For a recent (2021) summary of research evidence on CAT, read our blog So, How Effective is Cognitive Analytic Therapy?

For a listing of publications and blogs about research into cognitive analytic therapy over the last few years, visit our page on the CAT Evidence Base.

How can research tell us whether therapy really works?

It sounds simple doesn’t it? You just give someone a course of CAT therapy and question them closely about their difficulties at the start and again at the end. If they feel better, then surely the therapy must have worked?

Well, no. It’s not that straighforward. While it’s good news that the person feels better, we can’t be sure that it was the therapy that made the difference. It could have been that they would have felt better anyway. Perhaps they met a new partner, got a new job, or won the lottery during that time period. Maybe something very stressful changed. A bullying boss left, or benefits were re-started after a sanction. These things might have had an impact on how they felt.

To be even more certain, we would need to look in much more detail at the progress of that person during their therapy. This type of approach is known as a Single Case Experimental Design (SCED). It involves looking very closely at how someone’s difficulties changed over time. We’d have to assess things before therapy began, and then at several more points in time. The same assessment would need to be repeated during therapy and after it ended.

Strength in numbers?

Another option would be to look at a larger group of people, instead of just one. Better still, if a larger group was split into two, it would be possible to compare the two groups. One group would have the therapy, and the other would not. However they would both have the same amount of contact with the researcher, and complete the same questionnaires and other measures. The second group would then act as a “control group”, showing what might be likely to change even if the therapy didn’t take place.

But what if the two groups differed in some important ways? Perhaps the control group included more people who had more severe problems or who were less likely to get better. These differences would make it hard to compare these groups. To avoid these problems a researcher might randomly decide who is in which group (therapy or control) so help to ensure a fair comparison.

To make this comparison even more useful, the researcher might not even know which group has been given the therapy. It’s then more possible to see whether more people in the group having the therapy have improved, than those who were in the control group. This kind of study is called a Randomised Controlled Trial (RCT).

Research methods and CAT

In research about cognitive analytic therapy (CAT), researchers have studied its impact using both of these approaches. One of CAT’s strengths is that it is a very tailored and personal approach to psychotherapy. It doesn’t matter what diagnosis you might have been given, although some see diagnosis as a helpful way to describe collections of symptoms you are having, and to decide on treatment options.

In CAT a therapist is usually more interested in repeating patterns of thinking, feeling and acting. The focus is often on difficulties in relationships. A CAT therapist will be helping make sense of your difficulties by finding target problems.  Your target problems will be specific to you, and may not look like anyone else’s target problems. Click here for some examples of different target problems.

This more individual and personal emphasis has many strengths. For example, you may feel your therapy is more about you as a person than a label you have been given. The therapy can be tailored more accurately to your particular set of strengths and difficulties. The therapist can adapt what they offer to suit the way you work best.

A CAT therapist will bring with them many therapeutic skills and areas of knowledge from the approaches they trained in before qualifying in CAT. Depending on what works best between you, the approaches used when working on change (exits) might differ from one therapy to the next.

In this way, CAT can be viewed as a framework for therapy rather than using a standard set of techniques or approaches. While there are many good things about this, it makes it more of a challenge to study the impact of CAT across large groups for research purposes.

Thanks are extended to Samantha Hartley, Steve Kellett  and Peter Taylor for helpful contributions to this page.

Click below to read more about

Evidence through large groups – Randomised Controlled Trials

A more individual approach – Single Case Experimental Design

Research Update: Morbid Obsessional Jealousy

Blog: Adapting CAT to Help Self-Harm

Research Into CAT by ACAT Public Engagement Team
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