Psych CASC / OSCE · Psychotherapy
Explain CAT and negotiate a time-limited reformulation plan — CASC communication station
MRCPsych/FRANZCP-style CASC: engage a person seeking CAT, explain tools simply, co-create a safety-aware brief therapy plan, and manage expectations.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in community mental health. [3]
Candidate instructions. The person wants CAT. Establish rapport and validate the request. Explain CAT in plain language (shared map of relationship patterns; written reformulation; time-limited weekly sessions; practising new ways out of stuck loops). Check current self-harm risk briefly and agree a safety net. Address fear of being “dropped” at the ending. Avoid jargon piles and false cure promises. [3][4][5]
Candidate scenario
Your patient is 26. After boss or partner criticism they feel worthless, cut their upper arms, and then text people frantically. They googled CAT and want “the letter and the diagram like Ryle.” They dropped two counsellors who “just listened forever with no plan.” They fear any ending means “you never cared.” No high-lethality plan today, but they say “if therapy stops I will fall apart.” They can attend weekly for about four months. They want you to promise the criticism-pain will stop completely. [1][4]
Marking domains
- Warmth, validation, non-pejorative language (no “attention seeking” / “manipulative”)
- Elicits goals, prior therapy, and what “CAT” means to them
- Explains reciprocal patterns simply (how criticism roles get replayed)
- Explains letter + shared map + noticing patterns + trying exits
- States time-limited contract and that ending is planned work, not abandonment
- Brief risk check and safety plan / crisis pathway
- Collaborative, hopeful, no absolute cure promises; invites questions [3][4][5]
Reveal assessor key
Open. Thank them for coming; validate how exhausting criticism-triggered pain and self-harm cycles are; acknowledge that wanting a structured therapy is a strength. [4]
Elicit. What they understand by CAT; what happens after criticism before cutting; fears about ending; current urge level and plans; supports; barriers to weekly attendance. [4]
Explain (plain language). CAT is a brief talking therapy where we work together to map the patterns that keep repeating — especially around criticism, worth, and relationships — and put that understanding into a letter and a diagram we both use. We practise noticing the pattern earlier and trying safer “exits,” not only talking forever without a plan. Sessions are usually weekly for a set number of meetings so the work stays focused. [3][4]
Ending fear. Name that endings can feel like abandonment for good reasons from past roles, and that CAT treats the ending as part of therapy (including goodbye letters), not as proof that nobody cares. Hope without promising pain never returns. [4][5]
Risk. Brief check on current self-harm; collaborative safety plan; who to contact; ED if imminent high risk. Therapy maps do not replace emergency care. [1]
Close. Summarise shared plan (assessment sessions → reformulation tools → weekly work → planned ending); check understanding; follow-up time. [2][3]
Common fails
Calling them manipulative; equating any counselling with CAT letter/map work; promising complete permanent cure; launching into dense jargon (RRP/TPP lists) without plain language; ignoring current risk; talking for 8 minutes without checking understanding; dismissing ending fears; offering only “come back if you self-harm”. [3][4][5]
References
- [1]Chanen AM, Jackson HJ, McCutcheon LK, et al. Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial Br J Psychiatry, 2008.PMID 19043151
- [2]Clarke S, Thomas P, James K Cognitive analytic therapy for personality disorder: randomised controlled trial Br J Psychiatry, 2013.PMID 23222038
- [3]Calvert R, Kellett S Cognitive analytic therapy: a review of the outcome evidence base for treatment Psychol Psychother, 2014.PMID 24610564
- [4]Ryle A The contribution of cognitive analytic therapy to the treatment of borderline personality disorder J Pers Disord, 2004.PMID 15061342
- [5]Simmonds-Buckley M, Osivwemu EO, Kellett S, Taylor C The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates Clin Psychol Rev, 2022.PMID 35914380