Cognitive Analytic Therapy (CAT) in Glasgow

What CAT is

Cognitive Analytic Therapy was developed in the United Kingdom by the late Dr Anthony Ryle, originally at Guy's Hospital in London, as a way of bringing together the most useful elements of cognitive therapy and psychoanalytic thinking into a single, time-limited approach that could be offered within the NHS. Since then, CAT has grown into an established psychological therapy in its own right, with a UK-wide professional body, a structured training pathway, and a substantial evidence base across both common and complex mental health difficulties.

At the heart of CAT is the idea that we all develop, often in childhood, characteristic ways of relating to other people and to ourselves. These are sometimes called reciprocal roles: paired positions such as caring-to-cared for, criticising-to-criticised, or abandoning-to-abandoned. We learn these from the relationships that shaped us, and we tend to carry them forward, both in how we treat others and in how we treat ourselves internally. Difficulties often arise when these patterns become rigid, when only certain roles feel available, or when the strategies we developed to survive painful experiences begin to cost us more than they protect us.

CAT focuses on three classic relational and behavioural patterns:

• Traps: self-perpetuating loops where a way of coping ends up reinforcing the very problem it was meant to solve. For example, fearing rejection and so withdrawing, which then leads to feeling more alone and rejected.
• Dilemmas: places where you feel you only have two undesirable options, often expressed as "either I... or I...". For example, "either I keep everyone happy or I am selfish".
• Snags: where progress and positive change get pulled back, sometimes because of guilt, loyalty, or a sense that you do not deserve good things.

The aim of CAT is not to label these patterns as faults, but to help you see them clearly, understand how they made sense in the life you have lived, and then collaboratively work out how to step out of them.

How CAT works in practice

CAT follows a three-phase structure over 16 or 24 sessions. It gives the work shape and focus while remaining responsive to you as an individual.

1. Reformulation (sessions 1 to 4): Your psychologist asks about your current difficulties and the relationships and experiences that have shaped you. Around session 4 they write you a reformulation letter, a personal summary of how your difficulties make sense in the context of your life, often alongside a diagram or map (sometimes called an SDR) showing how the patterns play out. It is yours to keep.
2. Recognition and revision (the middle phase): With the map in hand, you and your therapist notice patterns as they happen, in your life outside therapy and often in the therapy relationship itself. The focus then moves to revision: finding small, concrete exits from each trap, dilemma or snag, and practising them.
3. Ending (the final sessions): CAT takes endings seriously, because endings are often where painful patterns show up. Your therapist writes you a goodbye letter, and you are invited to write one too, reflecting on what has changed and what is still in progress, so you leave with a clear, portable understanding of yourself.

What CAT helps with

CAT is a flexible therapy with a strong evidence base across a wide range of presentations. We particularly recommend CAT for:

• Persistent relational patterns: difficulties such as repeatedly ending up in similar painful dynamics in relationships at work, in friendships, or in romantic life. CAT is especially well suited to making these patterns visible and changeable.
• Depression that has not fully responded to other therapies: where low mood is bound up with self-critical or self-defeating patterns, CAT's map of reciprocal roles can open up new ways forward.
• Anxiety and chronic worry: particularly where anxiety is tied to expectations of being judged, abandoned, or controlled by others.
• Complex and developmental trauma: CAT was significantly developed alongside work with people who had experienced relational and developmental trauma, and it offers a containing, structured way to make sense of how those experiences shape current life.
• Personality-related difficulties: CAT is recognised in NICE guidance as a treatment option for personality disorder and is widely used in specialist NHS personality disorder services.
• Eating difficulties and self-harm: where these behaviours can be understood as procedures that have helped you cope but are now causing harm.
• Self-criticism, shame, and a harsh internal voice: CAT helps you see the internal "criticising-to-criticised" pattern and develop a different stance towards yourself.
• Major life transitions and identity questions: where you are trying to make sense of how the past has shaped you and what you want to do differently going forward.

How CAT relates to other approaches

CAT sits naturally alongside several of the other approaches our psychologists offer, and it can be a particularly good fit for people who have done some therapy before and want a deeper way of putting things together.

There is a close kinship between CAT and Schema Therapy: both work with patterns that have their roots in earlier life and both pay attention to relational dynamics, though Schema Therapy uses the language of schemas and modes while CAT uses reciprocal roles and procedures. Compared with CBT, CAT shares the structured, time-limited, collaborative style but offers more emphasis on developmental history and on what happens between you and your therapist. Compared with longer psychoanalytic work, CAT is briefer and more transparent, with the formulation actively shared and written down.

For trauma in particular, CAT pairs well with EMDR: CAT can provide an overarching map of the patterns and reciprocal roles that have grown up around traumatic experiences, while EMDR offers a focused way of processing specific memories. Where helpful, your psychologist may also draw on Compassion-Focused Therapy ideas to soften self-critical roles, or on DBT skills for managing intense emotions during the work.

Our CAT therapists

CAT is delivered by clinical psychologists with specialist postgraduate training in Cognitive Analytic Therapy.

Dr Zounish Rafique holds a postgraduate diploma in Cognitive Analytic Therapy and integrates CAT with DBT and EMDR in her work with adults, taking a trauma-informed approach to relational patterns and survival strategies.

Dr Julia McCallum is a qualified Cognitive Analytic Therapy Practitioner and brings nearly two decades of clinical experience, drawing on CAT alongside CBT, ACT, CFT, and EMDR across complex presentations and major life transitions.

View our full team to find the right psychologist for you, or get in touch and we will help match you.