What is Cognitive Analytic Therapy (CAT)?

Cognitive Analytic Therapy (CAT) is a collaborative, time-limited therapy that explores how past experiences influence current patterns of thinking, feeling, and relating. It helps clients recognise and change repeating relational or behavioural patterns that may be causing distress.

CAT involves mapping out patterns in your relationships and internal thinking, often using diagrams and written summaries. This shared understanding becomes the foundation for change, allowing you to develop healthier ways of relating to yourself and others.

What issues can CAT help with?

CAT is particularly helpful for: Relationship difficulties Low self-esteem or self-criticism Anxiety and depression Trauma and emotional dysregulation Repeating life patterns or interpersonal problems

Is CAT evidence-based?

Yes. CAT is an evidence-based therapy developed in the NHS and used widely in both public and private settings. It integrates cognitive, psychodynamic, and relational approaches, and is particularly well-suited for complex emotional difficulties.

How long does CAT take?

CAT is a time-limited therapy, typically offered over 16 to 24 sessions. This clear structure allows for focused, goal-oriented work, while also addressing deeper relational patterns.

How is CAT different from CBT or psychodynamic therapy?

CAT is integrative—it combines the structure of CBT with the relational depth of psychodynamic therapy. It helps clients understand why they behave and feel the way they do, while offering practical tools to make lasting change.

What happens in a CAT session?

In sessions, you’ll work with your psychologist to reflect on patterns in your life and relationships. You’ll co-create a shared understanding of these patterns—often through a “reformulation letter” or visual map—before moving into the change phase of therapy.

Can CAT be done online?

Yes. CAT can be delivered effectively both in person and online. We offer flexible options for professionals seeking support in a confidential, discreet setting.

Cognitive-Analytic Therapy

Cognitive Analytic Therapy, often called CAT, is a collaborative psychological therapy that helps you understand repeated patterns in how you relate to yourself, other people and difficult emotions. It can be especially helpful when the same difficulties keep happening in different parts of your life, even when you understand them intellectually or have tried hard to change.

Many difficulties are maintained not just by the original experience, but by the patterns that develop around it. You might become highly self-critical, expect rejection, withdraw from people, over-adapt to others, struggle with closeness, feel responsible for everyone, or find yourself repeating relationship dynamics that feel familiar but painful.

CAT brings together ideas from cognitive therapy, attachment theory and relational therapy. At Hampstead Psychology, we offer Cognitive Analytic Therapy in Hampstead, London, and online across the UK and internationally. We help you understand how these patterns developed, how they may still be shaping the present, and how you can begin to respond differently.

This page is for information and does not replace a clinical assessment, diagnosis, or medical advice.

When CAT might be helpful

ou might recognise some of these experiences:

You find yourself repeating the same emotional or relationship patterns.
You understand some of your difficulties, but still feel pulled back into old ways of coping.
You are highly self-critical or often feel not good enough.
You struggle with trust, closeness, conflict, rejection or feeling let down.
You feel caught between needing people and wanting to protect yourself.
You cope by withdrawing, pleasing others, shutting down, over-functioning or becoming very self-reliant.
You notice that old experiences still shape how you feel about yourself and others.
You want therapy that helps you understand patterns clearly and work on changing them.

If this sounds familiar, CAT may help. It is particularly useful when difficulties are relational, long-standing, repetitive or linked to earlier experiences.

What CAT can help with

Repeated relationship patterns

CAT can help when similar difficulties keep appearing in relationships, whether with partners, family, friends, colleagues or authority figures. Therapy helps you understand the roles you may be pulled into, the expectations you carry into relationships, and how old patterns can be recognised and changed.

Self-criticism, shame and low self-worth

Many people come to CAT because they feel dominated by a harsh inner voice or a persistent sense of not being good enough. CAT helps you understand where these self-critical patterns came from, how they are maintained, and how to develop a more flexible and compassionate relationship with yourself.

Anxiety, low mood and emotional overwhelm

CAT can help when anxiety, low mood or emotional overwhelm are connected to repeated patterns of coping, relating or self-protection. Rather than only focusing on symptoms, therapy looks at what triggers distress, how you respond, and how these responses may keep the difficulty going.

