Relational Therapy](https://viacara.com/approaches/relational-therapy/) [Integrative Therapy](https://viacara.com/approaches/integrative/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/)

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## References

1. Association for Cognitive Analytic Therapy (n.d.). *What is Cognitive Analytic Therapy?*. [acat.org.uk](https://www.acat.org.uk/cat-explained/what-is-cognitive-analytic-therapy/)
2. Association for Cognitive Analytic Therapy (n.d.). *What is CAT?*. [acat.org.uk (PDF)](https://www.acat.org.uk/media/zv1gmf0k/what-is-cat.pdf)
3. Association for Cognitive Analytic Therapy (n.d.). *How CAT Developed: Tony Ryle's life and legacy*. [acat.org.uk](https://www.acat.org.uk/cat-explained/how-cat-developed/)
4. Jenaway, A. (n.d.). *Relationship Roles*. Association for Cognitive Analytic Therapy. [acat.org.uk](https://www.acat.org.uk/cat-explained/what-cat-sessions-are-like/relationship-roles/)
5. Association for Cognitive Analytic Therapy (n.d.). *Traps, Dilemmas and Snags*. [acat.org.uk](https://www.acat.org.uk/cat-explained/what-cat-sessions-are-like/traps-dilemmas-and-snags/)
6. Jenaway, A. (n.d.). *What CAT sessions are like*. Association for Cognitive Analytic Therapy. [acat.org.uk](https://www.acat.org.uk/cat-explained/what-cat-sessions-are-like/)
7. Association for Cognitive Analytic Therapy (n.d.). *Diagrams and Maps in Cognitive Analytic Therapy*. [acat.org.uk](https://www.acat.org.uk/cat-explained/what-cat-sessions-are-like/diagrams-and-maps-in-cognitive-analytic-therapy/)
8. Association for Cognitive Analytic Therapy (n.d.). *CAT alongside other therapies*. [acat.org.uk](https://www.acat.org.uk/cat-explained/cat-alongside-other-therapies/)
9. Association for Cognitive Analytic Therapy (n.d.). *How Do I Know My Therapist is Qualified to Deliver Cognitive Analytic Therapy?*. [acat.org.uk](https://www.acat.org.uk/cat-explained/how-do-i-know-my-therapist-is-qualified-to-deliver-cognitive-analytic-therapy/)
10. Association for Cognitive Analytic Therapy (n.d.). *CAT Psychotherapy Training (IRRAPT)*. [acat.org.uk](https://www.acat.org.uk/cat-trainings/cat-psychotherapy-training-irrapt/)
11. Association for Cognitive Analytic Therapy (2019). *Finding CAT in the NHS*. [acat.org.uk](https://www.acat.org.uk/cat-explained/finding-cat-in-the-nhs/)
12. Association for Cognitive Analytic Therapy (2026). *CAT Practitioner Training*. [acat.org.uk](https://www.acat.org.uk/cat-trainings/cat-practitioner-training/)
13. Calvert, R. & Kellett, S. (2014). *Cognitive analytic therapy: a review of the outcome evidence base for treatment*. Psychology and Psychotherapy: Theory, Research and Practice. [doi:10.1111/papt.12020](https://doi.org/10.1111/papt.12020)
14. Hallam, C., Simmonds-Buckley, M., Kellett, S., Greenhill, B. & Jones, A. (2021). *The acceptability, effectiveness, and durability of cognitive analytic therapy: systematic review and meta-analysis*. Psychology and Psychotherapy: Theory, Research and Practice. [doi:10.1111/papt.12286](https://doi.org/10.1111/papt.12286)
15. Simmonds-Buckley, M., Osivwemu, E. O., Kellett, S. & Taylor, C. (2022). *The acceptability of cognitive analytic therapy (CAT): meta-analysis and benchmarking of treatment refusal and treatment dropout rates*. Clinical Psychology Review. [doi:10.1016/j.cpr.2022.102187](https://doi.org/10.1016/j.cpr.2022.102187)
16. Kellett, S., Bee, C., Smithies, J., Aadahl, V., Simmonds-Buckley, M., Power, N., Dugen-Williams, C., Fallon, N. & Delgadillo, J. (2023). *Cognitive-behavioural versus cognitive-analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial*. The British Journal of Psychiatry. [doi:10.1192/bjp.2023.78](https://doi.org/10.1192/bjp.2023.78)
17. Lally, C. & Naulls, S. (2025). *Regulation of psychological professionals in mental health care*. Parliamentary Office of Science and Technology. [doi:10.58248/RR85](https://doi.org/10.58248/RR85)
18. NHS (2025). *Talking therapies*. [nhs.uk](https://www.nhs.uk/tests-and-treatments/talking-therapies/)
19. Professional Standards Authority (n.d.). *UK Council for Psychotherapy*. [professionalstandards.org.uk](https://www.professionalstandards.org.uk/organisations-we-oversee/find-a-register/uk-council-psychotherapy)
20. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222/chapter/Recommendations)
21. National Institute for Health and Care Excellence (2020). *Generalised anxiety disorder and panic disorder in adults: management (CG113)*. [nice.org.uk](https://www.nice.org.uk/guidance/cg113/chapter/Recommendations)
22. NHS England (2024). *NHS Talking Therapies for anxiety and depression manual, version 7*. [england.nhs.uk (PDF)](https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf)

## Related

### [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/)

Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help.

### [Psychodynamic Therapy](https://viacara.com/approaches/psychodynamic/)

Learn how psychodynamic therapy works, what to expect in sessions and how exploring your past can change your present.

### [Schema Therapy](https://viacara.com/approaches/schema-therapy/)

Learn how schema therapy works with long-standing patterns from early life, what sessions involve and what the research does and does not show.

### [Relational Therapy](https://viacara.com/approaches/relational-therapy/)

Learn how relational therapy works through the relationship with your therapist, how it differs from psychodynamic therapy and what research shows.

### [Integrative Therapy](https://viacara.com/approaches/integrative/)

Learn how integrative therapy combines different approaches to create a flexible, personalised experience.

### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/)

A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods.