Mental Health, Occupational Therapy

Occupational Therapy and Cognitive Analytic Therapy

Not that “CAT”
‘Untitled’ by Lara Baquil (Flickr)

Last year, I wrote a blog post about using psychological approaches in occupational therapy practice. Since then, I have been studying Cognitive Analytic Therapy (CAT), a therapy that incorporates cognitive and psychoanalytic approaches.

Therapeutic Use of Self

The most significant influence that CAT has had on my practice is in strengthening my therapeutic use of self. When I’ve noticed physical or emotional reactions emerge during therapeutic interactions, CAT has given me the theoretical framework to describe and understand what is going on. Adopting this “helicopter view”/observer stance has given me perspective and prevented me from re-enacting problematic relational patterns with individuals and my team. CAT has given me the tools and confidence to work collaboratively with people to explore these patterns (including when they are happening “in the room”).


My favourite CAT tool has been the use of diagrams (“sequential diagrammatic reformulation” – examples available at this link) which I have used both in my personal reflections, and side-by-side with patients. Using these diagrams side-by-side, we have been able to identify problematic patterns of thinking, behaviour and/or relating that enact themselves within occupational engagement. We have then been able to “zoom out” and explore the consequences of these patterns, and identify potential “exits” from them. For me the most valuable aspect of this has been teaching people to use the diagrams independently to gain that “helicopter view”.


CAT has given me another valuable tool in the form of letters. It’s usual practice in CAT to write a reformulation letter near the beginning of therapy, and a goodbye letter at the end. I have found the goodbye letter a very powerful tool for summarising the gains made in therapy, and supporting the ending. This is the first time that I’ve used letters in my practice, and would like to explore this further (including in non-CAT work).

“Is My Therapy Truly Occupational, or Am I Gap Filling?” (Fortune, 2000)

I have regularly asked myself this question throughout my training.

As a novice CAT-informed practitioner, there have been times where I have had to abandon attempts to interweave CAT and OT, because I have been trying to grasp the complexity of CAT. And sometimes, parts of sessions have focused on non-occupational elements (e.g. life-threatening or therapy-interfering behaviours) because they have been the most pressing issue.

But as a whole, we have been working towards occupational goals, and individuals have tested out new ways of behaving/relating/thinking within occupational engagement and life roles (as “homework”). CAT has been a strategy to further explore and meet individuals’ occupational needs, used within the Model of Human Occupation as the over-arching theory. And I hope that, as my skill and confidence in CAT-informed work increases, I will become more adept at interweaving occupational therapy and CAT.



3 thoughts on “Occupational Therapy and Cognitive Analytic Therapy”

  1. It’s great you’re working to integrate CAT into occupational therapy and it’s not easy to learn another therapeutic method when you’re already skilled at one. It’s so important to develop CAT applications outside psychotherapy whilst retaining the fundamentals of dialogue, awareness of reciprocal roles and their enactment in relationships, and the therapeutic use of self. I really hope you continue to develop this and share it!

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