Trauma, attachment and earlier experiences

CAT can be useful when earlier experiences continue to affect your relationships, emotions, identity or sense of safety. Therapy helps you make sense of how past patterns may still be active in the present, without reducing everything to the past or losing sight of practical change.

Feeling stuck despite insight

Some people have already thought a lot about their difficulties, or have had therapy before, but still feel stuck in familiar patterns. CAT helps turn insight into a clear map of what happens in daily life, so you can begin to notice the pattern as it unfolds and respond differently.

Man taking notes on the couch in office._edited.png

Related difficulties we often see together.

Many people come to CAT with more than one difficulty. Relationship problems may sit alongside anxiety, self-criticism may sit alongside low mood, and trauma or early attachment experiences may sit alongside difficulties with trust, boundaries or emotional regulation.

Therapy works best when we understand the whole picture while keeping the work focused. CAT looks at how your thoughts, emotions, behaviour, relationships and earlier experiences interact in the present.

What keeps problems going?

CAT focuses on repeated patterns, often called procedures or relational patterns. These are the familiar ways we learn to cope, protect ourselves, relate to others or manage difficult feelings.

For example, you might expect criticism and become highly self-critical first. You might fear rejection and withdraw before anyone can get close. You might feel responsible for other people’s feelings and over-function until you feel resentful or exhausted.

These patterns usually developed for understandable reasons. Over time, however, they can become restrictive. CAT helps you recognise the pattern while it is happening, understand its emotional logic, and begin to create different choices.

How cognitive analytic therapy helps

At Hampstead Psychology, CAT is not delivered as a generic set of exercises. We begin by developing a shared understanding of the patterns you are caught in, including how they developed, how they show up now, and what keeps them going. CAT often uses a clear written formulation or map. This helps make complex emotional and relational patterns easier to see, so you can begin to notice them in real life rather than only talking about them afterwards.

What to expect from sessions

We begin by understanding what has brought you to therapy and how the current difficulties are affecting your life, relationships, work and sense of self. We then develop a shared formulation of the main patterns that seem to be keeping things stuck. Sessions focus on recognising these patterns as they happen, understanding the feelings and beliefs that drive them, and practising new ways of responding. The aim is not simply to analyse the past, but to use understanding to support practical change in the present.

How long does therapy take?

CAT is often offered as a time-limited therapy, commonly over a focused number of sessions. Some people benefit from a shorter piece of CAT work, particularly when there is a clear pattern they want to understand and change. Others may need longer therapy, especially where difficulties are linked to trauma, complex relationships, longstanding self-criticism, emotional dysregulation or repeated patterns across many areas of life. We review progress together so therapy remains purposeful and aligned with your goals.

Cognitive analytic therapy in London and online

We offer Cognitive Analytic Therapy in person in Hampstead, London, and online across the UK and internationally. Some clients prefer in-person work, while others value the flexibility of online therapy. Both can be effective.

Take the next step

If you feel stuck in repeated relationship patterns, self-criticism, emotional overwhelm, low mood, anxiety or old coping strategies that no longer work, Cognitive Analytic Therapy can offer a clear and thoughtful way forward.

Therapy helps you understand the patterns keeping you stuck and begin developing new ways of relating to yourself, others and difficult emotions. Contact Hampstead Psychology to enquire about Cognitive Analytic Therapy in London or online.

Useful links: Anxiety, Depression, Trauma & PTSD, Relationship Problems, Fees, Meet the Team, Contact.

Urgent Help

If you are worried about immediate risk to your safety, call 999 or go to A&E. If you need urgent support but it isn’t an emergency, contact NHS 111 or your GP. You can also contact Samaritans on 116 123 (24/7).

Meet The Team

At Hampstead Psychology, all of our psychologists have extensive training to doctoral level and decades of experience in their field of expertise. You will be matched with a psychologist that has the knowledge and skill to help you understand and overcome your problem - not just in the short term but for good.