Cognitive analytic therapy (MEQ)

(i) Definition. CAT is a time-limited, collaborative, integrative psychotherapy (Ryle) that links cognitive/procedural and object-relations ideas into a shared reformulation of how problems are maintained. Reciprocal role procedures (RRPs) are linked self–other (or self–self) positions — e.g. criticising–criticised, abandoning–abandoned — that organise feeling, thinking, and action and can be re-enacted in therapy.[3][6]

(ii) Traps, dilemmas, snags. Trap: circular sequence that worsens the problem (e.g. tries to please critic → still feels wrong → self-attack → more frantic pleasing → cuts after perceived criticism). Dilemma: false either/or (e.g. either perfect and safe or worthless and rejected). Snag: covert ban on improvement (e.g. “if I get better I abandon my chaotic family role / something bad will happen”). Map her cutting after criticism onto these procedures rather than pejorative labels.[3][6]

(iii) Phases and tools. Reformulation: history + psychotherapy file → shared reformulation letter + sequential diagrammatic reformulation (SDR/map). Recognition: notice RRPs/TPPs in daily life and in session. Revision: exits and role experiments. Ending: goodbye letters, anticipate abandonment enactments, plan follow-up. Typical contracts often 8–24 weekly sessions depending on complexity.[3][6][7]

(iv) Evidence. Chanen 2008: adolescent early intervention CAT vs manualised good clinical care — both improved; CAT faster on some trajectories.[1] Clarke 2013: 24-session CAT vs TAU for personality disorder — CAT superior on key outcomes in trial analysis.[2] Synthesis: Hallam 2021 effectiveness/durability meta-analysis; Simmonds-Buckley 2022 favourable engagement/dropout signals; Calvert 2014 quality review notes limited but growing RCT base.[3][4][5]

(v) Differentials and pitfalls. vs CBT: CAT centres reciprocal roles, letters, and maps more than automatic-thought records alone. vs MBT: MBT aims mentalising under arousal with dual individual+group format; CAT is brief map/letter/exit-focused individual reformulation. Pitfalls: calling unstructured chat “CAT”; writing a shaming letter that re-enacts criticising–criticised roles; ignoring risk while mapping; overclaiming universal guideline first-line status by brand alone.[3][6][7]