Cognitive analytic therapy — structured clinical viva

Markers want a structured professional answer: CAT as brief collaborative reformulation therapy; RRPs and T-D-S procedures; letter/map/exits/goodbye; honest evidence (Chanen both arms help; Clarke CAT vs TAU); CBT/MBT contrast; safety first and non-shaming letters.[1][2][3][6]

Time-limited, collaborative, integrative psychotherapy (Ryle) combining procedural/cognitive and object-relations ideas into a shared reformulation of reciprocal roles and problem procedures.[3][6]

Linked self–other positions that organise relating (e.g. criticising–criticised; abandoning–abandoned; controlling–controlled; idealising–idealised), including self-to-self variants. They can switch under stress and re-enact in therapy.[6]

Trap — circular worsening loop. Dilemma — false either/or. Snag — ban on getting better. Give one bedside example for each related to criticism-triggered self-harm.[3][6]

Reformulation letter + SDR map → recognition → revision/exits → ending with goodbye letters; typical weekly 8–24 session contracts depending on complexity; state time limit early.[3][7]

Chanen: CAT vs good clinical care in youth early intervention — both improve; CAT may be faster on some trajectories. Clarke: 24-session CAT vs TAU for adult PD — CAT superior on key outcomes in that RCT.[1][2]

CBT emphasises cognitive-behavioural cycles/experiments; CAT emphasises RRPs, letter, map. MBT aims mentalising under arousal with dual format/not-knowing; CAT aims shared role-procedure reformulation and exits in a brief contract.[3][6]

Shaming monologic reformulation letters; pseudo-CAT without tools; ignoring acute risk/medical issues; unprocessed ending that enacts abandonment. Meta-analyses support effectiveness/acceptability signals but do not license brand overclaiming.[4][5][6][7]