Some changes are incredibly easy to bring about. People who want to switch from coffee to tea, for example, might toss out their old coffee pots and filters, ensuring that only teabags line the cupboards of their homes. Similarly, those who want to switch from one language to another might move to a location in which the new language is popular, essentially forcing their minds to accept the new tongue movements the novel words require. But there are some changes that are intensely difficult to make. Those involving mental illness or addiction can be especially thorny, and people forced to find a new path could find themselves blocked, unable to see how they made the choices they once found ideal, and unable to conceive a new way in which to live.
Cognitive analytic therapy, or CAT, is a short form of talk therapy that allows people to really understand their current difficulties, and develop new methods they can use to keep the issue at bay in the future.
While this therapy can be intense, and some people find the format to be a little too rigorous for their liking, those who have significant concerns that can’t be amended in standard care might really appreciate the help that CAT sessions can provide.
Cognitive analytic therapy is typically completed in about 24 sessions, according to the Association for Cognitive Analytic Therapy, but it’s far from a surface-only technique. In fact, the therapy aims to dig down to a person’s long-lost history, uncovering the hurts that might infuse the way the person behaves right now.
In the early stages of therapy, clients are encouraged to tell the story of their lives in great detail. They might discuss:
- Relationships with parents and siblings
- Early experiences of loss
- Roles in which they’ve felt comfortable
- Ways in which they’ve dealt with negative feelings in the past
- Common thoughts that flit through the mind during a standard day
It’s vital for clients to feel comfortable with their therapists, as they’ll be sharing a significant amount of information that’s both intensely private and somewhat painful. If clients feel as though they can’t trust their therapists, they won’t speak openly and truthfully. As a result, this portion of the therapy tends to progress slowly, and therapists work hard to remain open and welcoming, asking open-ended questions and providing words of encouragement.
When the therapist has a firm grasp of the person’s history, that mental health professional writes a detailed letter in which all of the information is distilled into a few choice sentences. The therapist might outline all of the triggers that have led to the person’s behavioral concern, and the therapist might then outline the ways in which the person’s life might need to change.
Clients have the opportunity to read this letter and amend it in any way that seems appropriate. It forms the basis for the rest of the therapy, so clients might even be allowed to take the letter home and ruminate on it for a day or two. It’s vital to get all of the details just right, so rushing isn’t encouraged.
Once the therapist and client agree on the history that stands behind the behavior and the things that must change, they can begin to work on a plan of action that can make life just a little easier. Sometimes, therapists provide gentle coaching that can help people to examine persistent thoughts that trap them in a cycle of behavior. Those who think, “I will always fail, so I shouldn’t try,” might be encouraged to think, “I will always fail if I never try.” Those who believe that they’re unlovable might be encouraged to remember that people can and do love them. Changing thoughts can sometimes be enough to bring about big changes.
Some people need to change their reactions to triggers, however, and this might be as simple as understanding what a trigger is and how it works. The letters can sometimes allow people to develop a deeper understanding of their lives, so they know more about what makes them act and react in such predictable manners.
The relationship between the client and the therapist can also play a vital role in changing behaviors.
After all, clients walk into therapy sessions with the same assumptions and behaviors they employ in the outside world. They might:
- Lash out when challenged
- Develop an unhealthy need for acceptance
- Respond with tears to a perceived slight
- Storm out in anger when the talk is tough
- Cry and wail rather than deal with a difficult question
All of these behaviors are maladaptive, and expressing them in therapy provides the mental health professional with a perfect teaching tool. Clients who behave in this way might need to examine why they made that choice, and what they might consider doing differently.
The therapist and client decide together when the treatment should end, but typically, that time comes when the person’s behavior has undergone a radical change and the person feels capable of taking that change forward into the rest of life. At the end of therapy, the mental health professional writes another letter that summarizes the work that’s been done, and provides that letter to the client.
These letters can be remarkably important, according to an article in Psychotherapy Research: Journal for the Society of Psychotherapy Research, as they demonstrate how much the person has learned by participating in therapy. During times of distress, people can read those letters and think about how much progress has been made. The letters also demonstrate how hard the therapist was willing to work for the improvement of the client, and as a result, they demonstrate how much that client is cared for by another living, breathing person. That can be of vital importance to some people.
They might be asked to face old wounds that once triggered their disordered behavior, or they might find that their skills are eroding when they don’t have the support of a therapist. As a result, according to an article in Advances in Psychiatric Treatment, most clients are asked to set up a follow-up appointment three months after formal CAT ends. This way, the mental health professional can ensure that the person is still learning, growing and improving, and that no additional help is needed.
Cognitive analytic therapy has been proven effective in helping people with all sorts of mental health conditions, but it’s considered an especially important therapy for people with personality disorders. People with these conditions struggle to make healthy, supportive connections with others, and their lives may be littered with evidence of broken promises and failed relationships. The trusting, caring nature of the therapists that provide CAT, along with the real help provided in each session, could help people like this to change, where they may have found it difficult to do so in standard care.
In a study in the British Journal of Psychiatry: The Journal of Mental Science, researchers compared CAT with another form of therapy that’s commonly provided to people with personality disorders. Here, researchers suggest that CAT is the superior treatment, as it provided intense changes in behavior. Standard treatment didn’t deliver this kind of benefit. Studies like this seem to indicate that CAT is the right kind of therapy for people with personality disorders.
In addition, cognitive analytic therapy seems to be a therapy that people just enjoy, according to a study in the journal Psychology and Psychotherapy, especially if the therapist provides a trusting and collaborative environment. People seem to like to share with someone who seems to care about them, and they enjoy the idea of working hard in order to get better. Where some people might dislike other forms of therapy, and they might drop out of those therapy programs as a result, they seem to like the work that takes place in CAT sessions.
Risks and Drawbacks
Cognitive analytic therapy is generally considered safe, as there are no medication reactions to worry about or other contraindications to keep in mind, but some people find it difficult to think about their lives so holistically. Parsing each and every trauma that’s taken place, dredging up old hurts in the process, can be really painful and some people find it difficult to deal with their emotions when they’re not in therapy. For people who have a history of addiction, this can be risky, as they might be tempted to relapse when their therapy forces them to look at situations they’ve been ignoring.
Therapists can help by using CAT in concert with other therapies for addiction and mental illness. Encouraging clients to participate in addiction relapse prevention therapy while doing CAT might be a good idea, for example, as clients can learn new skills that can help them avoid drugs as they work on the hard lessons of therapy. Participating in an addiction support group might also be helpful, as people can learn from others who are also dealing with a persistent urge to relapse to drug use and abuse when they’re under distress.
Help Is Available
While therapy like cognitive analytic therapy can be important for people who have both addictions and mental illnesses, it can be hard for people like this to find the right kind of treatment program. They might be forced to participate in programs that deal only with addiction, for example, or they might be enrolled in programs that are designed for people who have less complicated forms of mental illness. Programs like this might not even offer CAT, as helpful as it might be, and people can feel discouraged and unable to heal without the right kind of therapy.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.