What's the difference between CAT and CBT?
CAT stands for Cognitive Analytic Therapy and CBT for Cognitive Behavioural Therapy. There are similarities between these therapies – both are brief therapies with a limit on the number of sessions; both will offer a focus on a limited range of goals and may use similar ways of helping you keep track of your difficulties, e.g. keeping a diary of a particular problem you want to tackle or how you are making changes. Both are collaborative approaches – working actively with the therapist on your difficulties.
People referred for CBT may have been diagnosed with disorders such as anxiety, panic, depression, obsessive compulsive disorder etc. CBT has specific, research proven ways of working with such clients using different techniques appropriate for their presentation. People who want to work with their therapist on actively changing their problems tend to do well here.
On the other hand, CAT works more interpersonally on relevant, jointly identified issues by creating a working relationship between client and clinician where together they:
- describe the issues affecting the client
- aim to understand their origins in previous relationships and experiences, and
- importantly, use the relationship between the client and therapist to reflect on how those learnt ways of being take place both in and out of the therapy room: the aim here is to practise both recognition (awareness) and change, both in and out of the room
- then work focuses on changes that the client wants to make now that they feel they have a description and an understanding that makes good sense to them
CAT offers a safe and clinically effective therapy intervention for people who wish to work through these underlying issues. Sometimes, people who have symptoms of, for example, anxiety or depression, have a history of abuse, trauma or neglect underlying their symptoms. A relationally focussed therapy like CAT can be helpful as it accesses and reflects on how the difficulties come up in normal life, and that includes the relationship between therapist and client: the goal here is to respectfully and progressively understand and name the difficulties together, as safely as possible.
The description below gives more detail about what is involved in CAT and CBT.
What is CAT?
In order to bring about change, CAT offers a way of:
- Thinking about yourself differently
- Finding out what your problems and difficulties are; how they started; how they affect your everyday life – your relationships, your working life and your choices of how to get the best out of your life
- Getting under the limitations of a diagnosis or ‘symptom hook’ (that is, understanding the reasons that underlie a symptom such as bulimia), by naming what previously learned patterns of thinking or behaving contribute to difficulties and finding new ways of addressing them within yourself.
- Thinking about the importance of relationships in your psychological life. This includes the relationship you have with yourself, and the relationship you have with the therapist
What does CAT involve?
- You can do CAT individually, sometimes as a couple, and sometimes in a group. A CAT therapy is time-limited, usually between 16-24 sessions – this is discussed and agreed with the therapist at the start of therapy. Each weekly session is for 50-60 minutes. Between one and five follow-up sessions are offered after the end of regular therapy. Again this is discussed and agreed with the therapist
- The first few sessions are the ‘reformulation phase’. You have the opportunity to speak openly and in confidence about what is happening in your life, about your own personal history and life experiences. As well as things going wrong in your life there are always some things that have gone right. The therapist will encourage you to name what works well and what areas have given you happiness and satisfaction so that you do not feel you are the sum total of the parts where things haven’t gone well
- You may be asked to complete a questionnaire called ‘The Psychotherapy File’ which divides commonly experienced difficulties into Traps, Dilemmas, Snags, and Unstable States of Mind. Examples are given within each grouping such as: “I act as if ‘either I keep feelings bottled up or I risk being rejected, hurting others or making a mess’.” There may be other questionnaires to help you look at mood shifts or symptoms. All these papers are ways of helping to focus accurately on exactly what sorts of thinking or behaving contribute to things going wrong
- After the first session you may agree with the therapist to monitor a particular symptom or mood
- At around session 4/5 the therapist may share with you a ‘Reformulation letter’ which is a written account of the understanding shared between you and the therapist about the problems that have brought you into therapy, how you have tried to cope with them, and what you are trying to change by coming into therapy
- The therapist will work with you to map out your problem patterns on paper. This can help you further develop your capacity to think about yourself and understand why you may repeat patterns which cause you distress but find hard to stop
- The active therapy that continues works towards helping you build recognition of the patterns of relating, thinking, acting and feeling that you want to change. The therapist might suggest ways of monitoring these patterns in between sessions, and you and he or she will look out for these patterns happening within therapy itself. CAT is an open and ‘up-front’ form of therapy, where the therapist shares their thinking with you explicitly. There are no hidden theories or secrets in CAT. The therapist is actively involved in treatment, and will encourage you to be the same
- The therapist will work with you on looking at how you revise your patterns but they will understand the difficulties involved in change. One of the strengths of CAT is that the letters and maps will help you continue working after the regular therapy sessions have finished
- CAT recognises that finishing therapy can be difficult, especially if endings in your life have been difficult in the past. The last three or four sessions are used to think back over the course of therapy and at the ending of this therapy relationship. The therapist will write a ‘goodbye letter’ and will invite you to do the same
- You will usually be offered a follow up appointment two-three months after the end of your regular appointments
What is CBT?
It is a way of talking about:
- how you think about yourself, the world and other people
- How what you do affects your thoughts and feelings and how you respond
- CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better. Many people find talking about the problems with a "here and now" focus helpful, while others find exploring past experiences helpful in how they have developed difficulties and how they can re-evaluate deeply held beliefs about themselves, others and their world.
What does CBT involve?
- You can do CBT individually or with a group of people, or even a self-help book or computer programme
- Individually, you will usually meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session lasts for 60 minutes
- The therapist will also ask you questions about your life now and about your past experiences.
- You decide with your therapist what you want to focus on
- With the therapist, you will look at your thoughts, feelings and behaviours to explore how they link together, how they might maintain your difficulties and how you can bring about changes to how you think and respond
- Your therapist will collaboratively work with you to see how you can use therapy in between sessions ("homework")
- Depending on the situation, you might start to:
- Question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT
- ecognise that you are about to do something that could make you feel worse and, instead, find out what happens when you do things differently, away from old established and unhelpful patterns
- At each meeting you discuss how you've got on since the last session. Your therapist can discuss with you if any parts of therapy, in and out of sessions, seemed too hard or did not seem to be helping
- They will not ask you to do things you cannot or don’t want to do - you decide the pace of the treatment. Therapy is developed at your pace and collaboratively, and is aimed at you developing being your own therapist. Sometimes, people return to therapy.
For more information on CBT please visit: www.babcp.com
CBT is a well-established, research driven, collaborative and measurable psychotherapy recommended by NICE for treating many difficulties including anxiety, depression, OCD, panic, sleep problems, body dysmorphic disorder, eating disorders, health anxiety, worry (GAD), psychosis, bipolar disorder personality disorders, pain, anger, trauma (PTSD), bereavement, coming to terms with past experiences and health anxiety
March 2013: Maddy Jevon, Inigo Tolosa and Stirling Moorey
CBT Section updated 2016 by Duncan Churchill-Moss