Cognitive Analytic Therapy

What is Cognitive Analytic Therapy?

Cognitive analytic therapy (CAT) is an integrative approach which focuses on the problems that bring you into therapy (which we call ‘target problems’) and then the deeper patterns that underlie them.

How does CAT therapy work?

CAT is an active therapy that invites you to become an observer of your own life and the parts that need to change. The changes may be small or they might be more significant, such as needing to find new ways of being in relationships. 


CAT looks at your patterns of relating and the impact they have. One of the aims of CAT is to help you see the way to change learned attitudes and beliefs so you can make healthier, more effective choices.


In CAT, the therapeutic relationship is a collaborative one and there is an expectation that the patterns that tend to get repeated outside of therapy are likely to be enacted in the therapy room. This is a powerful experience that can facilitate significant change as you begin to connect your cognitive understanding with your emotional understanding.


CAT can be an effective therapy for depression, anxiety and the treatment of borderline personality disorder. It is also a recommended approach for the treatment of eating disorders such as anorexia. If you are coming to therapy feeling troubled by your relationships with other people, then CAT might be the appropriate therapeutic approach for you.

Day 6

What happens in CAT therapy?

  • The first few sessions of CAT are the ‘reformulation phase’. During this stage of the therapy you will discuss your current difficulties and go over your developmental history in some depth. You are likely to reflect both on areas of achievement and satisfaction, as well as areas of difficulty
  • During the initial phase you are likely to complete a questionnaire called the ‘Psychotherapy File’. This aims to understand some of your difficulties and patterns within the CAT model
  • Around the fourth or fifth session your therapist will read to you a ‘reformulation letter’ which is a written account of a shared understanding of the story of your life and how some of your past experiences might be affecting you now. The letter will also form the foundation of what you are trying to change through therapy
  • After the reformulation letter, your therapist will also map out the patterns in your life on paper. This is a useful map through which you will develop exits from your existing patterns together
  • CAT is a short-term therapy and often lasts between 16-24 sessions. Towards the end, the focus of the work is on endings, particularly if you had difficult endings or losses in your early life. Just before the final session the therapist will write you a ‘goodbye letter’ and will invite you to do the same. You will be usually offered a follow up session one to three months after the end of the sessions

Frequently asked questions

You are likely to be offered CAT if your difficulties are mostly in the domain of relationships. For example, if you keep finding yourself in a recurrent pattern of dating the same types of people or if you’re experiencing general interpersonal difficulties. CAT can also be helpful if you’re looking to unravel how your past experiences may be impacting you today.

If the clinician carrying out your initial assessment feels that the nature of your difficulties has very clear childhood origins then you are more likely to be offered CAT as opposed to CBT. This is because CBT only focuses on the present and doesn’t look at the origins of a person’s difficulties.

CAT is generally a brief therapy approach and can be offered as a 16 session intervention. However, in some cases, we may believe you could benefit from a longer intervention and may offer up to 24 sessions.

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Dr Elena Touroni

Dr Elena Touroni is a skilled and experienced consultant psychologist with a track record of delivering high-quality services for individuals with all common emotional difficulties and those with a diagnosis of personality disorder. She is experienced in service design and delivery, the management of multi-disciplinary teams, organisational consultancy, and development and delivery of both national and bespoke training to providers in the statutory and non-statutory sector.

Having obtained a first degree in Psychology (BSc) at the American College of Greece, she completed her doctoral training at the University of Surrey. Dr Touroni is highly experienced in the assessment and treatment of depression, anxiety, substance misuse, personality disorder, eating disorders, obsessive compulsive disorder, adjustment disorder and relationship difficulties. She works with both individuals and couples and can offer therapy in English and Greek.

Dr Touroni has held a variety of clinical and managerial positions including as Head of Service in the NHS. Further she has held academic positions for the University of Surrey and the Institute of Mental Health lecturing on specialist postgraduate Masters and Doctorate programmes.

She is trained in several specialist therapeutic approaches such as schema therapy, dialectical behaviour therapy (DBT), cognitive behavioural therapy (CBT), mindfulness-based approaches and Cognitive Analytic Therapy (CAT). As well as holding a variety of NHS positions, Dr. Touroni is the co-founder of a private practice in Central London that has been a provider of psychological therapy for all common emotional difficulties including personality disorder since 2002. She is the founder and one of two directors of The Chelsea Psychology Clinic.